**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review and facility policy review the facility failed to implement a care plan regarding a resident needing assistance with Activities of Daily Living (ADL) for one (1) of 17 care plans reviewed. Resident #41 Findings Include Review of the facility policy titled, Comprehensive Plan of Care with a revision date of 10/10/22 revealed Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment . Record review of the Care Plan Detail for Resident #41 revealed Focus: Res (Resident) requires assist with all ADL's .Interventions/Task .Assist with all .Bathing .Personal Hygiene . An observation on 07/23/24 at 10:28 AM, revealed Resident #41 sitting up in her wheelchair with 6-8 white hairs on both sides of her chin that were approximately 1/8- 1/4 inch long. An observation and interview on 7/24/24 at 9:15 AM, with Certified Nurse Assistant (CNA) #1 confirmed Resident #41 had chin hairs on both sides of her chin that should have already been removed. She stated the resident had a doctor's appointment yesterday and she got in a hurry and did not remove them when she gave the resident her shower. She stated most women don't want hair on their face. CNA #1 stated, I know I would not. An interview on 7/24/24 at 9:40 AM, with the Minimum Data Set/Registered Nurse (MDS/RN) revealed she develops the care plans for ADL's and confirmed that Resident #41 needed assistance with her ADL's that included her facial hair removal. She agreed that the care plan was not implemented if the resident had a shower, and the facial hair was not removed. An interview on 7/24/24 at 1:30 PM, with the Director of Nurses (DON) confirmed Resident #41 needed assistance removing the hair from her chin and therefore her ADL care plan was not implemented. Record review of Resident #41's admission Record revealed the resident was admitted to the facility on [DATE] with medical diagnoses which included Unspecified Dementia. Record review of Resident #41's MDS with an Assessment Reference Date (ARD) of 6/11/24 revealed in Section GG the resident was totally dependent on staff for bathing and personal hygiene.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review and facility policy review, the facility failed to administer a medication according to the physician orders for one (1) of 31 medication administration opportunities. Resident #23 Findings Include: Review of the facility policy titled, Medication Administration with a revision date of 6/8/23 revealed Policy .Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection . An observation and interview on 7/24/24 at 8:15 AM, revealed Licensed Practical Nurse (LPN) #1 allowed Resident #23 to self administer an inhaler with no instructions to rinse and spit afterwards according to physician orders. LPN #1 stated, Well I messed that up. She revealed the resident refuses to rinse and spit, but I should have reminded her of the need to do so. She stated she was not sure the purpose of rinsing and spitting after the inhaler, unless it was just to get the taste out of their mouth. She confirmed Resident #23's order indicated the resident needed to rinse and spit following the administration of the inhaler, so therefore she did not follow the physician orders. An interview on 7/24/24 at 10:30 AM, with the Director of Nurses (DON) confirmed the nurse did not follow the physician orders and the nurse did not instruct the resident to rinse and spit after the administration of the inhaler. She stated that the purpose of rinsing and spitting after the inhaler was to prevent yeast and sores in the residents' mouth. Record review of physicianOrder Details revealed the following: 8/7/23 BREO ELLIPTA Inhaler 100-25-1 puff inhale orally one time a day related to Mild Intermittent Asthma, Uncomplicated, Rinse mouth with water (H2O) and spit after use. Record review of Resident #23's admission Record revealed the resident was admitted to the facility on [DATE] with medical diagnoses that included Mild intermittent asthma, uncomplicated and Acute Cough.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review and facility policy review, the facility failed to remove facial hair on a resident requiring assistance with Activities of Daily Living (ADL) for one (1) of 17 residents sampled. Resident #41 Findings Include: Record review of the facility policy titled, Activities of Daily Living (ADL) with a revision date of 9/15/22 revealed . Policy Explanation and Compliance Guidelines .3. