**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a Significant Change Minimum Data Set (MDS - a federally mandated assessment instrument completed by facility staff) was completed and submitted when one resident (Resident #41) had a significant change in two or more care areas out of 16 sampled residents. The facility census was 62. There was no MDS policy provided by the facility. Review of Change in a Resident's Condition Policy, Revised May 2017, showed: - If a significant change in the residents physical or mental condition occurs, a comprehensive assessment of the residents condition will be conducted as required by current regulation as outlined in the MDS, RAI instruction manual. 1. Review of Resident #41's quarterly MDS dated [DATE] showed: - Brief Interview for Mental Status (BIMS) score of 15, indicating no cognitive impairment. - Diagnoses included: Heart failure, blood circulation problems to lower legs and feet, seizures, and confusion. - He/She required the assistance of two staff members to transfer, groom, and hygiene care. - He/She had a urinary catheter (a tube inserted into the bladder from outside of the body to drain urine), wounds to his/her feet with a skin infection and upper respiratory infection. Review of his/her admission MDS dated [DATE] showed: - He/She required the assistance of one staff member to groom, transfer, and get dressed. - He/She had a BIMS score of 15, indicating no cognitive deficit. - Diagnoses included: Heart failure, blood circulation problems to lower legs and feet, seizures, and confusion. Observation and record review on 5/30/23 at 8:05 A.M., showed: - The resident had declines in activities of daily living, transfers, mobility, infections, meals, and now required assistance of two staff for positioning and mobility; - One staff physical assist for grooming and meal tray set up, and assistance with meals and drinking at the table, since the last comprehensive assessment. - He/She started antibiotics on 5/24/23 for both an upper respiratory infection and wound infection on left foot. - Observed the resident in the dining room trying to use a fork to cut up his/her meat and was not able to, was unable to reach the juice on the breakfast tray and had a tremor in his hand. During an interview on 5/31/23 at 8:45 A.M., the resident said: - He/She needed more help with feeding him/her self. - He/She was not aware that he/she was on antibiotics, only that his/her feet hurt, and he/she had a cold. During an interview on 6/1/23 at 3:02 P.M., the MDS/Care Plan RN said: - A significant change MDS is completed on residents who have had a significant change in their activities of daily living. - He/She did not work full time in the facility, but was in the building once weekly. - He/She was informed about changes in residents conditions by staff emailing him/her. - He/She was dependent upon CNA documentation in the electronic medical record the week before the MDS is due to be completed. During an interview on 6/1/23 at 3:45 P.M., the Administrator said: - She would expect that all residents MDS assessments should be accurate and thorough, and updated as needed.

Review of Resident #41's most recent re-admission MDS on 4/3/23 showed: - One person stand by assist for grooming, transfers, and hygiene is now total assist. - Alert and Oriented with mild confusion. - Diagnoses: Heart failure, blood circulation problems to lower legs and feet, seizures, and confusion. - He/She has urinary catheter, wounds to feet with skin infection and upper respiratory infection. Observation and record review on 5/30/23 at 8:05 A.M., showed: - There was no new base line care plan done with in 48 hours after re-admission from the hospital to address the new care needs of the resident. - The older care plans had not been revised to address the new changes with the residents condition. - He/she started antibiotics on 5/24/23 for both an upper respiratory infection and wound infection on left foot. - This was not indicated in the care plan. - Observed the resident in the dining room trying to use a fork to cut up his/her meat and was not able to, was unable to reach the juice on the breakfast tray and had a tremor in his hand. Current care plan states the resident is independent. During an interview on 5/31/23 at 8:45 A.M., resident #41 said: - He/She needed more help with feeding him/her self. - He/She felt much weaker and loss of strength. - He/She did not feel well over the last few days. - He/She was not aware that he was on antibiotics, only that his/her feet hurt, and he/she had a cold. During an interview on 6/1/23 at 3:02 P.M., the MDS/Care Plan RN said: - Base line care plans are done by the admissions liaison. - Updates to care plans are done as needed for changes in the residents conditions. During an interview on 6/1/23 at 3:45 P.M., the Administrator said: - She would expect that all residents care plans should be accurate and thorough, and updated as needed. Based on