Based on observations, interviews, and facility policy review, it was determined the facility failed to provide a privacy cover for a urinary catheter drainage bag for one (1) of three (3) sampled residents (Resident #59) reviewed for dignity. Findings included: Review of the facility's policy, titled, Catheter Care Procedure, revised 05/23/2020, revealed, drainage bags should be routinely checked to ensure drainage bag is covered with a privacy cover unless resident requested otherwise. Record review revealed the facility admitted Resident #59 on 09/18/2021 with diagnoses which included Stress Incontinence, Muscle Weakness, and Essential Hypertension. Further review of the record revealed no Minimum Data Set (MDS) assessment had been completed yet for the resident. Review of Resident #59's Comprehensive Care Plan, dated 09/20/2021, revealed Resident #59 had an indwelling catheter and staff were to provide catheter care as ordered. Observation on 09/21/2021 at 9:43 AM, revealed Resident #59 lying in bed, with a catheter drainage bag hanging on the right side of the bed. The catheter bag was not covered with a privacy bag. Further observation revealed urine was visible in the bag upon entering the resident's room. Observation on 09/22/2021 at 12:53 PM, revealed Resident #59 lying in bed, with a catheter drainage bag hanging on the right side of the bed. The catheter bag was not covered with a privacy bag. Further observation revealed urine was visible in the bag upon entering the resident's room. Observation on 09/23/2021 at 10:50 AM, revealed Resident #59 lying in bed, with a catheter drainage bag hanging on the right side of the bed. The catheter bag was not covered with a privacy bag. Further observation revealed urine was visible in the bag upon entering the resident's room. Observation, on 09/24/2021 at 8:35 AM, revealed Resident #59 lying in bed, with a catheter drainage bag hanging on the right side of the bed. The catheter bag was not covered with a privacy bag. Further observation revealed urine was visible in the bag upon entering the resident's room. Interview with Certified Nurse Aide (CNA) #2, on 09/24/2021 at 10:20 AM, revealed CNA staff were responsible for ensuring catheters were always in a privacy bag because it was part of catheter care provided. Interview with Certified Nurse Aide (CNA) #1, on 09/24/2021 at 10:40 AM, revealed CNA staff were responsible for a resident's catheter care by ensuring the catheter bag was always in a privacy bag. Interview with the Director of Nursing, on 09/24/2021 at 10:46 AM, revealed that a resident's catheter bag should always be in a privacy bag. The DON stated if staff moved Resident #59 out of the bed into a wheelchair, the staff possibly forgot to put the catheter bag back inside the privacy bag.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews, interviews, and facility policy review, it was determined the facility failed to ensure adequate nutrition status for the healing of pressure injuries for one (1) of three (3) sampled residents (Resident #46). The facility failed to ensure ordered fortified foods were provided and according to the resident's preference, ensure adequate assistance at meals, ensure reassessment of supplement effectiveness, and ensure finger foods were provided. Findings included: Review of the facility's policy titled, Medical Nutrition Therapy: Assessment and Care Planning, revised 09/2017, revealed, The Registered Dietitian Nutritionist (RDN) or other clinically qualified nutrition professional would be responsible for ensuring follow-up and appropriate documentation of recommended changes in the plan of care. Review of the facility's policy titled, Assistance with Meals, reviewed 06/27/2018, revealed, The facility staff would serve residents meals and help residents who required assistance with eating. Review of the facility's policy titled, Resident Food Preferences, reviewed 07/11/2018, revealed, The Dietitian would visit residents periodically to determine if revisions were needed regarding food preferences. The nursing staff would inform the kitchen about resident requests. The Food Services Department would offer a limited number of food substitutes for individuals who do not want to eat the primary meal. Record review revealed the facility admitted Resident #46 on 01/06/2021 and readmitted on [DATE] with diagnoses which included Pressure Ulcer of Sacral Region, Stage Four (4), Need for Assistance with Personal Care, Muscle Weakness, Type 2 Diabetes Mellitus, Protein-Calorie Malnutrition, Pressure-Induced Deep Tissue Damage of Left Heel, and Depression. Review of the Quarterly Minimum Data Set (MDS) assessment, dated 08/31/2021, revealed the resident's Brief Interview for Mental Status (BIMS) score was fifteen (15), which indicated intact cognition. Further review of the assessment revealed the resident required one-person physical limited assistance with eating. The assessment revealed the resident was identified as having weight loss and was not on a physician-prescribed weight loss regimen. Further review of the assessment revealed the resident was