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene . During an observation on 07/23/24 at 10:28 AM, revealed Resident #41 sitting up in her wheelchair with 6-8 white hairs on both sides of her chin that were approximately 1/8- 1/4 inch long. During an observation and interview on 7/24/24 at 9:15 AM with Certified Nurse Assistant (CNA) #1 confirmed that Resident #41 had chin hairs on both sides of her chin that should have already been removed. She stated the resident had a doctor's appointment yesterday and she got in a hurry and did not remove them when she gave the resident her shower. She stated most women don't want hair on their face. CNA #1 then stated I know I would not. An observation and interview on 7/24/24 at 9:25 AM, with the Director of Nurses (DON) confirmed Resident #41 had facial hair that should have been removed with her bath and should have been documented correctly under whether the resident had facial hair. She stated that facial hair removal is part of bathing and she expected it to be done. Record review of Resident #41's documented baths revealed the resident received a bath on 7/23/24 at 10:51 AM. Record review of Resident #41's admission Record revealed the resident was admitted to the facility on [DATE] with medical diagnoses that included Unspecified Dementia. Record review of Resident #41's Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 6/11/24 revealed in Section GG the resident was totally dependent on staff for bathing and personal hygiene.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident and staff interviews, record review and facility policy review, the facility failed to provide weekend activities for three (3) of eight (8) residents reviewed in the resident council meeting. Resident # 7, Resident #29, and Resident #40. Findings include: A record review of the facility policy titled Activities with a revised date of 11/28/2017 revealed, Policy: This facility shall provide ongoing activities in accordance with the interest, physical, mental, and psychosocial well-being of each resident During the resident council meeting held on 7/24/24 at 1:30 PM, with 8 residents in attendance, 3 residents revealed that they do not have activities on the weekend and stated there is really nothing for them to do. They stated they wished they had more things to do like they do during the week. Resident #7 During an interview in the resident council meeting, Resident #7, who is also the resident council president, revealed we don't have activities on the weekends. We have a preacher who comes in at 10 AM on Sundays and has Sunday School, but other than that, we really don't have anything to do. She revealed it would be nice to have something to do. Record review of Resident #7's admission Record revealed an admission date of 12/04/2020. Record review of Resident #7's Minimum Data Set (MDS) with an Assessment reference date (ARD) of [DATE], Section C, revealed a Brief Interview for Mental Status (BIMS) score of 15, which indicated Resident #7 is cognitively intact. Review of Section F Preferences for Customary Routine and Activities F0500 revealed While you are in this facility how important is it to you to do things with groups of people? And how important is it to you to do your favorite activities? revealed that Resident #7 considered this to be Somewhat Important. Resident #29 Resident #29 revealed in an interview, during the resident council meeting, We don't have activities on the weekend. There's really nothing to do. We understand the Activities Director must spend time with her family, but it would be nice to have something to do. Record review of Resident #29's admission Record revealed an admission date of 11/02/2018. Record review of Resident #29's MDS with an ARD of [DATE], Section C, revealed a BIMS score of 15, which indicated Resident #29 is cognitively intact. Review of Section F Preferences for Customary Routine and Activities F0500 revealed While you are in this facility how important is it to you to do things with groups of people? And how important is it to you to do your favorite activities? revealed that Resident #29 considered this to be Somewhat Important. Resident #40 Resident #40 revealed in an interview during the resident council meeting, We have coloring books and games that we can come in here and do by ourselves, but we don't have something to do as a group. She revealed that a lot of times, families come and visit on the weekends. Resident #40 stated,I guess that's why we don't have any activities. We just mainly stay in our rooms. Record review of Resident #40's admission Record revealed an admission date of 04/11/2022. Record review of Resident #40's MDS with an ARD of 06/24/24, Section C, revealed a BIMS score of 15, which indicated Resident #40 is cognitively intact. Review of Section F Preferences for Customary Routine and Activities F0500 revealed While you are in this facility how important is it to you to do things with groups of people? And how important is it to you to do your favorite activities? revealed that Resident #40 considered this to be Very Important. In an interview on 7/24/24 at 3:08 PM, the Activities Director revealed she is aware the weekend activities are lacking and confirmed the residents could benefit from organized activities. She revealed the residents have complained to her that there is nothing to do on the weekends, and she tried to come in at times and do activities with them, but it is not consistent. She