Based on record review and interviews during the recertification survey, the facility did not ensure that residents and/or their designated representative were fully informed of their right to an expedited review of a service termination for 2 of 3 residents reviewed. Specifically, the facility did not ensure 2 (Residents #141 and #142) who received Medicare Part A services, received timely notification (2-day notification) of the termination of services with the required form Notice of Medicare Non-Coverage, Form CMS 10123-NOMNC. This is evidenced by: There was no documented evidence that residents #141 and #142 received 2-day notification prior to the termination of rehabilitative services. During an interview on 9/06/2024 at 11:34 AM, Fiscal Clerk #1 stated that they could not account as to why residents #141 and #142 did not receive a 2-day notification prior to the termination of Medicare services. During an interview on 9/06/2024 at 11:37 AM, Administrator #1 stated that the Fiscal Clerk would be re-educated on the 2-day notification. 10 New York Codes, Rules and Regulations 415.3 (g)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews conducted during the recertification survey, the facility did not ensure drugs and biologicals were labeled and stored in accordance with professional standards of practice. Specifically, opened medications had no open and/or expiration dates for 1 (2nd floor medication cart) of 2 medication carts reviewed. This is evidenced by: The facility's Medication Storage and Expiration of Medications policy revised on 6/2018 documented, once any medication or biological product was opened, follow manufacturer/supplier guidelines with respect to expiration dates for opened medications. Record the date opened on the medication container when the medication had a shortened expiration date once opened. Record calculated expiration date based on date opened on the medication container. The facility's Medication Administration Procedures policy dated 9/2024 documented to not give a medication if the label was unclear or illegible. During an observation on [DATE] at 12:10 PM, 2nd floor, Cart #1 contained 1 Troujeo Max Solostar insulin pen with no expiration date, 1 Basaglar Kwik Pen insulin pen, and 1 Aspart insulin pen both without open dates or expiration dates. At the time of observation, Licensed Practical Nurse #1 stated the insulin pens must have been new because the cart was checked the previous day. During an interview on [DATE] at 12:10 PM, Licensed Practical Nurse #1 stated that new insulin pens should have had a sticker on them with the date opened and the expiration date written on them. Licensed Practical Nurse #1 stated they would not use an unlabeled pen and go ask the unit manager what to do as they had just started working at the facility. Licensed Practical Nurse #1 stated that they knew not to use the unlabeled pen, but they were unclear how to procure a new one. During an interview on [DATE] at 9:08 AM, Registered Nurse #1 stated the policy regarding labeling and storage of insulin pens was that when pens are opened, they should be labeled with the date opened and the expiration date. Registered Nurse #1 stated that if a staff member were to remove an insulin pen and saw that it was not labeled, the expectation was they would not use the unlabeled pen and procure a new one and label it appropriately. During an interview on [DATE] at 9:15 AM, Director of Nursing #1 stated they spoke to nurses about labeling medications often. They stated if two Registered Nurses were on every evening, one nurse would be tasked to go through all the medication carts weekly and check for expired or mislabeled medications. Director of Nursing #1 stated that this was last done on [DATE]. Additionally, the Director of Nursing #1 stated nurses discuss expiration dates and labeling medications. 10 New York Codes, Rules, and Regulations 415.18(d)

Based on observation, record review, and staff interview during the recertification survey, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, the concentration of quaternary ammonium compound chemical sanitizing rinse (QAC) was less than that required by the manufacturer and equipment required cleaning. This is evidenced as follows. The kitchen was inspected on 10/21/2021 at 10:36 AM. The concentration of QAC used to sanitize food contact equipment was found to be 150 parts per million (ppm) when measured at 71 degrees Fahrenheit (F). The manufacturer's label directions stated the concentration is to be between 200 ppm and 400 ppm when the solution is measured between 65 F and 75 F. The refrigerator shelving and door gaskets in the 1st floor nourishment area were soiled with food particles. Record review of the education given to dietary employees revealed that it did not provide specifics on how to check the QAC concentration and to clean refrigerator door gaskets. The Food Service Director stated in an interview on 10/21/2020 at 11:06 AM, that staff will be educated to properly clean refrigerators and to ensure the QAC is at the correct concentration. The Administrator stated in an interview on 10/25/2021 at 2:48 PM, that the Food Service Director will ensure the QAC concentration and cleaning issues will be addressed and will be reviewed for compliance. 10 NYCRR 415.14(h); Chapter 1 State Sanitary Code Subpart 14-1.110, 14-1.112