identified as having six (6) stage one (1) pressure ulcers, two (2) stage two (2) pressure ulcers (one (1) out of the two (2) pressure ulcers was present on admission), three (3) stage three (3) pressure ulcers (one (1) out of the three (3) pressure ulcers was present on admission), and one (1) stage four (4) pressure ulcer, present on admission. Review of the Comprehensive Care Plan, last revised 08/27/2021, revealed the resident had actual nutrition and/or hydration risk related to significant weight loss, multiple pressure ulcers (PU), weakness, and vitamin/mineral deficiencies. Interventions included finger foods when possible, supplement, vitamins and minerals as ordered, and provide diet as ordered. Observation and interview with Resident #46, on 09/22/2021 at 12:45 PM revealed the resident was in bed with a meal on the bedside table. Resident #46 stated the staff member told the resident she was coming back to help assist with the meal. The resident stated the meal had been sitting there for about half an hour and the food was cold. The resident stated staff never came back for meal assistance. The resident stated the facility did not provide preferences. The resident stated, they give what they want to. The lunch meal consisted of a glass of tea or juice, two (2) containers of sherbet, mashed potatoes, broccoli, a slice of bread, and a carton of milk. There was no ice cream, finger foods, or fortified milk observed on the tray. The resident further stated they were provided a supplement but did not like it and preferred a different flavor of vanilla instead of chocolate. The resident stated that not getting fed by staff was the problem, as the resident could not feed themselves and needed assistance to eat. Observation of the resident revealer he/she was leaning to the right side with their head on a pillow and was unable to fully move his/her upper extremities. Observation and interview on 09/22/2021 at 12:45 PM, revealed an unidentified staff member came into the room to assist Resident #46's roommate. Further observation revealed Resident #46 asked the staff where the certified nurse aide (CNA) was who was supposed to help him/her and the staff member stated the CNA had went on break. The staff member left the room to get another staff member to help reposition this resident. The resident attempted to pick up the melted sherbet but was unable to. The staff came back to assist the resident, and they asked the resident about breakfast. The resident stated they did not like the breakfast food, so they did not eat it. The resident stated they did not like the eggs, sausage, and biscuit the resident received most days. The resident asked them if they could warm the food up. The resident was observed to have offered the carton of milk to the roommate. At 1:07 PM, the staff proceeded to feed the resident his/her lunch meal. Review of Resident #46's meal intakes, dated 09/22/2021, revealed the resident had consumed 1-25% of his/her breakfast and 51-75% of his/her lunch. A review of the computerized physician orders (CPO) revealed the following: - Start date of 01/06/2021: Multivitamin with folic acid once a day. - Start date of 01/06/2021: Zinc 220 milligram (mg) once a day. - Start date of 01/19/2021 and discontinued 08/16/2021: Pro-Stat advanced wound care (AWC) 30 milliliter (ml) twice a day. - Start date of 05/09/2021: Vitamin C 500 mg, once a day. - Start date of 07/14/2021 and discontinued 09/14/2021: Juven (arginine-glutamine-calcium powder). - Start date of 07/16/2021: Diet order - Regular with thin fluids, finger foods when possible. [NAME] (specialized spill proof cup) cup for thin liquids. Fortified milk with meals. Ice cream with all meals. Magic cup - HS (night) snack. - Start date of 09/08/2021: Mirtazapine (Remeron) 15 mg once a day. - Start date of 09/16/2021: Med plus 200 milliliter (ml/cc) or five (5) times a day. A record review revealed fluctuations between Med Plus and sugar free (SF) Med Plus since admission. A review of the Medication Administration Record (MAR) revealed the resident refused Med Plus supplement 24 times from 09/16/2021 through 09/23/2021. Review of a Progress Note, dated 09/08/2021, revealed the resident felt okay but was having complaints of not having enough help with eating. Further review revealed he resident did not like the food there and it was hard to eat what you don't like. Review of the Progress Note further revealed a new order for Remeron fifteen (15) mg at night (HS) for increased hunger and depression. Continued review of the note indicated the resident's life was declining fast related to not eating enough protein and the body could not heal. The resident was aware of this, and stated they would try to eat more as long as staff provided all meals with feedings. Review of the Nurse Practitioner (NP) notes of service, dated 08/12/2021, revealed the resident's assessment and plan for protein calorie malnutrition. The NP documented she discussed ways with the resident to increase the resident's calorie intake as well as protein intake to promote wound healing. The NP discussed the