observation, interviews and record review, the facility failed to ensure base line care plans were completed within 48 hours of admission for two residents (Resident #23 and Resident #41) out of sixteen sampled residents. The facility census was 62. There was no facility policy provided for base line care plans. Review of Resident #23 Prospective Payment Schedule 5 day Minimum Data Set (PPS MDS a federally mandated assessment tool completed by facility staff. ) showed: -Brief Interview of Mental Status (BIMS) of 13 which indicated minimal cognitive loss. -Limited assistance from staff for Activities of Daily Living (ADL's: the tasks of everyday life. Basic ADL's include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet.) -Occasional incontinence of bladder -Frequent incontinence of bowel -Used a walker and wheelchair -History of recent falls. -Diagnoses of need for assistance with personal care, moderate protein calorie malnutrition (the state of inadequate intake of food) , hypertension, atrial fibrillation (an irregular and often rapid heart rhythm that can lead to blood clots in the heart)., chronic kidney disease and use of anticoagulants (medications used to prevent the clotting of blood). Review of the resident's medical record showed: -Initial admission date of 2/28/23 -readmission after hospitalization due to confusion on 4/21/23. -Individual care plan dated 4/21/23 showed he/she was at risk for falls. Assist the resident with ambulation and transfers, notify the provider of any falls, and evaluate fall risk on admission and as needed -No baseline care plan for assistance with ADL's, use of walker, diagnosis or use of anticoagulant medication. - There was no baseline care plan completed within 48 hours of the resident's admission to the facility. Observation and interview on 5/31/23 at 4:15 P.M. showed the resident had several days growth of beard. The resident said he/she didn't like it , but that was how it was. He/She thought he/she needed help with shaving. Observation and interview on on 6/01/23 at 9:44 A.M. showed the residents eyes were matted, clothes soiled with food debris, and the resident had several days growth of beard on his/her face. The resident said he/she did not have a good night and was up to the toilet several times. During an interview on 6/01/23 at 9:53 A.M. Certified Nurse Aide A said: Care needs should be in the care plan. He/She did not know if Resident #23 had a care plan.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #12's quarterly MDS, dated [DATE]., showed: - Diagnoses: Non-surgical dislocation of right humerus bone, insulin dependent diabetic, depression, anxiety, high blood pressure. - BIMS of 12 (Brief Interview for Mental Status) indicates cognition is impaired. Review of Resident #12's Care Plan, dated 8/19/22., showed: - There were no care plans to address individualized activities for the resident. - There were no psychosocial care plans to address my goals and strengths, wishes or needs. Review of the medical record on 5/31/23., showed: - No activity assessment. - No updated activity note for the month. - Resident at risk for falls. Observation of Resident #12 on 5/31/23 at 2:10 P.M. showed: - Resident sleeping in his/her wheelchair with head tilted forward, no television of lights on in room. During an interview on 6/1/23 at 10:20 A.M., Resident #12 said: - He/She use to receive an activities calendar monthly, but have not in a long time. - He/She enjoys playing the card game UNO, but has not played in a long time. - He/She has pain in right arm which makes going to activities difficult. - He/She lost son recently and struggles with depression, and feelings of loneliness. 3. Review of Resident #27's most recent comphrensive change in condition MDS, dated on 4/21/23 showed: - Diagnoses: Muscular Dystrophy (degenerative muscle weakness, and loss of muscle mass), Contracture of the right and left hands ( the folding of the fingers and wrist into the palm of the hand). - Resident had urinary catheter marked on MDS for neurogenic bladder (the inability for the brain to let the bladder know if is time to urinate). Review of Resident#27's most current care plan, dated 3/28/23., showed: - He/She used an electric scooter for mobility, - He/She had a Foley catheter to manage neurogenic bladder. Review of Resident #27's most recent physician orders and nursing progress notes for the month of May, 2023., showed: - New physician order to discontinue the urinary catheter on 5/8/23. - New re-occuring urinary tract infection on 5/23/23 indicated and was the reasoning behind the removal of the urinary catheter. - Nursing documentation 5/25/23 supporting that resident had an overall decline in daily activities as a result of re-occuring infections. Decreased energy, fatigue, decline in activity level. Observation of the resident on 5/31/23 at 11:25 A.M., showed: - The resident sitting in a manual wheelchair. - The resident without a urinary catheter or drainage bag. During an interview on 6/1/23 at 1:22 P.M., the resident said: - He/She had not had an electric scooter in a long time. - He/She did not have a urinary catheter any longer because of frequent infections. - He/She used to be more mobile around the facility when he/she had the scooter. 