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews during a recertification survey and an abbreviated survey (Case #NY00238270) the facility did not ensure the resident's physician was consulted when there was a significant change in the resident's physical, mental, or psychosocial status and when there was a need to alter treatment significantly (that is, a need to discontinue an existing form of treatment due to adverse consequences, or to commence a new form of treatment) for 1 (Resident #42) of 1 resident reviewed for infections. Specifically, for Resident #42, the facility did not ensure the physician was notified that the resident, with a recent history of Clostridium difficile (C-diff) (a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon), was having frequent episodes of loose stools and rectal irritation. This is evidenced by: Resident #42: The resident was admitted to the facility on [DATE], with the diagnoses of polyneuropathy, Parkinson's Disease, and past medical history of colon cancer (2000). The Minimum Data Set (MDS) dated [DATE], documented the resident was cognitively intact, was able to make self understood and could understand others. The Comprehensive Care Plan (CCP) titled At risk for skin breakdown due to decreased mobility, occasional oozing of bowel dated 3/6/19, documented interventions that included; treatments per MD (physician) orders, medications per MD orders, and to notify the MD of any changes. The CCP titled Resident at risk for decline in physical & medical status secondary to history of colon cancer, resident had occasional loose stools dated 3/6/19, documented to notify the MD of any changes, and medications per MD order. The nursing admission note dated 3/6/19, documented that the resident had a past medical history that included diarrhea, colorectal cancer, and a history of C-diff. MD order dated 3/6/19, documented the resident was to receive Diphenoxylate-Atropine (Lomotil, treats diarrhea) 2.5-0.025 mg and to give 1 tablet every 24 hours as needed for diarrhea (loose stools). MD order dated 5/4/19, documented the resident was to receive Loperamide (anti-diarrheal) 2 mg every 6 hours as needed for loose stools. The March 2019 bowel movement (BM) record that Certified Nurse Aide's (CNA's) used to document resident bowel movements included documentation the resident had loose/diarrhea BM's on seven occasions (3/15/19, 3/16/19, 3/18/19, 3/19/19, 3/21/19 and 2 times on 3/25/19). The Medication Administration Record (MAR) dated March 2019, documented the resident received Lomotil for loose stools on 2 occasions (3/16/19 and 3/25/19). The CNA BM record dated April 2019 documented the resident had 12 episodes of loose/diarrhea BM's (4/4/19, 4/12/19, 4/14/19, 4/15/19, 4/16/19, 4/20/19, 4/21/19, 4/22/19, 4/26/19, 4/28/19, 4/29/19, and 4/30/19). The MAR dated April 2019 documented the resident had received Lomotil for loose stools on 7 occasions (4/12/19 thru 4/15/19, 4/21/19, and 4/22/19). The CNA BM record dated May 2019 documented the resident had 9 episodes of loose/diarrhea BM (5/1/19, 5/3/19, 3 times on 5/4/19 and 2 times on 5/5/19). The MAR dated May 2019 documented the resident received Lomotil for loose stools on 2 (5/3/19 and 5/5/19). The resident received Loperamide on one occasion (5/4/19). A nursing progress note dated 5/3/19 at 10:07 PM, written by a Registered Nurse, documented the resident had loose stools 5 times that shift. The resident was complaining of rectal discomfort and had tiny openings around the rectum from irritation. Calmoseptine lotion was put on the area. Review of the Treatment Administration Record (TAR) dated 5/2019, did not include documentation for the treatment to or monitoring of the resident's rectal area. Review of the nursing progress notes from 3/6/19 thru 5/7/19, did not include documentation that the resident's MD was notified the resident was having loose stools. Review of the MD notes dated from 3/6/19 thru 5/7/19, did not include documentation that the MD was aware the resident was having loose stools. During an interview on 5/6/19 at 10:30 AM, Resident #42 stated that prior to coming to the nursing home, she was in the hospital and treated for C-diff. She stated her rectum was painful and sore due to the diarrhea she was having. The diarrhea started a few weeks after admission and had recently become much worse. She stated the nurses had not taken a sample of her stool for testing. During an interview on 5/08/19 at 11:28 AM, the MD stated he was not aware the resident had frequent episodes of diarrhea. He stated he should have been notified by the nurses and stated with the resident's recent history of C-diff, the resident should probably be tested for C-diff. During an interview on 5/08/19 at 11:31 AM the Registered Nurse Manager #3 stated that frequent loose stools had not been reported to her, She was not sure the resident was really having loose stools. She stated she saw one the other day that the resident said it was diarrhea and there was a small spot on the diaper. She stated the resident exaggerates and was told the nurses need to see the BMs. During an interview on 5/09/19 at 08:45 AM, LPN #4 stated on Saturday her husband came to the nursing station and asked for Imodium for loose stools. The resident reported loose stools and the nurses did not always see them. LPN did not know if the MD had been notified. She did not know about the open areas to the rectum. The LPN stated the MD should have been notified of the loose stools and the sore rectum. During an interview on 5/09/19 at 09:00 AM, CNA #1 stated the resident had frequent diarrhea BMs. The CNA stated sometimes there was so much diarrhea that it traveled up her back. The CNA's reported it to the nurses. The resident's rectum was very sore, but was better. During an interview on 5/09/19 at 12:45 PM, the Director of Nursing stated she was not aware the resident was having loose stools and had a history of C-diff. She stated the MD should have been notified. 10NYCRR 415.3(e)(2)(ii)(b)