patient's dietary likes and dislikes. The resident's food preferences were passed along to the dietary department and there was a request for the dietary manager to review further with the resident. The NP documented the resident was a moderate risk and would follow up to monitor. Review of the registered dietitian's (RD) quarterly assessment, dated 08/13/2021, revealed the resident's weight was 156 pounds. Usual food intakes were noted as 25-50%. The interventions included: 200 ml sugar free (SF) Med Pass five (5) times/day, Juven twice a day (BID), and 30 ml Pro-Stat BID. The nutrition care summary revealed the resident was receiving multiple nutrition interventions to help meet estimated nutrition needs for weight maintenance and wound healing. The resident had many pressure ulcers in various stages, significant weight loss since admission but was relatively stable over the last 90 days. The resident's intakes were fair, the resident accepted Med Pass supplement, but did not accept Juven. The note indicated that intake of Med Pass alone could have met the resident's estimated nutrition needs for weight maintenance. The RD recommend discontinuing Pro-Stat due to the resident refusing it. The goals included no significant weight changes and improved skin condition. Review of the NP note of service, dated 08/31/2021, revealed the resident was a moderate risk resident who was monitored for multiple chronic conditions including stage four (4) pressure ulcer. The resident had a history of poor caloric intake resulting in protein calorie malnutrition. Weight was noted at 145 pounds. The assessment and plan revealed the resident had a significant weight drop over the past week. The NP would have dietary re-evaluate the patient preferences and encourage supplementation of the resident's oral intake with Med Plus. The goals of care included that the NP discussed with the resident the overall goal of tissue and wound healing and the importance of proper nutrition to assist in the continued healing of the resident's large stage four (4) pressure wound. There was no mention of the resident's additional pressure areas. Interview with Med Tech (MT) #1, on 09/22/2021 at 2:03 PM revealed the resident took the Med Plus supplement sometimes. MT #1 stated the flavor of the supplement was vanilla, but they sometimes had butter pecan. She was unaware if other supplements had been attempted for this resident. She stated the resident ate a lot of snack foods and liked sweets. Interview with MT #2, on 09/23/2021 at 7:43 AM, revealed the resident refused the Med Plus supplement. MT #2 stated the resident reported it was too thick and did not like the taste. No other supplements had been attempted with the resident. She stated Ensure or Boost supplements were usually provided by the families. She had not seen any carton nutritional shakes in a while. She stated the resident ate well if they fed the resident. The resident loved pinto beans and would eat that every day. She stated the resident enjoyed candy and chips brought in from the family. Observation of the resident on 09/23/2021 at 7:54 AM, revealed the resident received a carton of whole milk with the breakfast meal. Further observation revealed there was no fortified milk on the tray. The Director of Nurses (DON) was observed to feed the resident 12 minutes after meal was delivered. The resident had received an egg omelet, a piece of sausage, and a piece of toast. The DON was interviewed following the observation and reported the resident consumed a Magic Cup (high calorie frozen ice cream equivalent) and a honey bun at breakfast. The DON said the resident did not like milk. Observation of the resident, on 09/23/2021 at 12:15 PM, revealed the resident received a glass of milk but did not drink it. Further observation revealed the resident was not provided with any finger foods and he/she had consumed some of the meat, potatoes, and peas provided. The resident stated he/she only drinks milk with cereal. Interview with [NAME] #2, on 09/23/2021 at 8:51 AM, revealed they prepared fortified foods which included oats with brown sugar, milk with dry powder, mashed potatoes with extra butter, and cream soup with powdered milk. Interview with the Registered Dietitian (RD) on 09/23/2021 at 9:00 AM, revealed her work duties included completing resident assessments, MDS assessments, following up on weights and skin, and monthly kitchen sanitation audits. She stated they had fortified foods, carton nutritional shakes, nutrition treats, Med Plus supplement, Pro-Stat, and Juven to help with weight gain. The Dietary Manager (DM) usually obtained resident food preferences. She stated they had a standard menu and always had a list of foods available. She stated when a resident had a food dislike, they placed it into the system so that the food item would not show up on the tray card. Interview with the RD, on 09/23/2021 at 9:37 AM, revealed the facility had a Nutrition at Risk (NAR) meeting, but she was not involved in the meeting. She stated the staff would notify her if there was something she needed to know. She said the DM was