**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record for Resident #51 revealed the facility admitted the resident on 10/23/19 with diagnoses that included Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, and Diabetic Neuropathy. Review of the nurse's notes for Resident #51 revealed an entry dated 10/25/19 at 11:33 AM stating the resident had been sent to the acute care hospital for decreased level of consciousness and an increased blood glucose level. The nurse's note also revealed that a copy of the bed hold policy was sent with the resident. However, there was no indication of whether the resident or the responsible party had elected to choose bed hold. In addition, review of a copy of the facility's bed hold policy revealed there was no amount listed as to what would be expected as payment for bed hold after the days were exhausted. Interview conducted with Registered Nurse (RN) #1 on 12/18/19 at 12:17 PM, revealed she had transferred Resident #51 to the hospital on [DATE]. The RN stated she had been directed to just send a copy of the bed hold policy with the resident to the hospital. The RN further stated she generally did not tell residents or responsible parties about bed hold. Interview conducted with the Director of Nursing (DON) on12/18/19 at 12:20 PM, revealed the facility should notify the family of the status of the bed. However, we don't here as much because we are so small and hold everybody's bed. Interview conducted with the Administrator on 12/18/19 at 12:28 PM, revealed the facility was currently just providing the bed hold policy and not asking the resident or family if they would like for the facility to hold the resident's bed at the time of transfer. The Administrator stated if a resident used all their bed hold days and the bed was needed for another resident the responsible party would be contacted to see if they wanted to pay for bed hold and the amount to be charged would be relayed at that time. Per the Adminstrator, no calls were made to Resident #11, Resident #51, or their responsible parties regarding bed hold. The Administrator stated residents were never charged bed hold here unless the facility needed the bed. The Administrator stated it had been a long time since the facility called a resident or resident's representative to see if they wanted to request a bed hold. The Administrator stated she did not regard it as a problem since the residents were not going to lose their beds. Based on interview, record review, and policy review, it was determined that the facility failed to ensure the resident or the resident's representative received a written notice of the facility's bed hold policy when the residents were hospitalized for two (2) of two (2) residents from a sample of twenty (20) residents. Resident #11 was transferred to the hospital on [DATE] and Resident #51 was transferred to the hospital on [DATE]. There was no evidence that Resident #11's or Resident #51's responsible party was given written notification of the bed hold and the reserve bed payment policy upon transfer to the hospital. The findings include: Review of the facility's policy entitled Resident admission Agreement, dated 2018, revealed that at the time a resident is to leave the facility for a temporary stay in a hospital or for therapeutic leave, the resident or the resident's legal representative will be given a written copy of the Bed Hold Policy and may elect to hold open the room and bed until the resident's return to the facility. Further review of the admission Agreement revealed that at the time of transfer, the resident or the resident's legal representative will indicate in writing whether they desire or decline the bed hold. Further review of the Resident admission Agreement revealed that the resident will be notified of the rate at the time of temporary discharge. 1. Observation on 12/16/19 at 11:36 AM revealed Resident #11 was sitting in a wheelchair in his/her room. Further observation revealed the resident was alert and pleasant, but confused. Review of the Minimum Data Set (MDS) dated [DATE] revealed Resident #11 was admitted to the facility on [DATE] with diagnoses that included Hip Fracture, Alzheimer's, Dementia, Renal Insufficiency, Arthritis, Hypertension, Benign Prostatic Hyperplasia, and Depression. Further review of the MDS revealed Resident #11 had a Brief Interview for Mental Status (BIMS) score of nine (9) indicating the resident had moderately impaired cognition. Review of the nursing progress notes dated 09/26/19 at 10:31 AM revealed Resident #11 was noted to have pneumonia. The note stated that the resident had received a one-time antibiotic injection and was started on an oral antibiotic on 9/25/19. Review of the nursing progress notes dated 09/26/19 at 11:05 PM for Resident #11 revealed the aide notified