Based on record review and interviews during a recertification survey, the facility did not ensure the residents and/or resident representatives were provided with specific notification when the facility determined that the residents no longer qualified for Medicare Part A services and Medicare benefit days remained for 3 of 3 residents reviewed for Beneficiary Protection Notification. Specifically, for Resident #'s 59, 293, and #294, the facility did not ensure the residents or resident representatives were informed of the beneficiary's potential liability for payment and related standard claim appeal rights using the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN), form CMS-10055. This is evidenced by: The facility was unable to provided documentation that the SNFABN was issued to the identified residents or the resident representatives. During an interview on 5/09/19 at 11:12 AM, Accounts Receivable #10 stated she was unable to find documentation that the SNFABN was issued for the identified residents. She stated she was not familiar with the SNFABN form and it had never been explained as to why the SNFABN had to be issued. During an interview on 5/09/19 at 12:57 PM, Accounts Receivable #11 stated her department would be responsible for issuing the notification, but the facility was not aware that the SNFABN was required. 10NYCRR 415.3 (g)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interviews during a recertification survey the facility did not ensure that it addressed the resident's goals of care and treatment preferences. If the resident indicates an interest in returning to the community, the facility must document any referrals to local contact agencies or other appropriate entities made for this purpose, and update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact agencies or other appropriate entities, for one (Resident #22) of two residents reviewed for discharge to the community. Specifically, for Resident #22, the facility did not ensure a referral was made to the appropriate entities when the resident stated she wanted to go home. This is evidenced by: Resident #22: The resident was admitted to the nursing home on 4/20/18, with diagnoses of muscle weakness, Urinary Tract Infection (UTI), lymphedema, glaucoma, hypertension (HTN), peripheral vascular disease (PVD). The Minimum Data Set (MDS) dated [DATE], assessed the resident as having intact cognitive skills for daily decision making. It documented that the resident understood and was understood by others. Progress notes for the following dates documented: 4/25/19 - The Social Worker (SW) documented the resident had a bad day and was weepy. The resident stated she would like to go home. The resident missed her husband and pets. Will offer additional support. 2/12/19 - The SW documented that the resident had been weepy again about wanting to go home. 1/24/19 - The nurse documented that the resident was weepy again about issues with her daughter and wanting to go home. 1/14/19 - the resident was weepy stating she wanted to go home. 1/09/19 - the resident was still insisting she wanted to go home. 1/07/19 - the SW documented the resident has been very weepy lately. The resident was crying because she wanted to go home. The resident was reminded that she could not take care of herself both physically and medically. Her husband was also unable to care for her. The resident continued to be weepy stating she just wants to go home. During an interview on 5/06/19 at 10:11 AM, the resident stated she gets depressed because she wants to go home. During an interview on 5/07/19 at 10:28 AM, Certified Nursing Assistant (CNA) #11 stated the resident got weepy and stated she wanted to go home at times. CNA #11 stated that when this happens she informs the nurse. During an interview on 5/07/19 at 12:29 PM, the Social Worker (SW) stated the resident had verbalized quite often that she wanted to go home. The SW stated that a referral to Open Doors (an agency that assists residents to return to the community) had not been made but should have been. 10NYCRR 415.11 (d)(3)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview conducted during a recertification survey, the facility did not ensure that residents in need of respiratory care, received such care consistent with professional standards for 2 residents (Residents #59 and Resident #70) of 2 residents reviewed. Specifically: For Resident #59 and 70, the facility did not ensure a physician's order and indication for use was obtained for the administration of oxygen. This is evidenced by: The Facility Policy and Procedure (P&P) titled Physicians Routine Standing Orders, dated 2/2018, documented a Procedure for Limited Use Respiratory Standing Order for; Oxygen (02) 2-3 Liters (L) as needed (PRN) vial nasal cannula (NC) up to 5L/minute (min) PRN via mask. The Facility Policy and Procedure (P&P) titled Oxygen by Concentrator, dated 12/2013, documented a general instruction to adjust liter flow as ordered by the physician. Resident #59: The resident was admitted to