revealed Resident #40 specifically voiced to her again recently that there is nothing to do on the weekends and has told her that it's boring on the weekends and the only thing they do is sit in their rooms. In an interview on 7/24/24 at 3:32 PM, the Director of Nurses (DON) revealed she was aware there had been complaints in the past from some residents wanting more activities on the weekend. She revealed she thought that the Activities Director was leaving stuff with the charge nurse at the desk for them to do on the weekends, but she admitted she was not sure. In an interview on 7/24/24 at 4:40 PM, the Administrator confirmed the weekend activities are lacking. She revealed that we recently added an extra nurse to help with weekend activities but confirmed that they had not fully implemented it yet.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Resident #16 An observation and interview on 06/05/23 at 11:05 AM, with Resident #16 revealed his nebulizer machine and mask were located on the bedside table with no storage bag placed over the nebulization mask. The resident revealed he used the nebulizer several times a day. An observation on 06/06/23 at 9:05 AM, revealed Resident #16's nebulizer mask lying on the bedside table with no storage bag over the mask. An observation on 06/07/23 at 9:30 AM, revealed Resident #16's nebulizer mask clipped onto the nebulizer machine located on the bedside table with no storage bag placed over the mask. An interview on 06/07/23 at 9:40 AM, with Licensed Practical Nurse (LPN) #2 confirmed that Resident #16's nebulizer mask was not placed in a storage bag. She revealed that not placing the mask in a storage bag could cause the mask to become contaminated with germs and could lead to respiratory issues. An interview on 06/07/23 at 9:55 AM, with the Infection Preventionist (IP) revealed that staff are supposed to keep the nebulizer mask bagged if not in use. She revealed that leaving Resident #16's mask out of the storage bag could cause bacteria to enter the mask and could cause respiratory infection. An interview with the Director of Nursing (DON) on 06/07/23 at 10:10 AM, acknowledged that Resident #16's nebulizer mask should not be left out in the environment and doing so could lead to respiratory infection. She stated that the facility has IP's (in pouches) that the mask should be stored in between usage. Record review of the medical record revealed Resident #16 was re-admitted to the facility on [DATE] with diagnoses that included Personal history of COVID-19, Centrilobular Emphysema, Anxiety Disorder, and Shortness of Breath. Record Review of Resident #16's Physician Orders List revealed an order dated 01/12/23, DUO-NEB 0.5-2.5MG(milligrams)/3ML(milliliter) neb (nebulizer) give 3ML inhalation via nebulizer QID (four times a day); Emphysema Record review of the MDS with an ARD of 04/04/23 revealed under section C a Brief Interview for Mental Status (BIMS) score of 13, which indicates Resident #16 is cognitively intact. Based on observations, staff interviews, record review and facility policy review the facility failed to prevent the possible spread of infection during medication pass for two (2) of 35 medication administrations observed (Resident #18 and Resident #21) and by not storing a nebulizer mask properly when not in use for one (1) of five (5) residents reviewed for respiratory care (Resident #16). Findings Include: Review of the facility policy titled, Infection Prevention and Control with a revision date of 5/12/23 revealed, Policy .This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections as per accepted national standards and guidelines. Review of the typed statement on facility letterhead revealed the facility did not have a policy on utilizing a barrier when administering medications and was signed by the Administrator dated 6/7/23. Review of the typed statement on facility letterhead revealed the facility did not have a policy on nebulizer storage when not in use that was signed by the Administrator and dated 6/7/23. Resident #18 An observation on 6/7/23 at 9:18 AM with Resident #18 revealed Licensed Practical Nurse (LPN) #2 entered the resident's room to administer medications and eye drops to the resident and placed a bottle of eye drops on the resident's bedside table with no barrier and did not wipe down the table prior to placing the eye drops on the table. LPN #2 then administered the resident's other medications, followed by the eye drops. After administering the eye drops, LPN #2 returned the eye drop bottle to her medication cart and placed them back in the drawer of the medication cart. An interview on 6/7/23 at 9:30 AM, with LPN #2 confirmed that she should have put a barrier down to set the eye drops on instead of setting them directly on the resident's bedside table, because there was no way to know what could have been on that table. She stated that the barrier would have prevented the possible spread of infection. Record review