4. Review of Resident #41's most recent re-admission MDS on 4/3/23., showed: - One person stand by assist for grooming, transfers, and hygiene. - Alert and Oriented with mild confusion. - Diagnoses: Heart failure, blood circulation problems to lower legs and feet, seizures, and confusion. - New medication- anticoagulant for heart failure. Review of Resident #41's care plan dated 4/3/23., showed: - No care plan to address new anticoagulant medication needs for the resident. During an interview on 6/1/23 at 10:45 A.M., the resident said: - He/She was not aware he/she was taking a medication called Eliquis for risk of blood clots. 5. During an interview on 6/1/23 at 3:02 P.M., the MDS/Care Plan RN said: - He/She said all care plans were updated as resident's care or needs change. - Care plans were updated with MDS updates. 6. During an interview on 6/1/23 at 3:45 P.M., the Administrator said: - She would expect that all residents care plans should be accurate and thorough, and updated as needed. Based on observation, interview, and record review, the facility failed to ensure they developed a comprehensive person-centered plan of care consistent with measurable objectives and timeframe to meet the residents medical, nursing, mental, and psychosocial needs for four (Resident #12,#23,#27, and #41) of 16 sampled residents. The facility census was 62. Review of the facility's Care Plan Policy, dated September 2022., showed: - 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 time frames to meet a resident's medical, nursing, and mental as well as psychosocial needs that are identified in the resident's comprehensive assessment. 1. Review of Resident #23 Prospective Payment Schedule 5 day Minimum Data Set (PPS MDS a federally mandated assessment tool completed by facility staff. ) showed: -Brief Interview of Mental Status (BIMS) of 13 which indicates minimal cognitive loss. -Limited assistance from staff for Activities of Daily Living (ADL's: the tasks of everyday life. Basic ADL's include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet.) -Occasional incontinence of bladder -Frequent incontinence of bowel -Used a walker and wheelchair -History of recent falls. -Diagnoses of need for assistance with personal care, moderate protein calorie malnutrition (the state of inadequate intake of food) , hypertension, atrial fibrillation (an irregular and often very rapid heart rhythm that can lead to blood clots in the heart). , chronic kidney disease and use of anticoagulants (medications used to prevent the clotting of blood). Review of the resident's medical record showed: -Initial admission date of 2/28/23 -readmission after hospitalization due to confusion on 4/21/23. -Individual care plan dated 4/21/23 showed he/she was at risk for falls. The resident required assistance with ambulation and transfers. -No baseline care plan for assistance with ADL's, use of walker, or use of anticoagulant medication. -No comprehensive care plan. Observation and interview on 5/31/23 at 4:15 P.M. showed the resident had several days growth of beard. The resident said he/she didn't like it , but that was how it was. He/She thought he/she needed help with shaving. He/she wanted something to do, there was nothing to do. Observation and interview on on 6/01/23 at 9:44 A.M. showed the residents eyes were matted, clothes soiled with food debris, and the resident had several days growth of beard on his/her face. During an interview on 6/01/23 at 9:53 A.M. Certified Nurse Aide A said: Care needs should be in the care plan. He/She did not know if resident #23 had a care plan.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, the facility failed to provide reliable pharmaceutical services to establish and maintain a system to ensure medications were available for the licensed and certified nursing staff to provide to the residents and according to the physician orders. This affected four Residents ( #4, #13, #18, #210) out of the 16 sampled residents. This additionally placed other residents at risk of not receiving medications as ordered. The facility census was 62. There was no medication or pharmacy policy provided. 1. Review of Resident #4's quarterly MDS (Minimum Data Set), a federally mandated assessment, completed by facility staff, dated 3/11/23., showed: - BIMS ( Brief Interview of Metal Status) score of 15, cognitively intact; - Diagnoses: Heart failure, insulin dependent diabetic, high blood pressure, irregular heart beat. Review of Resident #4's physician orders for June 1,2023 showed: - Ferrous Sulfate 325 mg, one tablet to be given by mouth with meals 8 A.M., 12 P.M., 6 P.M. for diagnosis of anemia (low iron in the blood). Observation on June 1, 2023 at 9:02 A.M., showed CMT A: - Did not have Ferrous Sulfate 325 mg of the stock supply to give to the resident; - Requested someone help obtain some over the counter medications. A member of the activities staff was sent to local drug store to obtain the Ferrous Sulfate 325 mg over the counter medication. Observation on June 1, 2023 at 10:11 A.M., showed that CMT A: - Obtained the Ferrous Sulfate 325 mg medication from the activities person; - Administered the Ferrous Sulfate 325 mg as ordered to Resident #4 two hours later. 