the facility on [DATE], with a diagnosis of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and Lewy body dementia (LBD). The Minimum Data Set (MDS) dated [DATE] documented the resident's cognition was severely impaired. The resident usually understands others and usually make self understood. A physicians standing order dated 12/18/18, documented 02 at 2-3L/min PRN via nasal cannula (NC) up to 5L/min via mask every shift to maintain 02 Saturation (sats) Observations of Oxygen flow rates; 05/06/19 at 10:41 AM - 1.0 liter via NC, 05/06/19 at 11:59 AM - 1.5 liters via NC, 05/07/19 at 02:51 PM - 1.5 liters via NC, 05/08/19 at 07:32 AM - 1.5 liters via NC, 05/09/19 at 07:58 AM - 1.5 liters via NC. Nursing progress notes and physician orders did not include documention of the current oxygen flow rate of 1.5 liters, or that the physician was notified for an order to decrease in oxygen flow rate. Review of the Treatment Records (TARS) dated 4/1/19 through 5/7/19 documented the the residents oxygen saturations performed every shift ranged between 90% to 98%. During an interview on 5/08/19 at 7:32 AM, Licensed Practical Nurse (LPN) #4 stated the resident's oxygen flow rate was set at 1.5-liter NC. The resident had a limited use physicians standing order for 02 at 2-3L/min PRN via NC up to 5L/min via mask every shift to maintain 02 sat. The standing oxygen order was used for someone who was short of breath or their oxygen saturation fell below 90 (normal 95-100%). There should have been an order for her current oxygen rate of 1.5 liters NC and its indication for use. During an interview on 5/08/19 at 11:33 AM, the Medical Director stated physicians standing orders should be used in an emergency and the resident should be seen by the physician at the next visit. There should be specific oxygen orders to address each resident's health status. During an interview on 5/09/19 at 7:43 AM, the Registered Nurse Unit Manager (RNUM) #3 stated the resident is on continuous oxygen. During an interview on 5/09/19 at 8:22 AM, the Director of Nursing (DON) stated the limited use, physicians standing order for oxygen is for short term use, and the resident should have had an updated physicians order for oxygen with an indication for use. Resident #70: The resident was readmitted to the facility on [DATE], after a post-acute hospital with a diagnosis of fracture of left femur, congestive heart failure, chronic kidney disease and dementia. The Minimum Data Set (MDS) dated [DATE], documented the resident was unable to complete the cognition interview. The resident can sometimes makes self understood, and sometimes understands others. A physician's standing order dated 5/3/19, documented 02 at 2-3 L/min PRN via NC up to 5L/min via mask. During an observation on 5/07/19 at 3:33 PM, LPN #1 performed a room air 02 sat on the resident, which read 91% and replaced the resident's oxygen and LPN #1 stated the oxygen flow rate is set at 1-liter NC. During an observation on 5/07/19 at 4:00 PM, the resident's oxygen flow rate was set at 1 liter via NC. During an interview on 5/07/19 at 4:10 PM, RNUM #2 stated the resident came back from the hospital on 5/2/19 and they activated the physicians standing order for oxygen that documented 02, 2-3 L PRN NC up to 5L/min mask. She decreased the resident's 02 to 1 liter via NC yesterday and documented it in the progress notes that 02 sats were 94% on 1 liter and they would wean as the resident was able. She should have obtained an order for the continued use of the oxygen and the flow rate. During an interview on 5/07/19 at 4:15 PM, Registered Nurse (RN) #4 stated the physician should have been notified and an order obtained for the oxygen with an indication for use. 10NYCRR415.12(k)(6)

Based on observation, manufacturer's directions review, and staff interview during the recertification survey, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Chemicals used in food equipment sanitizing are to be at the correct concentration, food contact surfaces are to be cleaned after use, and non-food contact surfaces must be kept clean. Specifically, the concentration of quaternary ammonium compound chemical sanitizing rinse (QAC) was less than that required by the manufacturer, food contact equipment required cleaning, and non-food contact equipment was not clean. This is evidenced as follows. The kitchen was inspected on 05/06/2019 at 8:45 AM. The concentration of QAC used in the sanitizing rinse sink, and the third sink, was found to be at 0 parts per million (ppm) when measured at 70 degrees Fahrenheit (F). The manufacturer's label directions stated the concentration is to be between 150 ppm and 400 ppm when the solution is measured between 65 F and 75 F. The cutting boards on the storage rack under the food prep table were soiled with food debris, and the exhausted fan guards were covered in dust. The Dietary Director stated in an interview on 11/26/2018 at 9:40 AM, that the chemical sanitizer bottle that feeds the sanitizing sink was empty. The Dietary Director stated there would be a discussion with staff about proper cleaning procedures of the cutting boards and the exhaust fan guards. 10 NYCRR 415.14(h); Chapter 1 State Sanitary Code Subpart 14-1.110, 14-1.112