of Resident #18's June 2023 Physician Orders revealed an order dated 12/27/18 for Artificial Tears one drop each eye twice per day for Dry Eyes. Record review of Resident #18's Face Sheet revealed the resident was admitted to the facility on [DATE] with medical diagnoses that included Dry Eye Syndrome. Record review of Resident #18's Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 5/16/23 revealed in Section C a Brief Interview for Mental Status (BIMS) of 15, which indicated the resident was cognitively intact. Resident #21 An observation on 6/7/23 at 8:57 AM, with Resident # 21 revealed that LPN #1 entered the resident's room, set the resident's ordered eye drop bottle on the overbed table with no barrier, administered the residents by mouth (PO) medications and then picked the eye drop bottle up off of the overbed table and administered the eye drops. LPN #1 then left the residents room and returned the eye drop bottle to the medication cart drawer. An interview on 6/7/23 at 9:15 AM, with LPN #1 confirmed she set Resident #21's eye drops on the overbed table with no barrier before administering and then returned them to the medication cart. She revealed that she should have used a barrier under the eye drops before setting them on the overbed table to prevent the possible spread of infection and she stated that she knew better. An interview on 6/7/23 at 9:50 AM, with the Infection Preventionist (IP) confirmed that the nurses should have placed a barrier down to place the eye drop bottle on instead of setting them directly on the resident's furniture. She stated that they are absolutely supposed to use a barrier and that the nurses are trained in using a barrier for infection control purposes when they are hired and during annual in-services. An interview on 6/7/23 at 2:10 PM, with the Director of Nurses (DON) confirmed that the nurses should not set an eye drop bottle down in the resident's room without using a barrier to prevent the spread of infection. Record review of Resident #21's Physician Orders List revealed an order dated 3/31/21 for Olopatadine HCL 0.1% eye drops, administer one drop in both eyes daily for Allergies. Record review of Resident #21's Face Sheet revealed the resident was admitted to the facility on [DATE] with medical diagnoses that included Unspecified Dementia, Unspecified Severity with behavioral disturbances and Allergic Rhinitis Unspecified. Record review of Resident # 21's MDS with an ARD of 5/30/23 revealed in Section C a BIMS of 11 which indicated the resident was moderately cognitively impaired. Record review of the facility in-services regarding infection control revealed the facility had an in-service on 7/22/22 and 2/16/23 that was attended by all nursing staff including LPN #1 and LPN #2.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview and record review the facility failed to correctly complete a Level I Pre-admission Screening (PAS) for a resident requiring a Level II Pre-admission Screening and Resident Review (PASRR) for major mental illness for one (1) of three (3) residents reviewed for no PASRR with diagnosis. Resident #42. Findings include: An interview and record review of Resident #42's admission paperwork and Level I Pre-admission Screening (PAS), on 12/28/21 at 10:00 AM, with the Social Worker (SW), confirmed Resident #42 was admitted to the facility on [DATE], with a diagnosis of Major Depressive Disorder. The SW confirmed Resident #42 had a physician's order for Seroquel 25 milligrams (mg), dated 6/1/21. The SW confirmed that she answered PAS questions incorrectly related to person has diagnosis of major mental illness, person has a recent history of a major mental illness, and person takes, or has a history of taking psychotropic medication, causing the PAS not to trigger for Resident #42 to have a Level II Pre-admission Screening and Resident Review (PASRR). SW confirmed it was important for a PAS to be completed correctly, to ensure Resident #42 received appropriate mental health services while in the nursing facility. An interview, on 12/28/21 at 02:35 PM, with the Administrator, confirmed the PAS submitted for Resident #42, on 6/7/21, had questions answered incorrectly. The Administrator confirmed the questions being answered incorrectly on the PAS, caused Resident #42 to not receive a Level II PASRR. The Administrator confirmed she was aware that Resident #42 had a diagnosis of Major Depressive Disorder and a physician's order for Seroquel 25mg, dated 6/1/21, in the admissions paperwork, when admitted to the nursing facility on 6/1/21. The Administrator confirmed it was important for Resident #42 to have received a Level II PASRR to ensure the facility provided appropriate mental health services while in the nursing facility. The Administrator stated the facility did not have a policy regarding completion of a PAS. Record review, of the PAS, for Resident #42, revealed it was submitted on 6/7/21. The PAS was answered, no, for person has diagnosis of major mental illness, person has a recent history of a major mental illness, and person takes, or has a history of taking psychotropic medication. Record review of the Face Sheet revealed Resident #42 was admitted to the facility on [DATE]. Record review of the Diagnosis/History revealed a diagnosis of Major Depressive Disorder dated 6/1/21. Record review the June 2021 Physician's Orders revealed an order dated 6/1/21 for Seroquel 25mg one (1) orally two times a day, Altered Mental Status. Review of the Minimum Data Set (MDS) Significant Change in Status Assessment, dated 12/17/21, noted Resident #42 had a Brief Interview for Mental Status (BIMS) score of 05, which indicated the resident had severe cognitive impairment.