2. Review of Resident #13's quarterly MDS, dated [DATE]., showed: - BIMS score of 7, indicating moderate cognitive impairment. -Diagnoses: Dementia, stroke with impaired ability to swallow, depression. Review of Resident #13's physician orders for June 1, 2023 showed: -Vitamin D 1000 iu, by mouth daily at 8 A.M., for osteoporosis (degenerative bone and joint disease) Observation on June 1, 2023 at 9:32 A.M., showed that CMT A: - Did not have stock supply of the Vitamin D, 1000 international units (IU) available to give the resident or a bubble pack card from the pharmacy. - Did not provide the Vitamin D medication to resident #13 - He/She wrote down the Vitamin D medication that needed to be ordered for replenish of the facility stock if unable to obtain from the resident's pharmacy. 3. Review of Resident #18's quarterly MDS, dated [DATE]., showed: - BIMS score of 15, Cognitively intact; - Diagnoses: Anemia, arthritis, seasonal allergies. Review of Resident #18's physician orders for June 1, 2023 showed: - Ferrous Sulfate 325 mg, one tablet to be given with meals for diagnosis of anemia; 8 A.M., 12 P.M., 6 P.M. - Zaditor eye drops 0.25%, one drop to each eye twice daily (for allergy eyes, redness, and itching) at 8 A.M., and 8 P.M. Observation on June 1, 2023 at 9:42 A.M., showed CMT A: - He/She did not have Ferrous Sulfate 325 mg of the stock supply to provide to the resident; - He/She did not have Zaditor eye drops 0.25% available to provide the resident for allergy eyes. - He/She requested to LPN A for someone help obtain some over the counter medications. A member of the activities staff was sent to the local drug store to obtain the Ferrous Sulfate 325 mg over the counter medication and the Zaditor eye drops. Observation on June 1, 2023 at 10:21 A.M., showed CMT A: - Obtained the Ferrous Sulfate 325 mg medication from the activities person; - Administered the Ferrous Sulfate 325 mg and the Zaditor eye drop as ordered to Resident #18 two hours later. 4. Review of Resident #210's Quarterly Assessment on 4/15/23., showed: - BIMS score of 7, indicating moderately impaired cognition; - Diagnosis: Dementia, diabetes, high blood pressure. - Review of Resident # 210's physician order for June 1, 2023 showed: -Amoxicillin 187/125 mg, 1 tablet by mouth twice a day for 10 days for upper respiratory infection 8 A.M. and 8 P.M. -Amlodipine 10 mg, 1 tablet by mouth daily for high blood pressure at 8 A.M. Observation on June 1, 2023 at 10:28 A.M., showed that CMT A: - Did not have the Amoxicillin antibiotic or the Amlodipine medication available for the resident through the established resident pharmacy. - He/She asked the Assistant Director of Nursing to pull these medications from the emergency supply medication cart in order for the resident to receive the medications. - Medication Technicians had been pulling these two medications from the emergency supply for greater than five days. Observation on June 1, 2023 at 10:31 A.M., showed that CMT A: - Obtained the medications from the Assistant Director of Nursing and given two hours late to the resident. During an interview on June 1, 2023 at 10:35 A.M., CMT A said: - He/She did not always have the medications needed during the scheduled medication pass times. - Often he/she had to ask the licensed staff to pull medications from the emergency medication stock supply. - He/She will indicate the number 9 in the medication administration record when medication is not available to give the residents. - Shortage of medications and the delay in receiving medications from local pharmacies had been an increasing problem over the last several months. -He/She was aware that looking for available medications delay's the delivery of the medication to the resident. - He/She believed there was a plan in place for different pharmacy to take over the medication medication delivery due to delay's from the local pharmacies. 5. During an interview on June 1, 2023 at 11:05 A.M., the Director of Nursing said: - She was aware of the delay in receiving medications from local pharmacies. 6. During an interview on June 1, 2023 at 2:45 P.M., the Administrator said: - She was aware of the new pharmacy services starting soon; - Residents were still able to use the pharmacy of their choice; - She was aware that there had been some delays with receiving medications at times. - It is her expectation that the residents have their medications available and on time.