Based on observation and staff interview during the recertification survey, carbon monoxide detection was not provided in accordance with adopted regulation. The International Fire Code, 2015 Edition Section 915 Carbon Monoxide Detection, requires carbon monoxide detection in all areas with gas operated equipment. Specifically, carbon monoxide detection was not installed in an area with gas fuel fired equipment. This is evidenced as follows. Observations on 05/07/2019 at 1:55 PM, revealed a fuel burning appliance in the kitchen and laundry rooms without a carbon monoxide detection device. The Plant Operations Director stated in an interview on 05/07/2019 at 2:05 PM, that he was unaware that it was a requirement to provide carbon monoxide detection in these areas. 483.70 (b); 2015 International Fire Code, Section 915

Based on record review, and interviews during the recertification survey, the facility did not ensure training was provided to their staff on dementia management and resident abuse prevention. Specifically, the facility did not ensure staff were educated on factors related to dementia care and abuse prevention, including conflict resolution, anger management skills, and identifying and addressing staff burnout, frustration, and stress. This is evidenced by: Review of an undated in-service titled Caring for Residents with Dementia provided by Registered Nurse (RN) #7 did not include information related to conflict resolution between staff and residents, visitor and resident, and resident to resident conflicts, anger management, and identifying and addressing staff burnout, frustration, and stress in staff. During an interview on 5/09/19 at 10:23 AM, RN #6 was not able to provide documentation that facility staff had received been educated on resolving conflicts, anger management skills, and identifying and addressing staff burnout, frustration, and stress in staff prior to survey exit. 10 NYCRR 415.49(b)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview during a recertification survey the facility did not ensure each resident was treated with respect and dignity and cared for in a manner and in an environment that promotes maintenance or enhancement of quality of life for 1 (Unit 2) of 2 resident dining rooms and 4 (Resident #'s 2, 4, 70, and #73) of 5 residents reviewed for dignity. Specifically, the facility did not ensure staff were interacting with residents rather than with each other while assisting residents with meals in 1 of 2 dining rooms; Specifically, for Resident #2, the facility did not ensure the resident's pants were not urine soaked, that a puddle of liquid was not beneath the resident's chair and feet, and that the odor of urine did not permeate a public area of the unit where the resident was observed sitting in a recliner chair; for Resident # 4, the facility did not ensure the resident's right to privacy was protected in the resident dining room; for Resident # 70, the facility did not ensure the resident's request to stop being fed was honored for; Resident # 73, the facility did not ensure the resident's personal space was protected when staff entered her room without knocking and pushed the resident's wheelchair from behind without informing the resident first. This is evidenced by: Finding #1 The facility did not ensure staff were interacting with residents rather than with each other while assisting residents with meals in the Unit 2 dining room. During observation(s) on 5/06/19 at 12:44 PM, 5/07/19 at 8:51 AM, 5/07/19 at 12:24 PM staff were sitting with residents in the dining room, having personal conversations among each other, and had minimal interactions with the residents. During an interview on 5/08/19 03:07 PM, the Director of Nursing (DON) stated she would not expect to hear personal conversation in the dining room, and she had spoken about not having personal conversations in the dining room with staff during CNA meetings. During an interview on 5/09/19 at 7:35 AM, the Food Service Director (FSD) #1 stated the DON has educated staff on dining with dignity. During an interview on 05/09/19 at 8:36 AM, Registered Nurse (RN) #1 stated the Director of Nursing (DON) had spoken with the staff several times about dining room etiquette and staff on the unit have been educated. She stated conversations in the dining room should have been focused around the residents and include the residents. Staff should not have personal conversations. Finding #2 The facility did not ensure the resident's pants were not urine soaked, that a puddle of liquid was beneath the resident's chair and feet, and that the odor of urine did permeate a public area of the unit where the resident was observed sitting in a recliner chair. Resident #2: The resident was admitted to the facility on [DATE], with the diagnoses of dementia, schizophrenia and hypertension. The Minimum Data Set (MDS) dated [DATE], documented the resident had severe cognitive impairment and was rarely able to make herself understood, and sometimes able to understand others. The Comprehensive Care Plan (CCP) titled Bladder Incontinence related to (r/t) Confusion and dated 4/25/18 documented that the resident will be clean, dry and odor free daily through next review. Interventions included cleaning the peri-area with each episode of incontinence. The CCP titled Resident Requires Assistance with ADL's (activity of daily living) r/t Dementia dated 4/11/17, documented that the resident's ADL's will be met daily as evidenced by being clean, neat and well groomed. Interventions included; enjoys being in recliner near nurses station after meals to watch tv and nap, ensure dignity during care, and toilet every 2-4 hours as needed. During an observation on 5/6/19 