the nurse that the resident's blood pressure was low. Further review of the note revealed the nurse assessed the resident and the resident's blood pressure was 70/42, pulse was 144, and respirations were 22 with an oxygen saturation of 91 percent and temperature of 101.2. Further review revealed the responsible party and the physician were notified of the resident's condition. According to the progress notes, the physician ordered the resident to be sent to the Emergency Room. Further review of the progress note revealed no documentation that the resident or the resident's responsible party received a written notice of the bed hold that included if the resident desired for the bed to be held or desired to decline, and included the rate for the cost of the bed hold. Interview with the Business Office Manager on 12/18/19 at 12:39 PM revealed that the facility is not at capacity and the staff seldom ask a resident regarding bed hold. According to the interview, the facility holds all beds for the residents. Further interview revealed no phone calls or notifications are made to the responsible party related to the bed hold or the cost of the bed charges. Interview with the Director of Nursing (DON) on 12/18/19 at 12:20 PM revealed the staff should be notifying the family of the status of the bed hold; however, the staff does not do the bed hold notifications due to being a small facility and not having many admissions. Further interview revealed the facility holds the beds for all residents. According to the interview, the DON was unable to find any information that Resident #11's responsible party was notified of the bed hold prior to the transfer to the hospital. Interview with the Administrator on 12/18/19 at 12:28 PM revealed the Administrator expected the staff to provide a copy of the bed hold policy to the resident at the time of transfer. According to the interview, the business office manager would call the family if they were going to request a financial bed hold. Further interview revealed there was no evidence that Resident #11's responsible party was notified of the bed hold and the cost of the reserve bed payment. According to the interview, the resident was not charged for holding the bed during the resident's hospital stay.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy it was determined the facility failed to ensure the care plan for one (1) of eighteen (18) sampled residents was revised after a change in the resident's status. Resident #10 had a change in code status from do not resuscitate (DNR) to full code status per advance directive signed on 01/25/19. Review of the care plan did not reveal the update until 08/01/19. The findings include: Review of the facility policy, Care Planning and Interventions, dated 07/23/19, revealed the care plan was to be updated as needed, but no less than quarterly when conditions change. Observation of the resident on 12/17/19 at 11:24 AM, revealed the resident lying in bed with eyes closed. Further observation revealed a urinary catheter drainage bag hanging on the bed frame inside a dignity bag. Review of the medical record revealed Resident #10 was admitted to the facility on [DATE] and had diagnoses of Unspecified Dementia without Behavioral Disturbance, Unspecified Cirrhosis of Liver, Chronic Pulmonary Edema, Neuromuscular Dysfunction of Bladder, Anoxic Brain Damage, Metabolic Encephalopathy, and Type 2 Diabetes Mellitus. Review of the Minimum Data Set (MDS) annual assessment, dated 10/03/19, revealed a Brief Interview for Mental Status (BIMS) score of ninety-nine (99), which indicated the resident was not able to respond to any of the interview appropriately. Further review of the record for Resident #10 revealed a Code Status form, which showed the family had signed for the resident to be a full code, dated 01/25/19. Review of the physician orders revealed an order dated 01/28/19 that stated Resident #10 was to be a full code. Review of the care plan revealed a care plan in the chart that identified that the advance directive for Resident #10 was a DNR, dated 01/05/19. Review of the care plan for Resident #10 in the electronic medical record (EMR) revealed the resident had an advance directive status of full code, revised date of 08/01/19. Further review of care plans in the EMR revealed care plan reviews dated 02/26/19, 03/14/19, 06/10/19, and 07/11/19, which showed Resident #10 to be DNR. Interview with the Assistant Director of Nursing on 12/17/19 at 12:07 PM, revealed the care plan on the chart was not the most recently updated care plan for Resident #10. She further stated the most recently updated care plan would be in the EMR. Interview with the MDS Nurse on 12/17/19 at 3:45 PM, revealed Resident #10's code status was not updated on the care plan until 08/01/19. Interview with