the nutrition representation at the meeting. Interview with the DM, on 09/23/2021 at 9:54 AM, revealed he completed resident food preferences on admission and upon any resident complaints. He stated he participated in the NAR meeting and they reviewed weight losses during the meeting and added any new interventions needed. The DM further stated potential interventions included appetite stimulants, fortified foods, double portions, and supplements. He stated they had not had to add any additional supplements at meals or snack times for any residents. Interview with the RD, on 09/23/2021 at 9:54 AM, revealed she monitored meal percentages for the Med Pass supplements. She stated she considered the meal percentage equivalent to the percentage of fortified food consumed. Additional interview with the RD, on 09/23/2021 at 11:51 AM, revealed Resident #46 did not eat much. She stated she had not spoken to the resident directly. The resident was on palliative care, and she had charted multiple times. She further stated the resident was on fortified foods and ice cream at meals and usually consumed about 50 percent. She stated she was unsure why the resident was not eating much and thought it could have been related to contractures and positioning concerns. She stated the resident's pressure areas were related to lack of mobility and poor intakes. The resident was on fortified milk because the resident tended to drink better than eat and wasn't aware the resident disliked milk. Interview with the RD, on 09/23/2021 at 12:42 PM, revealed the only supplements the resident had tried was Med Plus, Pro-Stat, Juven, and ice cream. She stated she did not see any other supplements attempted. The resident was ordered for finger foods at meals. Additional interview with the RD, on 09/23/2021 at 1:07 PM, revealed she obtained preferences from the resident on this day. She stated the resident would be willing to try fortified oatmeal and potatoes. She stated they would continue the nutritional treat and ice cream. She stated they would add sandwiches of choice and some chocolate carton nutrition shakes. Interview with the DM, on 09/23/2021 at 12:49 PM, revealed he last reviewed the resident's preferences at the beginning of August 2021. He stated the resident was getting bacon and wanted sausage. He stated he was not aware the resident was receiving a carton of milk instead of fortified milk and was not aware the resident disliked milk. Interview with the Director of Nursing (DON), on 09/23/2021 at 3:18 PM, revealed the resident's nutrition had declined, and the resident refused to be repositioned. She stated the resident did not eat how the resident needed to eat and the resident had declined a tube feeding. She stated the Certified Nurse Aides (CNAs) on the floor would have told the nurse any preferences, and the nurse would notify the DM. She stated the DM should update preferences quarterly and as needed. Interview with the Nurse Practitioner(NP), on 09/23/2021 at 3:31 PM, revealed the resident was non-compliant with pressure relief. She stated the resident was non-complaint with diet and ate a lot of junk food. The NP further stated the goal was to maintain current wound status and prevent infection. Interview with the Nursing Home Administrator (NHA), on 09/24/2021 at 10:30 AM, revealed the resident refused meals and wanted snacks. She further stated that nurses were communicating with the RD about the resident's consumption.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record reviews, and facility policy review, it was determined the facility failed to ensure oxygen therapy was administered per the physician's orders for two (2) of three (3) sampled residents (Resident #32 and Resident #15); and failed to have a physician order for oxygen use for one (1) of three (3) sampled residents (Resident #60) reviewed for oxygen therapy. Findings included: Review of the facility's policy titled, Respiratory, revised 10/23/2020, revealed the policy did not contain anything specific related to oxygen use. 1. Record review revealed the facility admitted Resident #60 on 09/16/2021 with diagnoses which included Muscle Weakness, Morbid (severe) Obesity due to Excess Calories, and Essential Hypertension. No Minimum Data Set (MDS) had been completed yet for the resident. Review of Resident #60's Comprehensive Care Plan, initiated 09/17/2021, revealed the resident did not have a care plan related to oxygen therapy. Review of the admission Physician Orders, dated September 2021, revealed there was no current order for oxygen. Observations on 09/21/2021 at 10:38 AM and on 09/23/2021 at 3:56 PM, revealed the resident was wearing a nasal cannula for oxygen administration at two (2) liters per minute. Interview with the Director of Nursing, on 09/24/2021 at 10:46 AM, revealed she was not sure if Resident #60 had an order for oxygen and if the resident should be receiving oxygen continuously via nasal cannula. She stated Resident #60 was a new admission, and when the resident arrived at the facility the resident was on oxygen on the stretcher. Further interview with the DON on 09/24/2021 at 11:30 AM, revealed the resident should be on two liters of oxygen and she had just updated the resident's care plan and physicians orders to reflect the usage. 