at 9:32 AM, Resident #2 was sitting in the lounge across from the nursing station in a recliner chair. She was sitting on a wet incontinence pad, the front of the resident's pants were wet, and the resident's feet were in a large puddle of liquid on the floor in front of the chair. The odor of urine was strong in the area. The resident was notably restless. The resident was continuously changing her position in the chair. At 10:15 AM, a staff member entered the lounge area with a nourishment cart and at the same time the resident was observed trying to make an attempt to stand. The staff member told Resident #2 to sit back down. At 10:25 AM, a housekeeping staff member walked into the lounge and passed by Resident #2. At 10:45 AM, a Certified Nurse Aide (CNA) approached Resident #2 and took her to her room. During an observation on 5/7/19 at 08:11 at AM, the resident was sitting in the lounge across from the nursing station in a recliner chair. The incontinence pad that the resident was sitting on was wet and the front of the resident's pants were wet. There was a strong urine odor in the area where the resident sat. At 08:21 AM, a nurse walked into the lounge area and addressed another resident. At 08:28 AM, a CNA covered the resident with a clothing protector and sat down next to her and fed her breakfast. At 08:39 AM ,breakfast was over and the CNA walked the resident to her room to be changed. During an interview on 5/7/19 at 2:00 PM, CNA #2 stated that the resident requires total assistance with checking and changing. After breakfast the resident is taken to her room for toileting and changing, then she is checked every 2 hours for toileting. During meals a CNA is assigned to watch the residents that are not in the dining room, monitoring the halls and the lounge area. If any staff member saw that the resident was wet, they should have changed her. When CNA #2 brought her breakfast tray to her that morning he saw that she was wet, but she was grabbing at the breakfast tray. CNA #2 thought it best to feed her then take her to be changed. During an interview on 05/07/19 at 02:10 PM, CNA #3 stated that all staff are supposed to be toileting or changing residents in need, it does not matter if the resident is not assigned to the CNA. Yesterday (5/6/19) a helping hands staff member came to me and said Resident #2 needed to be changed, and I brought her to the room and toileted her. The resident often does not urinate on the toilet and a short while after she will be soaked. During an interview on 05/07/19 at 02:13 PM, LPN #4 stated that any staff member who notices a resident is wet should report it to a nurse or CNA or change her. It is the job of all staff members to take care of a resident in need. The housekeeper should have reported to someone that Resident #2 was wet, and any nursing staff member could have changed her. During an interview on 05/07/19 at 02:34 PM, Registered Nurse Manager (RNM) #3 stated the CNAs have their own assignment and provide initial care to those residents. Once the initial care is done any staff member could have changed her. RNM #3 would have changed her if she saw her wet. This is not the norm in this facility, anyone could change them. All departments are taught if they see a resident in need, they should report it. Finding #3 The facility did not ensure the resident's right to privacy was protected in the resident dining room. Resident #4: The resident was admitted to the facility on [DATE] with diagnoses of malignant neoplasm of the brain, dysphasia, and seizures. The Minimum Data Set (MDS) dated [DATE], documented the resident had severely impaired cognition, could sometimes understand and could rarely or never make himself understood. During an observation on 05/07/19 at 9:06 AM, the Nurse Practitioner (NP) and Registered Nurse (RN) #2 entered the resident dining room to see the resident while he was being assisted to eat his breakfast. Residents at his table were also eating breakfast. The resident stopped eating for the NP to visually examine his eyes and face. After the NP finished her examination, she and the RN stood behind the resident's wheelchair in the dining room to discuss the resident's medical condition. The conversation could be overheard by others. During an interview on 05/07/19 at 3:09 PM, RN #2 stated the resident was in the dining room eating breakfast when the NP went to see him for redness to his left eye. She stated the resident should not have been seen by the NP in the dining room. She stated she should have removed the resident from the dining room for privacy. During an interview on 05/08/19 at 11:02 AM, the NP stated she went to see the resident for eye redness in the dining room yesterday. She stated she would not normally see residents in the dining room but due to limited time she did. She stated resident information should not have been discussed where it could be overheard by others. She stated she had not thought that seeing a resident in the dining room for a medical concern was a possible dignity issue. She stated she would be more mindful of seeing residents in private locations and would also be more mindful of where she was when discussing residents medical. Finding #4 The facility did not ensure that the resident was not being fed when the resident did not want to be fed. Resident #70: The resident was admitted to the facility on [DATE], with diagnoses of dementia with behavioral disturbance, fracture of the left femur, and