Based on observations and staff interview, it was determined that the facility failed to store foods in a manner that protects them from contamination and in a manner to prevent spoilage. This was evident during the initial kitchen tour. The findings include: On 10/07/24 at 8:35 AM, an initial kitchen tour was conducted with Staff #1. An observation was made in the large walk-in refrigerator of the kitchen. A box of 6 yogurts with expiration date of 9/25/2024 were present. An open and undated package of bacon was seen sitting on an open rack above open containers of produce. These findings were verified by Staff #1. After surveyor intervention, Staff #1 discarded the box of 6 expired yogurts and the open and undated package of bacon. On 10/09/24 at 9:18 AM, an interview was conducted with the Certified Dietary Manager (Staff #8). When asked who handles the storage of perishable foods in the refrigerator, Staff #8 stated that she handles all the storing of the food products in the kitchen. When asked what their expectation was for how to check for product's expiration dates, Staff #8 stated that she checks the expiration dates everyday and ensures to place the newer products behind the older products on the shelves.

Based on observation, medical record review and staff interview it was determined the facility failed to ensure that a staff member did not make negative remarks about Residents #23 and #32 in front of them. This was evident for 2 of 5 residents present in the Day Room when the remarks were made. The findings include: On 10/22/19 at 12:05 PM, 5 residents were observed sitting in the Day Room. Two residents were sitting at tables being fed by Geriatric Nursing Aides (GNA)s #2 and #3. GNA #1 was standing in the middle of the room next to a resident but with her back to the surveyor. She was overheard saying, [He/she] has spit at me 3 times and I'm not going to feed [him/her] anymore. A tray on the table next to this resident had the name of Resident #32 on it. The surveyor then left the room to make observations in the main dining room. At 12:25 PM on 10/22/19 when the surveyor returned to the day room, GNA 3# was sitting at a table feeding a resident and GNAs #1 and #2 were sitting together at a different table and each feeding a resident. GNA #1 had her back to the surveyor and was overheard saying, [He/she] makes up more excuses than anyone I know. [He/she's] a picky eater and just pushes things around on the plate. When GNA #1 got up and left the room, GNA#3 was asked who the resident was that GNA #1 was feeding. She (GNA#3)stated it was Resident #23. When the residents had finished eating, Resident #23 was interviewed. The resident was asked if he/she liked the lunch and after talking for a little while, stated he/she liked food but was a picky eater. When asked if staff were nice to him/her, she mumbled for a little bit and then said, yes. It was unclear if she (#23) really understood the questions. Resident #32 had already left the area so was not interviewed at this time. At 12:50 PM on 10/22/19, the Director of Nursing (DON) was notified of the remarks made by GNA #1 in front of the residents so that she could initiate an investigation. On 10/22/19 at 10:15 AM the medical record of Resident #23 was reviewed. The resident has a diagnosis of dementia and his/her most recent Brief Interview for Mental Status (BIMs) test on 8/23/19 was 4 of 15. According to https://www.verywellhealth.com/bims-identifying-dementia-98637: BIMS stands for Brief Interview for Mental Status. The BIMS test is used to get a quick snapshot of how well you are functioning cognitively at the moment. It is a required screening tool used in nursing homes to assess cognition . To reach a final tally, add up the total points from all three tests. The numeric value can be interpreted as follows: 13 to 15 points: intact cognition 8 to 12 points: moderately impaired cognition 0-7 points: severely impaired cognition Resident #32, also, has a diagnosis of dementia and on 9/10/19 his/her BIMs score was 3 of 15. On 10/22/19 at about 11:00 AM Resident #32 was interviewed but did not respond appropriately to any questions. On 10/22/19 the surveyor asked to interview GNAs #2 and #3. GNA #3 was not available. At 2:20 PM GNA #2 was interviewed and asked what she heard GNA #1 say about Residents #32 and #23 at lunch when the incident occurred. She stated she heard GNA #1 say that Resident #32 had spit 3 times and she wasn't going to feed him/her anymore. She stated she heard GNA #1 say that Resident #23 was a picky eater and just likes sweets.