Based on observation, interview, record review and facility policy review, the facility failed to provide a safe and clean environment for preparing and storage of food for two (2) of three (3) kitchen/nourishment room tours. Findings include: Review of facility policy, titled, Cleaning Instructions: Oven, dated 2017, revealed Policy: Ovens will be cleaned as needed and according to the cleaning schedule (at least once every two weeks). Spills and food particles will be removed after each use . Review of facility policy, titled, Cleaning Instructions: Ranges, dated 2017, revealed, Policy: The cook/chef on each shift is responsible for keeping for range as clean as possible during the preparation of the meal. The range will be cleaned after each use. Spills and food particles will be wiped up as the occur . Review of facility policy, titled, Cleaning Instructions: Fryers, dated 2017, revealed Policy: Fryers will be cleaned on a regular basis and cared for in such a way to maintain optimum production . Review of facility policy, titled, Food from Outside Sources, dated 2008, revealed, .Procedure: 5. Food brought in should be labeled with the individual's name and dated if it must be stored. An observation, on 12/28/21 at 2:00 PM, revealed there was a yellow and brown build up on a large steam table pan lid, a flat/thin silver sheet of metal, and two (2) cookie sheets, that were being used to cover the deep fryer. There were four (4) deep fryer baskets, sitting on top of the deep fryer covers, covered with yellow and brown build up. The stove top had black colored build up on the areas surrounding the eyes. There was black, crusty, build up on the pipes under each stove eye. The inside of the convection oven doors was covered with a dark brown build up that had run down on the ledge on the outside of the stove under the oven doors. The back wall of the convection oven was covered in a dark brown build up. There was a dark and thick, yellow and brown, build up on the silver panel located behind the stove. There were six (6) baking pans and five (5) pots covered with a dark brown and black build up on the outside. The baking pans had a dark brown build around the sides on the inside of the pans. An observation and interview, on 12/28/21 at 2:12 PM, with Dietary [NAME] #1, confirmed that there was grease build up on the stove top, that there was black crusty build on the pipes under the stove eyes, that there was a yellow and brown build up on the 4 deep fryer baskets, that there was a yellow and brown grease build up on the large steam table pan lid, a flat piece of silver metal, and two (2) cookie sheets, that were being used to cover the deep fryer, that there was a brown build up inside the doors of the convection oven, that there was a dark brown build up on the ledge of the convection oven on the outside under the doors, that there was a brown build up on the back wall inside of the convection oven, and that there was a yellow and dark brown build up on the silver panel located behind the stove. Dietary [NAME] #1 stated all of the appliance's should have been cleaned and were supposed to be cleaned every week. Dietary [NAME] #1 stated she did not know when the last time the deep fryer was used or cleaned. An observation and interview, on 12/28/21 at 02:20 PM, with Dietary Staff #2, confirmed the stove top, the deep fryer covers, and the 4 deep fryer pans had grease build up and had not been cleaned. Dietary Staff #2 revealed she did not know who was assigned to clean the stove and she did not know how long the fryer basket had been dirty. Dietary Staff #2 confirmed the baking pans and the pots had yellow and black build on the outside and the baking pans has dark brown build up on the inside. An interview, on 12/28/21 at 02:25 PM, with Dietary Staff #3, revealed the deep fryer had not been used in a very long time, and she could not give a specific time frame. Dietary Staff #3 stated there were plenty of cleaning supplies available to clean the kitchen appliances, but did not know who was supposed to be cleaning the fryer. An observation and interview, on 12/28/21 at 03:30 PM, with the Administrator, confirmed there was a brown and yellow grease build up on a large steam table pan lid, a flat