congestive heart failure. The Minimum Data Data (MDS) dated [DATE], documented the resident had moderately impaired cognition, could usually understand others, and could sometimes make herself understood. During an observation on 5/08/19 at 9:15 AM, the resident was being fed breakfast by staff in a common area with other residents aroun. The resident was yelling out and coughing during the meal. During an observation on 5/06/19 at 12:30 PM, Resident #70 was being fed in the common area with the television on. The resident was yelling no and help. The Certified Nursing Aide (CNA) stated I am trying to help you, but you are yelling in my ear. The resident continued to yell no and help. The CNA continued to feed the resident fluids and solids. At 12:49 AM, the resident stated don't feed me anymore, I don't want anymore. The CNA continued to try to feed the resident. During an interview on 5/07/19 at 12:40 PM, CNA #5 stated the resident is able to tell you what she wants at meals. She stated the resident seemed tired today. During an interview on 5/08/19 at 11:52 AM, Registered Nurse (RN) #2 stated the resident can make her needs known. 10NYCRR415.3(c)(1)(i)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interviews during a recertification survey the facility did not ensure that it developed and implemented a comprehensive person-centered care plan for each resident, consistent with the resident rights that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment, for five Residents (# 33, 42, 70, & 91) of 22. Specifically: for Resident #33, the facility did not ensure that that her care plan for toileting was implemented and addressed the fact that she was continent, that Resident #42 had a care plan to address the different types of pain, that Resident # 70 &91's care plans for pain had interventions individualized for those residents . This is evidenced by: Resident #42: The resident was admitted to the facility on [DATE], with the diagnosis of polyneuropathy, low back pain with spinal stenosis and Parkinson's Disease. The Minimum Data Set (MDS) dated [DATE], documented the resident was cognitively intact, able to make her understood and able to understand others. The Physician (MD) Orders dated 3/6/19, documented Lyrica 150 milligrams (mg) three times per day (tid) for Polyneuropathy and Fentanyl patch 72 hr, apply patch transdermally every 72 hours for pain. The MD orders dated 3/18/19 documented Zanaflex 4 mg tid for muscle spasms. The comprehensive care plan (CCP) titled Risk for pain related to polyneuropathy, low back pain with history of back surgery, and history of knee replacement. On 3/16/19, the resident had complaints of muscle spasms and numbing of legs. Interventions included; monitor effectiveness of pain medication regime; monitor location, intensity, and duration of pain; administer warm packs and/or ice per PT recommendations. The care plan did not differentiate interventions given the three types of pain the resident experienced, neuropathic, bone and muscle cramping. During an interview on 05/06/19 at 10:55 AM, the resident stated that she had constant pain. She had neuropathic pain and was on 300 mg Lyrica twice per day for that. She stated she had a botched back surgery in the past couple years and it left her in constant pain to her low back and hips, she was awaiting a Orthopedic appointment to schedule another back surgery. She stated the nurses do not give her anything for pain when it gets bad. , During an interview on 05/08/19 at 10:00 AM, the Occupational Therapist stated that the resident's pain fluctuated day to day, some days the pain would be greater than other days. A couple of days she was unable to do therapy. She had neuropathic pain in her extremities that never got better, and she had back and hip pain. PT would give her moist heat treatments in therapy. During an interview on 05/09/19 at 12:45 PM, the Director of Nursing (DON) stated the staff should have been addressing her pain with or without meds. The Standing Medical Order for Tylenol could have been used for her pain. The Lyrica would not help with breakthrough pain, she would have needed something more. The staff could have used different options to make her comfortable. The care plan should address the residents different types of pain, and interventions to treat. Resident #33: The resident was admitted to the nursing home on 5/15/17 with diagnoses of CKD, AKA, upper respiratory infection. The Minimum Data Set (MDS) dated [DATE] assessed the resident as having moderately impaired cognitive skills for daily decision making, and that she was not on a toileting program and frequently incontinent. It documented that the resident understood and was understood by others. During an interview on 5/06/19 at 9:47 AM, the resident stated she knew when she had to go to the bathroom, but she was sometimes incontinent if staff did not get there fast enough. Bedside [NAME] documented toilet per toileting schedule, monitor for any pattern of incontinence and adjust toileting schedule as needed. During an interview on Certified Nursing Assistant (CNA) #8 stated that for the most part the resident knew when she had to go, and is usually continent. She is at times incontinent but does not think it is caused by not getting to the light they are usually quick to answer call bells. During an interview on 5/09/19 at 12:21 PM, the MDS Coordinator stated she was responsible for care planning and thought the resident lacked bladder tone