the Administrator on 12/18/19 at 10:47 AM, after reviewing the care plans on Resident #10, revealed the care plan had not been updated to reveal the change in the advance directive from DNR to full code as indicated by a physician order dated 01/28/19, and the code status determination form dated 01/25/19. Interview with the Director of Nursing (DON) on 12/18/19 at 9:55 AM, revealed many things could lead to an update on the care plan. She stated physician orders or a change in condition would prompt that an update was needed for the care plan. She further stated she signs the MDS assessment for completeness, not for accuracy. She then added that the discipline that was responsible for completion of that area of the care plan would be the one to review for accuracy. Interview with the Social Services Director on 12/18/19 at 11:07 AM, revealed she would have been responsible for reviewing the care plan area related to advance directives for Resident #10. She stated she did miss that the resident's code status had not been updated on the care plan. She also stated she had no clue why she missed this.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review it was determined that the facility failed to ensure an ongoing program of activities was developed to meet the needs of one (1) of eighteen (18) sampled residents (Resident #1). Interview conducted with Resident #1 on 12/16/19 at 11:01 AM, revealed the resident was bored on the weekend as there was only one activity (Bingo for one hour) offered on Saturday and no activity other than church services on Sunday. The findings include: Review of the facility policy titled Group Programming, dated 05/02/19, revealed the purpose of the policy was to ensure each resident the opportunity for active participation in group programming designed to accommodate his or her social and/or cognitive abilities and to promote quality of life. Review of the record for Resident #1 revealed the resident was admitted on [DATE] with diagnoses that include Pain in Right Hip, Depression, and Left Artificial Hip Joint. Review of the most recent annual Minimum Data Set (MDS) assessment dated [DATE], revealed the resident had been assessed to have a Brief Interview for Mental Status (BIMS) score of eleven (11), which indicated the resident had been assessed to have moderately impaired cognition and was therefore interviewable. The MDS further revealed it was very important for Resident #1 to participate with group activities. Review of the comprehensive care plan for Resident #1 dated 01/28/19, revealed the resident enjoys visiting with a group of residents in the lobby or dining room. The care plan also revealed the resident enjoyed Bingo, cards, and other games. Review of the December Activity Participation Record for Resident #1 dated December 2019 revealed the only activity documented for Resident #1 for the month of December on Saturdays was Bingo. The documentation did not include how long the activity lasted. The record did have a place to document the resident response to the activity, and an A was noted by each entry, which indicated active participation. Review of the facility activity calendar dated December 2019 revealed the only activity listed for Saturdays was Bingo. Interview conducted with Resident #1 on 12/16/19 at 11:01 AM, revealed the resident stated, I would like to be able to assist with activities. I am a retired teacher. I feel I might be of use to the residents. I do not have any activities in the afternoon on Saturdays. I would like to see more games played. I have talked to the Activity Director (AD) in the past. Observation of Resident #1 on 12/16/19 at 11:30 AM revealed the resident was observed in the dining room playing Bingo. Group interview on 12/16/19 at 3:00 PM with Resident #20, Resident #38, Resident #15, Resident #32, Resident #37, and Resident #18, revealed they were provided with no activities on Saturdays except for Bingo for one (1) hour on Saturday mornings. The group revealed they had made the AD aware they wanted more activities on Saturdays and they were told they have no funding for more activities on the weekend and have no volunteers available to provide more activities. Interview conducted with the AD on 12/18/19 at 10:17 AM, revealed she had been aware Resident #1 had wanted more activities on Saturdays. The AD stated that in order to provide more activities on Saturdays she would have to cut an activity through the week to provide the staff. The AD stated she might have a volunteer who would be willing to work Saturday afternoon. Interview conducted with the Administrator on 12/18/19 at 10:44 AM, revealed staff had at times come in and provided activities on Saturdays. The Administrator stated she had not been aware there was a problem with not enough activities on Saturdays.

