Based on observation, interview, and record review, it was determined that the facility failed to properly label, store and dispose of medications in 2 of 9 medication carts inspected. This deficient practice was evidenced by the following: On 8/4/21 at 9:15 AM, the surveyor inspected the Heritage [NAME] medication cart #2 in the presence of a Licensed Practical Nurse (LPN#1). The surveyor observed an opened Novolog Insulin that did not contained a label with a resident's name. At that time, the surveyor interviewed LPN #1 who stated that the Novolog insulin pen should have contained a label with the resident's name. On 8/4/21 at 10:15 AM, the surveyor inspected the Heritage East medication cart #2 in the presence of LPN #2. The surveyor observed an opened vial of Humalog insulin that did not contained a label with a resident's name. At that time, the surveyor interviewed LPN #2 who stated that the Humalog insulin vial should have contained a label with the resident's name. On 8/4/21 at 1:15 PM, the surveyor met with the Administrator and the Director of Nursing (DON) and no further information was provided by the facility. A review of the facility's policy for Medication Labels dated 12/17/20 that was provided by the DON indicated the following: 1. Labels are permanently affixed to the outside of the prescription container. No mediation is accepted with the label inserted into a vial. If a label does not fit directly onto the product, e.g eye drops, the label may be affixed to an outside container or carton, but the resident's name must be maintained directly on the actual product container. and 2. Each prescription medication label includes: a). Resident's name. A review of the facility's policy for Medications from Home dated 9/7/20 that was provided by the DON indicated the following: b). Verify that the medication is in the original manufacturer/outside pharmacy packaging; and d). For home medications from an outside pharmacy, verify that the medication is properly labeled by an outside pharmacy as per current state/federal labeling regulations for prescription medication. NJAC: 8:39-29.4 (a) (h) (d)

Based on observation, interview and review of documentation provided by the facility, it was determined that the facility failed to maintain the kitchen environment and equipment in a sanitary manner in order to prevent contamination from foreign substances and potential for the development of a foodborne illness. This deficient practice was evidenced by the following: On 9/12/19 at 9:20 AM, in the presence on the Food Service Director (FSD) the surveyor observed the following: 1. The three-door refrigerator did not have a thermometer inside the refrigerator. 2. The over flow milk refrigerator did not have a thermometer inside the refrigerator. The FSD stated, the staff cleaned the refrigerators last night and did not put the thermometers back in. The FSD further stated that they go through many thermometers in this way. The surveyor reviewed the temperature logs for the above two refrigerators. The temperature log documented on 9/12/19 at 8:00 AM that the temperature of the cooks reach in refrigerator was 40 degrees and the kitchen milk refrigerator at 8:00 AM was 37 degrees. The surveyor asked the FSD how the staff documented the temperatures at 8:00 AM, if the thermometers were not inside the two refrigerators at that time. The FSD stated, They probably read the temperatures on the thermometers that were on the outside of the refrigerator. 3. A bottle of honey and a gallon of water were on a tray that had food crumbs on it. 4. Convection oven #1 had dried brown drippings on both glass doors and the four oven knobs had a buildup of a brown grease like substance. 5. Convection oven #2 had dried brown drippings on both glass doors and the four oven knobs had a buildup of a brown grease like substance. 6. Oven #1 had a buildup of a brown, black grease like drippings on the backsplash and the six oven knobs had a build-up of a brown grease like substance. 7. Oven #2 had six knobs that had a buildup of a brown grease like substance. 8. The knob of the steamer had a buildup of a brown grease like substance. The FSD told the surveyor that the outside of the ovens and steamer were cleaned daily. The surveyor reviewed the form titled, Dietary Department Daily Cleaning Assignments, that was posted on the window outside of the FSD's office door. There was no date written on the weekly form and no staff signatures next to the cleaning assignments from the past Monday through Thursday. The area for the Supervisor initials was left blank. The surveyor asked the FSD where the staff sign when they complete their cleaning assignments. The FSD stated, They don't sign anything. The FSD further stated that she or her supervisor double checks that the daily cleaning assignments are completed, however the FSD was unable to provide written documentation of the completion of the daily cleaning assignments done by the kitchen staff. A review of the facility's policy titled Food Storage indicated under Procedure #5, All refrigerators will have and internal thermometers to monitor for safe food storage temperatures. Units must maintain safe internal temperatures 32 degrees Fahrenheit to 41 degrees Fahrenheit. The surveyor requested the policy and procedure for sanitation of kitchen equipment from the FSD. The FSD gave the surveyor the facility's form titled Cleaning of Stovetop that indicated under #1: After each use the stovetop will be cleaned to ensure sanitary conditions. And under #2 and #3 indicated: After use, remove knobs and soak in soapy water and scrape excess loose soil from surface with a spatula or grill scraper. The FSD told the surveyor they did not have a policy and procedure for sanitation of kitchen equipment. On 9/12/19 at 1:30 PM, the surveyor discussed the above concerns with the Administrator and Director of Nursing. No further information was provided. NJAC 8:39-17.2(g)