2. Record review revealed the facility re-admitted Resident #32 on 04/02/2021 with diagnoses which included Type 2 Diabetes, Muscle Weakness, COVID-19 Acute Respiratory Disease (history of), and Chronic Obstructive Pulmonary Disease (COPD). Review of Resident #32's Quarterly Minimum Data Set (MDS), dated [DATE], revealed the resident's Brief Interview for Mental Status (BIMS) score was fourteen (14), indicating the resident was cognitively intact. Further review of the MDS assessment revealed Resident #32 required oxygen therapy. Review of Resident #32's Comprehensive Care Plan, updated 09/21/2021, revealed the resident was at risk for respiratory complications related to a diagnosis of COPD. A further review revealed interventions included oxygen to be administered as ordered. Review of Resident #32's current physician's orders, dated October 2020, revealed an order for oxygen to be administered continuously at two (2) liters per minute via nasal cannula. Observations of Resident #32, on 09/21/2021 at 10:44 AM and 09/22/2021 at 9:47 AM, revealed the resident was wearing a nasal cannula for oxygen administration at four (4) liters per minute. Interview with the Director of Nursing (DON), on 09/24/2021 at 10:46 AM, revealed nursing staff should have been checking the resident's oxygen concentration setting every shift and every time they checked the resident's oxygen saturation. The DON further stated she was not sure why Resident #32's oxygen settings were not at the correct liters on 09/21/2021 and 09/22/2021. 3. Record review revealed the facility re-admitted Resident #15 on 07/10/2021 with diagnoses which included Shortness of Breath, Muscle Weakness, and Chronic Respiratory Failure with Hypoxia. Review of Resident #15's Quarterly Minimum Data Set (MDS), dated [DATE], revealed the resident's Brief Interview for Mental Status (BIMS) score was fifteen (15), which indicated the resident was cognitively intact. Further review of the MDS assessment revealed Resident #32 required oxygen therapy. Review of Resident #15's Comprehensive Care Plan, updated 08/26/2021, revealed the resident was at risk for respiratory complications related to a diagnosis of chronic respiratory failure with hypoxia. A continued review revealed interventions included oxygen to be administered as ordered. Review of Resident #15's current physician's orders, dated 05/2021, revealed an order for oxygen to be administered continuously at two (2) liters per minute via a nasal cannula. Observations of Resident #15, on 09/21/2021 at 11:12 AM and 09/22/2021 at 12:56 PM, revealed the resident was wearing a nasal cannula for oxygen administration at four (4) liters per minute. Interview with the Director of Nursing (DON), on 09/24/2021 at 10:46 AM, revealed nursing staff should have been checking the resident's oxygen concentration setting every shift and every time they checked the resident's oxygen saturation. The DON further stated she was not sure why Resident #15's oxygen settings were not at the correct liters on 09/21/2021 and 09/22/2021.

Based on observations, interviews, and facility policy review, it was determined the facility failed to label and date one (1) vial of Tuberculin Purified Protein Derivative and failed to dispose of a medication after the dispose-of date in one (1) of two (2) medication rooms (Grace Hall). The facility also failed to dispose of a liquid protein supplement sixty (60) days after opening on one (1) of five (5) medication carts (Oak Lawn 1). Findings included: Review of the facility's policy titled, Medication Administration General Guideline, reviewed 09/2018, indicated, expiration dates should be checked on packages/containers and no expired medications should be given to a resident. The nurse should place a date opened sticker on the medication if one is not provided by the dispensing pharmacy and enter the date opened. Observation on 09/24/2021 at 9:31 AM, of the medication refrigerator in the Grace Hall Medication Room, revealed an opened and undated multi-use vial of Tuberculin Purified Protein Derivative (PPD) Diluted Aplisol. Further observation revealed a liquid medication mixture for wound care for Resident #14. The bottle of medication had a label that indicated, DO NOT USE AFTER 08/29/2021. Observation on 09/24/2021 at 8:40 AM, of the Oak Lawn 1 medication cart, revealed a container of a liquid protein supplement with an open date of 06/21/2021 on top of the cart. Further observation of the label of the protein supplement indicated the supplement should be discarded 60 days after opening. Certified Medication Aide (CMT) #2 verified at that time the liquid protein supplement was outdated and should have been taken out of the medication cart. CMT #2 stated he/she was unsure why the protein supplement remained on the cart. Interview with Licensed Practical Nurse (LPN) #1, on 09/24/2021 at 9:40 AM, revealed the PPD had no opened date, and the liquid wound