Based on interview, record review and review of facility policy, it was determined the facility failed to ensure the comprehensive care plan is reviewed and revised by an interdisciplinary team composed of individuals who have knowledge of the resident and his/her needs for one of sixteen (16) sampled residents (Resident #4). The facility failed to ensure the care plan for Resident #4 was reviewed and revised with care assistance information after a Quarterly Minimum Data Set (MDS) assessment was completed. The findings include: Review of facility's policy titled, Fall Management, last issued November 2016, revealed the facility will implement a fall management system that results in reducing resident falls. The interdisciplinary team will review and revise, if indicated, all residents fall management care plans upon the completion of each comprehensive, significant change and quarterly Minimum Data Set (MDS) assessment, upon a fall event and as needed thereafter. Further review revealed the policy stated care plan revisions will be made at that time, as indicated. Record review revealed the facility admitted Resident #4 on 04/02/18 with diagnoses which included Hemiplegia and Hemiparesis following Cerebral Infarction, Unspecified Osteoarthritis, Other Abnormalities of Gait and Mobility, Muscle Weakness and Type Two (2) Diabetes Mellitus. Review of the Quarterly MDS assessment, dated 06/18/18, revealed the facility assessed Resident #4's cognition to be intact with a Brief Interview for Mental Status Score of fifteen (15) which indicated the resident was interviewable. Further review of the 06/18/18 quarterly MDS assessment, revealed the facility assessed Resident #4 required extensive assistance of two (2) staff for toileting. However, review of Resident #4's Activities of Daily Living Care Plan related to history of Cerobvascular Accident and Impaired Mobility, dated 04/09/18 and last revised on 06/18/18, revealed an intervention for staff to provide the amount of assistance/supervision that is needed to complete, instead of the assessed extensive assistance of two staff for toileting which would require staff to determine what the appropriate assistance they provide would be. In addition, review of Resident #4's At Risk for Falls Comprehensive Care Plan, dated 04/09/18 and last revised on 06/18/18, revealed there was no intervention or guidance listed for staff to know what type of assistance Resident #4 required for toileting transfers. The facility was unable to provide a copy of the Care Directive (CNA Care Plan) prior to the fall. Review of the facility 'Incident Follow-up and Recommendation Form', dated 07/06/18, revealed Resident #4 sustained a fall with no injuries on 07/06/18 while one (1) staff member was assisting Resident #4 with toileting. The immediate action listed on the incident form was to make Resident #4 a two person assist for toileting. Interview with MDS Coordinator on 09/27/18 at 02:30 PM, revealed she expected the MDS assessments to be completed accurately and reflect the resident's true status. She stated the care plans should match the MDS assessments. She further revealed she expected the care plans to be updated and reviewed/revised in between MDS assessments to reflect resident changes. Interview with the Director of Nursing (DON) on 09/27/18 at 1:03 PM, revealed she expected the care plan to show the required needs and assistance for each resident and it not have an intervention where staff would have to determine what type of or how much assistance to provide. She stated she would expect the MDS Coordinator to ensure the care plans reflect the MDS assessment when they are done and to review and revise the care plans ongoingly as needed. Interview with Facility Administrator on 09/27/18 at 1:22 PM, revealed she expected the care plans to reflect the required needs and assistance the residents required based on their MDS assessments. She stated she expected the MDS Coordinator to ensure the care plans match the MDS assessments and to review and revise the care plans in between assessments to continually reflect the residents' status.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review, it was determined the facility failed to complete a discharge summary and recapitulation of the resident's stay for one (1) of three (3) residents' closed records reviewed in the selected sample of sixteen residents (Resident #61). Resident #61 was discharged home on [DATE]; however, the facility did not complete a recapitulation of the resident's stay. The findings include: Review of the facility policy titled, Discharge Summary, last revised 07/24/17, revealed the discharge summary will contain a recapitulation of the resident's stay that includes, but is not limited to, diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results. Record review revealed the facility admitted Resident #61 on 07/01/18 and discharged the resident home on [DATE]. Further review of this resident's closed record, revealed no evidence of a complete recapitulation of this resident's stay. Interview with Medical Records Director on 09/26/18 at 2:57 PM, revealed she would expect the facility to ensure a complete recapitulation of stay to be done on all residents discharging home or community.