piece of silver metal, and two (2) cookie sheets, that were being used to cover the deep fryer, that there were four (4) deep fryer baskets covered with yellow and brown build up, that the stove top had grease build on the areas surrounding the eyes, that there was black, crusty, build up on the pipes under each stove eye, that there was a thick, yellow and brown build up on the silver panel behind the stove, that the inside of the convection oven doors were covered with a dark brown build up that had run down on the ledge on the outside of the convection oven under the oven doors, that the back wall of the convection oven was covered in a dark brown build up, that there was a yellow and dark brown build up on the silver panel located behind the stove, and that the baking pans and pots were covered with a brown and black build up on the outside, that the baking pans had a dark brown build around the sides on the inside of the pans. The Administrator stated the grease build up on the stove top, on the stove pipes, and on the deep fryer could possibly cause a fire. The Administrator revealed she only had a copy, for one week, of the December 2021 kitchen cleaning schedule, that showed kitchen staff cleaning task assignments. The Administrator revealed that the December 2021 kitchen cleaning schedule did not have a date that indicated which week in December the cleaning took place. The Administrator confirmed there has been no in-services done on the cleaning of the kitchen. An observation, on 12/28/21 at 04:00 PM, revealed the resident nourishment refrigerator had an excessive amount of yellow and dark tan build up inside at the bottom of the refrigerator. The entire bottom of the inside of the refrigerator had yellow and tan spillage, that was dried and run out of the bottom under the door. There was also spillage down the lower part of the back wall inside of the refrigerator. Observation also revealed there were several outside food items and drinks in the resident nourishment refrigerator that were not labeled with a resident's name or dated, to show when they were placed in the resident nourishment refrigerator. Items observered included two (2 ) plastic containers with food, cold cut tray, two (2) zip lock bags and three (3 ) opened partially empty drink bottles in the nourishment refrigerator that were not labeled or dated. An observation and interview, on 12/28/21 at 04:05 PM, with Licensed Practical Nurse (LPN) #1, confirmed the resident nourishment refrigerator had an excessive amount of yellow and dark tan build in the bottom and the nourishment refrigerator should have been cleaned. LPN #1 stated the nourishment refrigerator was supposed to be cleaned by the night shift staff, but not sure how often the refrigerator was to be cleaned. LPN #1 stated the outside food, not being labeled and dated in the resident nourishment refrigerator, could cause a resident to have been given the wrong food or old food, and a resident could get sick. An observation and interview, on 12/28/21 at 04:14 PM, with Director of Nursing (DON), revealed the resident nourishment refrigerator at the nurses station had an excessive amount of yellow and dark tan build up, in the bottom of the refrigerator, on the inside, and there was several food items, two (2 ) plastic containers with food, cold cut tray, two (2) zip lock bags and three (3 ) opened partially empty drink bottles in the nourishment refrigerator that were not labeled or dated. The DON confirmed the resident nourishment refrigerator should have been cleaned. The DON confirmed the 11:00 PM to 7:00 AM shift's nursing staff were responsible for the nourishment refrigerator cleaning task. DON confirmed a resident could get sick if they were given the unlabeled food or drinks. A telephone interview, on 12/29/21 at 11:50 AM, with Dietary Staff #4, revealed she last cleaned the stove top and the convection oven, on Saturday, 12/18/21. Dietary Staff #4 stated it was not her job to clean the stove and oven and the Kitchen [NAME] was responsible for cleaning the stove. Record review of the December kitchen cleaning schedule title, Daily Cleaning Schedule Form, dated December 2021 revealed the schedule covered one week and did not indicate which week in December it represented. The cleaning schedule revealed the cleaning of the stove top and the convection oven were to be done weekly. There was no indication of how often the fryer was to be cleaned. The December kitchen cleaning schedule revealed Dietary Staff #4's initials, that indicated she was the last one to clean the stove top and the convection oven, on a Saturday, with no specific date noting which Saturday in December the cleaning took place. Record review of the cleaning schedule for the nourishment refrigerator titled, 11-7 Cleaning Schedule, dated 04/23/14 revealed the nourishment refrigerator was to be defrosted and cleaned every Thursday, and all Certified Nursing Assistants were to work together to complete the task.