Based on observation, record review and interview, the facility failed to prepare and serve food in accordance with professional standards for food service safety when staff failed to label and date food when it was received, opened for use with the year, did not wash hands before serving food, failed to record food cooking temperatures, failed to document food temperatures before meal service, and only had one inch of water in sanitizer container. The facility census was 54. Review of the facility policy, food preparation and service, revised 7/14, included -The 'danger zone' for food temperatures is 41 degrees -135 degrees Fahrenheit (F). This temperature range promotes the rapid growth of pathogenic microorganisms that cause food borne illness. -Thermometers will be placed in hot and cold storage areas and checked for accuracy in accordance with accepted health standards -The temperature of foods held in steam tables will be monitored by food service staff -The following internal cooking temperatures/times for specific foods must be reached to kill or sufficiently inactivate pathogenic micro-organisms: a.) Poultry and stuffed foods - 165 degrees F b.) Ground meat, ground fish and eggs held for service - at least 115 degrees F c.) Fish and other meats - 145 degrees F d.) Fresh, frozen or canned fruits/vegetables - 135 degrees F e.) Unpasteurized eggs - until all parts of the egg (yolks and whites are completely firm (160 degrees F) f.) Foods cooked in a microwave - 165 degrees F in all parts of the food. It is critical to measure the food temperature at multiple sites and allow the food to stand covered for two (2) minutes after microwave reheating. -Previously cooked food must be reheated to an internal temperature of 165 degrees F for at least 15 seconds. Reheated foods that are not consumed within 2 hours will be discarded. -Food service staff, including nursing services personnel, will wash their hands before serving food to residents. Employees also will wash their hands after collecting soiled plates and food waste prior to handling food trays. -Bare hand contact with food is prohibited. Gloves must be worn when handling food directly. However gloves can also become contaminated and/or soiled and must be changed between tasks. Disposable gloves are single-use items and shall be discarded after each use. -Dietary staff shall keep fingernails trimmed and clean. Jewelry shall be worn minimally, and hand jewelry (i.e. wedding rings) shall be covered with gloves Review of facility policy, sanitization, dated 10/08, included -Between uses, cloths and towels used to wipe kitchen surfaces will be soaked in containers filled with approved sanitizing solution. Sanitizing solution will be changed at least once per shift or if solution becomes cloudy or visibly dirty Review of facility policy, food receiving and storage, dated 7/14, included: -All foods stored in the refrigerator of freezer will be covered, labeled, and dated 'use by' date. -Beverages must be dated when opened and discarded after twenty-four (24) hours. Review of facility policy, preventing food borne illness-food handling, dated 7/14, included: -This facility recognizes that the critical factors implicated in food borne illness are: a. poor personal hygiene of food service employees b. Inadequate cooking and improper holding temperatures; c. Contaminated equipment; and d. Unsafe food sources -Potentially hazardous foods will be cooked to the appropriate internal temperatures and held at those temperatures for the appropriate length of time to destroy pathogenic microorganisms. -Potentially hazardous foods held in the 'danger zone' (41 degrees F to 135 degrees F) for more than 4 hours (if being prepared from ingredients at room temperature) or 6 hours (if cooked and then cooled) will be discarded. Dry Storage showed: -Undated receipt date of items on top shelf included hash browns, rice pilaf, scalloped potatoes, and mashed potatoes. Freezer storage showed: -Undated and unopened with no receipt date of 3 frozen broccoli bags. -Undated and unopened with no receipt date of 3 frozen imperial vegetables. Walk in cooler showed: - Undated opened 1 gallon of red hot sauce almost gone. - Undated opened 8 lb mild salsa. - 2 packages undated browned red cabbage slices. - Undated and opened 24 oz Hershey chocolate syrup. - Undated and opened 22 oz Strawberry syrup. - Undated leftover cherry cobbler covered in plastic cling wrap. - Tray of leftover desserts in serving bowls on tray dated 5/24 included banana pudding and five cakes. - Undated and opened gallon of