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review, it was determined the facility failed to ensure supervision and adequate assistance to prevent accidents for one (1) of sixteen (16) sampled residents (Resident #4). Resident #4 was assessed by the facility to require extensive assistance of two (2) staff for toileting on 06/18/18; however, on 07/06/18 only one (1) staff was providing toileting transfer assistance when Resident #4 fell. The findings include: Review of facility's policy titled, Fall Management, last issue November 2016, revealed the purpose of the policy is to promote resident safety and reduce resident falls by proactively identifying, care planning and monitoring of residents' fall indicators. Further review of the policy, revealed based on comprehensive assessment of the resident, the facility must ensure that residents receive treatment and care in accordance with professional standard of practice, the comprehensive care plan and the resident's choice. Record review revealed the facility admitted Resident #4 on 04/02/18 with diagnoses which included Hemiplegia and Hemiparesis following Cerebral Infarction, Unspecified Osteoarthritis, Other Abnormalities of Gait and Mobility, Muscle Weakness and Type Two (2) Diabetes Mellitus. Review of the Quarterly MDS assessment, dated 06/18/18, revealed the facility assessed Resident #4's cognition to be intact with a Brief Interview for Mental Status Score of fifteen (15) which indicated the resident was interviewable. Further review of the 06/18/18 quarterly MDS assessment, revealed the facility assessed Resident #4 required extensive assistance of two (2) staff for toileting. Review of Resident #4's Fall Risk Evaluation sheet, revealed the most recent assessment done on Resident #4 prior to the fall on 07/06/18 was an assessment done on 05/03/18. Review of the Fall Risk Evaluation dated 05/03/18, revealed Resident #4's scored sixteen (16) which indicated this resident was a high falls risk. Further review revealed the facility assessed this resident, under mobility, on the Fall Risk Evaluation as having problems with ambulation, mobility and balance. Review of Resident #4's Activities of Daily Living Care Plan and At Risk for Falls Comprehensive Care Plan, related to history of Cerobvascular Accident and Impaired Mobility, dated 04/09/18 and last revised 06/18/18, revealed an intervention for staff to provide the amount of assistance/supervision that is needed to complete on the Activities of Daily Living Care Plan , instead of the assessed need of extensive assistance of two staff for toileting. The facility was unable to provide the Care Directives (CNA care plan) that was in place at the time of the fall. Review of the facility 'Incident Follow-up and Recommendation Form', dated 07/06/18, revealed Resident #4 fell on [DATE] while one (1) staff member was assisting Resident #4 with toileting. The immediate action listed on the incident form was to make Resident #4 a two person assist for toileting. Interview with Certified Nurse Aide (CNA) #2 on 09/27/18 at 2:37 PM, revealed Resident #4 was listed as requiring two staff assist for toileting transfers on the Care Directive at the time of the fall on 07/06/18. She stated she should have had a second person with her for the toileting transfer of Resident #4, but did not get another staff to help. She revealed she did not have a gait belt in use when Resident #4 lost his/her balance and fell, but she was supposed to be using one. Interview with the Director of Nursing (DON) on 09/27/18 at 1:03 PM, revealed she would expect staff to use the appropriate amount of assistance and the amount of staff required for toileting cares / needs that was assessed for the resident. She further stated she expects staff to use a gait belt with all transfers.

Based on observation, interview, and record review, it was determined the facility failed to ensure a resident who displays or is diagnosed with dementia, receives the appropriate treatment and services to attain or maintain his or her highest practicable physical, mental, and psychosocial well-being for one (1) of sixteen (16) sampled residents (Resident #34). Record review revealed no documented evidence the facility developed and implemented person-centered care plans that included and supported the dementia care needs of Resident #34, whom had a diagnosis of Dementia. The findings include: Interview with the Administrator on 09/27/18 at 3:53 PM, revealed the facility did not have a specific policy related to patient centered care planning and the facility follows State and Federal regulations in regards to patient centered care planning. Review of the facility policy, Resident Assessment Instrument (RAI) and Care Plan, last revised 11/28/16, revealed the RAI is not all inclusive, therefore, other sources of information are to be included when developing an individualized person-centered care plan for each patient that is reviewed by the interdisciplinary team with each assessment including the patient and other participants as the patient desires. Further review of the policy revealed the Care Plan includes measure objectives, timeframe's to meet the patient's cultural, nursing, mental, and psychosocial needs including services being provided to meet those needs. Record review revealed the facility readmitted Resident #34 on 07/06/16, with diagnoses to include Unspecified Dementia with Behavioral Disturbance, Major Depressive