Licensure Reference Number 175 NAC 12-006.11(E) Based on an observation and an interview, the facility failed to store food in a manner to prevent the potential for food born illness. This had the potential to affect all residents who ate out of the kitchen. The facility census was 18. Findings are: An observation on 4/28/25 at 10:17 AM revealed in the stand up refrigerator: - a metal silver bowl with macaroni salad was not labeled or dated, - a metal silver bowl of cut up muskmelons was not labeled or dated. An observation on 4/28/25 at 10:30 AM revealed in the stand up freezer: -a zip lock bag of corn dogs with no opened date on it and ice crystals observed on the corn dogs, -a bag of opened fish sticks with no opened date on them, - a gallon tub of vanilla Ice cream that was opened with no date on it. A review of the Food and Nutrient Services Policy and Procedure Food Safety: Topic Refrigerated Storage Dated: February 2009, Revised August 2017 -All refrigerated items are stored in the original container/packaging or in a container that is fully covered or sealed so as to maintain freshness and quality and prevent cross-contamination -All items are labeled with the common name of the item and dated with the month, day and year when opened or prepared. An interview on 4/28/25 at 11:00 AM with the Dietary Supervisor confirmed that the items listed above had no name (not labeled) or was not dated when opened or prepared and should have been dated and/or labeled.

Based on record review and interview, the facility failed to ensure the Infection Preventionist had the required qualifications prior to assuming the role. This had the potential to affect all residents in the facility. The facility census was 19. Findings are: During an interview on 04/08/2024 at 10:13 AM, the Administrator (ADM) revealed that Registered Nurse (RN) A was the facility's Infection Preventionist (IP-a professional who makes sure the facility's staff and residents are doing all the things they should to prevent the spread of infections). The ADM further revealed that RN A had not completed the Centers for Disease Control (CDC) Nursing Home Infection Preventionist Training Course. The ADM also revealed that the previous IP had left at the end of March 2024, and RN A had assumed the role on 04/01/2024. The ADM provided copies of Certificate of Training CDC Train for RN A for a total of six modules completed: -Module 1-Infection Prevention and Control Program dated 03/28/2024. -Module 2-The Infection Preventionistdated 03/28/2024. -Module 3-Integrating Infection Prevention and Control into the Quality Assurance Performance improvement Program dated 04/02/2024. -Module 4-Infection Surveillance dated 04/02/2024. -Module 5-Outbreaks dated 04/02/2024. -Module 13 -Occupational Health Considerations for the Infection Prevention and Control Program dated 03/28/2024. A review of the CDC website https://www.cdc.gov/longtermcare/training.html revealed the Nursing Home Infection Preventionist Training course consisted of 23 modules and sub-modules. During an interview on 04/11/2024 at 2:20 PM, the DON confirmed confirmed RN A had been working on the Infection Prevention modules through the CDC but was not done.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** LICENSURE REFERENCE NUMBER 175 NAC 12-006.11E Based on observation, record review, and interview: the facility kitchen staff failed to ensure outdated foods were not available for use. This had the potential to affect all residents in the facility. The facility staff identified a census of 19. Findings are: Observation on 4-17-23 at 9:30 AM with the morning [NAME] A revealed the following outdated food items: -Cornstarch expiration dates was 5/22. -Creamy rice cereal expiration dates was 6/21. -3 large bag potato chips expiration dates was 2/23. -Champions pizza sauce expiration dates was 11/22. -Baby kidney beans expiration dates was 1/23. -Krispy onions expiration dates was 5/22. -Chili sauce expiration dates was 5/22. -[NAME] dressing expiration dates was 1/23. -Taco shells expiration dates was 9/22. On 4-17-23 at 9:30 AM interview an interview was conducted with [NAME] A. During the interview [NAME] A confirmed the food items were outdated and available for use.