milk. Record review of food temperature logs showed: -5/7/23 no evening meal temperatures recorded, only one temperature documented for each item served at breakfast and noon meal. -5/8/23 no evening meal temperatures recorded. -5/9/23 no evening meal temperatures recorded. -5/10/23 no evening meal temperatures recorded. -5/11/23 no evening meal temperatures recorded. -5/12/23 no evening meal temperatures recorded, only one temperature documented for each item served at breakfast and noon meal. -5/13/23 no evening meal temperatures recorded. -5/14/23 no noon and evening meal temperatures recorded. -5/16/23 no evening meal temperatures recorded, only one temperature documented for each item served at breakfast and noon meal. -5/17/23 no evening meal temperatures recorded. -5/18/23 no evening meal temperatures recorded. -5/19/23 no evening meal temperatures recorded. -5/20/23 only one temperature documented for each food item at breakfast, noon, and evening meal. -5/21/23 only one temperature documented for each food item at breakfast, noon, and evening meal. -5/22/23 no evening meal temperatures recorded. -5/23/23 no evening meal temperatures recorded. -5/24/23 no noon and evening meal temperatures recorded. -5/25/23 no evening meal temperatures recorded. -5/26/23 no evening meal temperatures recorded, only one temperature documented for each item served at breakfast and noon meal. -5/27/23 no evening meal temperatures recorded. -5/28/23 no evening meal temperatures recorded. -5/30/23 no evening meal temperatures recorded, only one temperature documented for each item served at breakfast and noon meal. During an interview on 5/30/23 at 10:48 A.M., Dietary Manager said: -He/She expected staff to date food items. -Staff were supposed to date items when they arrive to the facility. During an interview and observation in the kitchen on 5/31/23 at 4:08 P.M., showed: - Cold food items included lettuce salad and dessert was not temperature checked by the facility staff before the food service. - Food observed on the steam table with no food temperatures recorded on food temperature log. - 4:21 P.M., Dietary Aide A (DA) A exited the kitchen and re-entered the kitchen. DA A did not wash his/her hands placed meal cards on room trays. - 4:29 P.M., DA A entered the kitchen he/she did not wash his/her hands, and did not have on gloves. DA A grabbed a plate of uncovered corn bread and left the kitchen to take the cornbread to the resident care unit. - 4:30 P.M. [NAME] A did not wash hands before serving food. -4:33 P.M., DA A entered the kitchen and did not wash his/her hands. -4:35 P.M., [NAME] A left the kitchen to take food cart to hallway he/she re-entered the kitchen. He/She did not wash his/her hands. -4:36 P.M., Dietary Manager entered the kitchen, did not wash his/her hands, grabbed a plate from the stack below the steam table. -4:36 P.M., DA A entered the kitchen did not wash his/her hands, DA B entered kitchen and used hand sanitizer. -4:38 P.M. [NAME] A used the rag from the sanitizer solution container to wipe down cook prep tables by staff. The sanitizer solution had only 1 inch of water and three rags sitting in container. [NAME] A put away recipe book, did not wash hands and began meal service by plating meals. [NAME] A said he/she thought the sanitizer solution needed to be remade as it was almost out of water. The sanitizer solution was not remade. - Cold food items were not temperature checked before food the service. -5:05 P.M., DA A entered the kitchen, he/she did not wash his/her hands. He/she obtained vinegar for residents from the container and took the vinegar to the dining room. DA A returned to the kitchen and used hand sanitizer. -5:15 P.M. DA C entered kitchen he/she did not wash his/her hands. He/She applied gloves and got a sandwich out of the cooler. Spice rack showed: -Expired cumin dated 5/15/22 on the shelf. -Undated year of paprika dated 12/1. -Undated year of celery seed dated 5/28. -Undated year of chopped Italian seasoning dated 5/28. -Undated year cinnamon dated 4/29. -Undated year onion powder dated 5/30. -Undated year garlic powder dated 5/12. -Undated year dark chili dated 5/21. -Undated year old fashioned oats dated 5/31. -Undated and opened ground ginger. -Expired sesame seed dated 5/25/22. -Undated year celery seed dated 12/10. -Expired sage dated 5/30/22. -Undated year poultry seasoning dated 11/15. -Undated year lemon pepper dated 2/21. -Undated year red pepper dated 5/30. -Undated year ground ginger dated 11/30. -Undated year cayenne pepper dated 9/3. -Expired ground cayenne pepper dated 