care medication was past the expiration date. LPN #1 stated the person that opened the vial of PPD was responsible for writing the open date on the vial. She further added she was unsure how the liquid medication would be disposed. LPN #1 stated she was not sure who was responsible to ensure the medication refrigerator did not contain discontinued, unlabeled, or outdated medications. Interview with the Assistant Director of Nursing (ADON), on 09/24/2021 at 10:30 AM, revealed typically the night nurses were responsible for taking discontinued medications out of the carts and out of the medication rooms. The ADON added that any nurse or CMT that opened a vial or bottle of a medication were responsible for dating when opened and removing the medication when outdated or discontinued. She further stated that she and the DON reviewed medication carts and medication rooms weekly to make sure all medications were labeled and ensured discontinued medications had been removed or discarded. The ADON stated that leaving the medications on the cart after expiration and not dating the medications was an oversight of the nurses, the CMTs, and the supervisory staff. Interview with the Director of Nursing (DON), on 09/24/2021 at 9:30 AM, revealed the nurse or CMT on the hall that opened a medication was responsible for placing an opened date on the medication. The nurses or CMT on the hall were also responsible for removing any discontinued, outdated, or unlabeled medications. The DON added the nurse managers for the halls checked the medication carts and the medication rooms one (1) to two (2) times per week to make sure all medications were dated when opened and/or removed when discontinued. She was unsure why the PPD had not been dated or the wound medication and the liquid protein supplement remained on the cart when expired.

Based on interviews and document reviews, it was determined the facility failed to ensure there was a qualified food and nutrition director with appropriate competencies and skills sets to carry out food and nutrition services The facility failed to ensure the Director for Food and Nutrition Services was a Certified Dietary Manager (CDM), a Certified Food Service Manager, had a national certification for food service management, or had an associates or higher degree in food service management. This could affect all residents who receive meals from the kitchen. Facility census of sixty-one (61) residents. Findings included: Review of the job description for Dining Services Director, revised 09/2017, revealed, A facility that employs a qualified dietitian less than full time should require a full time Director of Dining Services who is a certified dietary manager or a certified food service manager or has similar national certification for food service management and safety from a national certifying body; or had an associates or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management, from an accredited institution of higher learning; and in states that had established standards for food service managers or dietary managers, should meet state requirements for food service managers or dietary managers. Review of the Dietary Manager's (DM) personnel record revealed completion of in-services (dated 08/03/2021) for personal protective equipment (PPE); hand washing; cleaning and sanitizing; cross contamination; garbage and trash disposal; glove usage; grease fire procedures; knife, slicer, and cutting board use; plate presentation; pots and ware washing; receiving and storage of food; service line procedure; texture modification; time and temperature control; and labeling and dating. A ServSafe (food safety course) certification was completed on 12/13/2019. The CDM certification program had been not been completed, but had been started with a portion of module one (1) completed. Interview with the Registered Dietitian (RD), on 09/23/2021 at 9:00 AM, revealed she was in the facility every week, not to exceed eight (8) hours. She stated she completed resident assessments, portions of the Minimum Data Set (MDS) assessment, followed up on weights and skin concerns, and visited with residents for needed assessments. The RD further stated the current DM was not a Certified Dietary Manager (CDM). She stated the current DM obtained resident preferences and was the nutrition representative for the Nutrition At Risk (NAR) meetings. Interview with the Dietary Manager (DM), on 09/23/2021 at 9:47 AM, revealed he had been the DM for about two and a half (2.5) to three (3) months. He stated it was supposed to have been a more permanent position, but he was transferring to another facility. He further stated he had completed some of the first module for the CDM program, but an extension had to be filed. He stated it had been tough with COVID-19. Interview with the Nursing Home Administrator (NHA), on 09/24/2021 at 10:30 AM, revealed the DM had been in the current position since July 2021. She further stated she was aware of the DM education/training requirement, but was not aware of the DM's past work experience or his progress in the CDM course.