Disorder, and Anxiety Disorder. Review of the Quarterly Minimum Data Set (MDS) Assessment, dated 08/05/18, revealed the facility assessed Resident # 34's cognition as severely impaired with a Brief Interview for Mental Status (BIMS) score of seven (7). Review of Resident #34's Comprehensive Care Plan for Cognitive Loss related to Dementia, as evidence by (AEB) poor decision making abilities, dated 02/13/18, revealed goals for resident to maintain current level of cognition and be free from injury through next review. Further review revealed approaches to provide cues and reminders as needed, reorient/redirect as needed, call resident by name and identify self with each interaction, consult MD as needed, remind resident of facility policies as needed, remove items if noted, and call daughter as needed. However, the care plan did not reflect any individualized person-centered goals and interventions for Resident #34. Observation of Resident #34 on 09/25/18 at 11:14 AM, revealed he/she was in bed, lying on his/her back with eyes closed. Interview with the Minimum Data Set (MDS) Coordinator on 09/27/18 at 2:06 PM, revealed she is responsible for creating Dementia care plans. She further revealed Resident #34's care plan was very similar to other residents diagnosed with Dementia. Interview with the Social Services Director on 09/27/18 at 2:23 PM, revealed she had received Dementia Care training, but not specifically related to care plans. She further stated dementia care plans for residents closely resembled one another. Interview with the Director of Nursing (DON) on 09/27/18 at 11:17 AM, revealed she expected all Dementia residents to have care plans specific to their needs. She stated the care plans are created to be specific for each resident including those residents with dementia, however, the care plans may resemble one another. Interview with the Administrator on 09/27/18 at 3:53 PM, revealed the resident Dementia care plans should be more person centered and specific to each resident.

Based on observation, interview, record review, and facility policy review, it was determined the facility failed to ensure one (1) resident not in the selected sample of sixteen (16) received foods that accommodated the resident's preferences (Resident 18). The facility assessed Resident #18 disliked black-eyed peas and black-eyed peas was listed as a dislike on the resident's meal card; however, on observation on 09/25/18,revealed the facility staff served black eyed peas to the resident. The findings include: Review of the facility policy titled, Food Preferences, last revised 01/01/07, revealed individual, cultural/religious food preferences are honored, when possible, to enhance the resident's satisfaction with food and dining. Further review of the policy revealed dislikes, food intolerance's/allergies, special requests and specific beverage preferences are noted on the resident's tray card. Record review revealed the facility readmitted Resident #18 on 01/19/18 with diagnoses which included Major Depressive Disorder, Hypothyroidism, and Hypertension. Review of the Quarterly Minimum Data Set (MDS) Assessment, dated 07/13/18 revealed the facility assessed Resident #18's cognition as intact, with a Brief Interview for Mental Status (BIMS) Score of fourteen (14), which indicated the resident was interviewable. Observation of meal service on 09/25/18 at 12:27 PM, revealed Resident #18's tray card indicated the resident disliked black-eyed peas; however, black-eyed peas were served to the resident. Interview with Resident #18 on 09/25/18 at 12:30 PM, revealed he/she did not like black-eyed peas and he/she wanted green beans instead. Resident #18 further stated he/she has been served dislikes on other occasions and he/she must bring it to staff's attention. Interview with Dietary Aide #1 on 09/27/18 at 12:35 PM, revealed she should have checked Resident #18's tray card prior to serving the black-eyed peas to the resident. She stated if she had noticed the dislike she would have made the kitchen aware. Interview with the Dietary Manager on 09/27/18 at 12:42 PM, revealed she expected the aide to have noticed the resident's dislikes prior to serving the food. She stated she had spoken with Dietary Aide #1 and she admitted it was an oversight on her part.

Based on observation, interview, and facility policy/audit review, it was determined the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety. Observation of the kitchen, on 09/27/18, revealed dished were not being stored properly. Review of the facility Census and Condition, dated 09/25/18, revealed fifty-four (54) of fifty-four (54) residents received their food from the kitchen. The findings include: Interview with the facility Administrator on 09/27/18 at approximately 3:30 PM, revealed she stated the facility did not have a specific policy related to the proper storing of dishes, but the facility followed the Federal Guidelines in regard to the proper storage of dishes. Observation of the kitchen dish room on 09/27/18 at 8:18 AM, revealed dozens of clean bowls to be used for the residents were being stored on a cart that was uncovered and the bowls were not stored inverted to prevent contamination. Interview with the Dietary Manager on 09/27/18 at 3:04 PM, revealed she stated she expect the dishes to be stored inverted or covered to prevent contamination.