5/25/22. During an interview on 6/1/23 at 10:44 A.M., [NAME] B said: -Food should be temperature checked whenever it is cooked. -Food should be temperature checked before service and when it is put on steam table. -Food items should be dated for the day it is delivered including the year. -Leftovers should be thrown out within three days. During an interview on 6/1/23 at 2:44 P.M., the Dietary Manager said: -Food items should be dated when they are put up for storage. -Cans should be dated when they arrive to the facility. -His/Her expectation is for staff to date food items. -Leftovers should be thrown out in four days. -Food should be labeled including the year. -Food temperatures should be taken at beginning of food service and end of food service, both temperatures are recorded on the temperature log. -Food should be temperature checked when it is cooked to ensure proper cooking temperature has been reached, those temperatures are not recorded anywhere. -Hands should be washed as the staff enter the kitchen, after food preparation, after removing gloves, or go to the restroom. -Staff should wash their hands at the beginning of the meal service. -Every time staff go in and out of kitchen they have to use alcohol based hand sanitizer when they are serving plates and when serving snacks. -The sani-bucket should be changed twice a day and should be approximately half-way full of water. During an interview on 6/1/23 at 3:20 P.M., Administrator said: -Kitchen was supposed to follow the facility policies for hand hygiene which included washing hands at start of meal service and when the staff enter the kitchen. -Food temperatures should be completed according to the policy when starting meal service. -Temperatures should be documented at meal service. -Food should be dated when it is received and put away. -Leftovers should be dated and thrown out after four days. -Foods should be dated when they are opened.

Based on record review and interviews, the facility failed to provide a quarterly statement that included all transactions to the resident, resident representative, and/or conservator on a quarterly basis for three sampled residents (Residents #6, #34, and #108). The facility had seven interest bearing accounts and 18 petty cash accounts. The facility census was 54. Review of an undated facility policy titled Resident Trust Fund Account Policy and Procedure showed the following: - It is the policy of the facility to manage personal funds of the residents, upon request and written authorization of the resident or legal representative. Funds will be managed in accordance with Federal and State Regulations; - The facility will provide individual financial records in the form of quarterly statements. Copies of the quarterly statements will be maintained in the management office in the Resident Trust Fund notebook with two copies sent to the resident's legal representative. - The quarterly statements will reflect each deposit, withdrawal and interest allocation and the beginning and ending balance for the quarter. 1. Review of Resident #6's quarterly statement for the resident interest bearing account, dated 7/1/20, showed the following: - Quarter statement date- 4/1/20; Quarter End date 6/30/20; - The beginning balance- $0.00; - Total deposits this quarter- $3326.00; - Interest earned- $0.02; - Total withdrawals this quarter- $3226.00; - Ending balance- $100.02; - The quarterly statement did not show each transaction during the quarter. 2. Review of Resident #34's quarterly statement for the resident interest bearing account dated 7/1/20, showed the following: - Quarter statement date- 4/1/20; Quarter End date 6/30/20; - The beginning balance- $599.87; - Total deposits this quarter- $54.06; - Interest earned- $0.18; - Total withdrawals this quarter- $36.54; - Ending balance- $617.57; - The quarterly statement did not show each transaction during the quarter. 3. Review of Resident #108's quarterly statement for the resident interest bearing account dated 7/1/20, showed the following: - Quarter statement date- 4/1/20; Quarter End ate 6/30/20; - The beginning balance- $616.51; - Total deposits this quarter- $150.00; - Interest earned- $0.18; - Total withdrawals this quarter- $64.62; - Ending balance- $702.07; - The quarterly statement did not show each transaction during the quarter. 4. During an interview on 9/17/20, at 2:45 P.M., the Business Office Manager said the quarterly statements only showed the total amount of the transactions for the quarter. She had completed the quarterly statements this way for the last 10 years.