and this made her incontinent at times; this should have been addressed in her care plan. They had not tried a bladder training program but should have because she was continent at times. During an interview on 05/08/19 04:06 PM the DON stated that the resident was continent at times and would sometimes ring to be toileted. They could not tell by the CNA documentation if the resident was being toileted per her care plan. They had talked to staff about documenting when the resident was toileted or changed; staff were having difficulty getting it done as they were moving right to the next person. Additionally, her CCP was not person centered; it should document that was continent when she wanted to be. Resident #91: The resident was admitted to the nursing home on 4/21/17 with diagnoses of compression fractures of the spine, degenerative disc disease, osteoporosis, and osteoarthritis. The Minimum Data Set (MDS) dated [DATE] assessed the resident as having mod cognitive skills for daily decision making. It documented that the resident understood and was understood by others. A Comprehensive Care Plan for at risk for pain dated 4/21/17, documented administer medications per MD order; monitor for non-verbal signs and symptoms of pain i.e. grunting, moaning, restlessness, irritability and grimacing and monitor the location, intensity, and duration of the pain. On 5/2/19, the following interventions were added: use the pain scale; administer warm packs and /or ice per physical therapy recommendation and /or MD order. monitor the effectiveness of pain medication regime, monitor for changes in sleep patterns, decreased functional abilities, or resistance to care and utilize diversion techniques. During an interiew on 5/09/19 at 12:21 PM, the MDS Coordinator stated the pain care plan was not person centered to this resident. She did not think there was an order for the hot or cold packs. It was a generic intervention she added but it should not have been added unless the MD ordered it, she did not know why she added it. The CP was not person centered, and did not include indidualized interventions for this resident. 10NYCRR 415.11(c)(3)(i)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review, and interviews during a recertification survey the facility did not ensure that pain management was provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan (CCP), and the residents' goals and preferences, for three (Resident #'s 42, 70, and #91) of seven reviewed for pain. Specifically, for Resident #42, 70, and #91, the facility did not ensure that the resident's received adequate pain management. This is evidenced by: The Policy & Procedure titled Pain Management dated 8/2018 documented, it is the policy of the Nursing Home to provide adequate pain management to keep the residents as comfortable as possible. Each Resident each shift and with each pain medication pass will be asked to rate his/her pain according to the MDS pain rating scale. The response will be documented on the electronic Medication Administration Record (eMAR). Documentation for routine pain management needs to include the number from the scale. If resident has pain you need to re-approach 1/2 hour to 1 hour later documenting the effectiveness of the pain medication, using the MDS pain rating scale. Resident #42: The resident was admitted to the facility on [DATE], with the diagnoses of polyneuropathy, chronic back pain with spinal stenosis, and Parkinson's disease. The Minimum Data Set (MDS) dated [DATE], documented the resident was cognitively intact, was able to make self understood and could understand others. It documented the resident had pain almost constantly, making it hard to sleep at night, and the pain intensity was 5 out of ten. The CCP titled Risk for pain related to (r/t) polyneuropathy, low back pain with history of (h/o) back surgery, h/o knee replacement documented the following interventions; administer medications per MD order, warm packs and/or ice per PT recommendation and MD order, monitor effect of pain medication regime, monitor location, intensity, duration of pain, and offer snack or beverage as diversion to pain. The Pain assessment dated [DATE], documented neuropathy pain to the legs and back. The pain level was 6 out of 10. The best pain level was 4, and the worst pain level was 10. The Physician Orders (MD) dated 3/6/19, documented Lyrica 150 mg three times per day (tid) and Fentanyl patch 72 hr, administer every 72 hours. Side lying wedge in bed for comfort and positioning. The MD orders dated 3/13/19, documented to change Lyrica to 300 mg twice per day (bid). The MD orders dated 4/12/19, documented to discontinue the Fentanyl patch. The eMAR dated 3/2019, documented a Pain Scale routine every shift to monitor for pain. Pain levels documented: 03/9/19 - pain of 7 on the evening shift; 3/10/19 - pain of 5 on the evening shift; 3/15/19 - pain of 5 on the day shift; 3/16/19 - pain of 10 on the day shift. There was no documentation that the resident received any as needed pain (prn) medication for the pain levels. The eMAR dated 4/2019, documented a Pain scale routine every shift to monitor for pain. Pain levels documented: 4/15/19 - pain of 9 on the evening shift; 4/16/19 - pain of 7 on the evening shift; 4/17/19 - pain of 7 on the evening shift; 4/19/19 - pain of 5 on the evening shift; 4/20/19 - pain of 6 on the evening shift; 4/21/19 - pain of 5 on the evening shift; 4/25/19 - pain of 5 on the day and evening shift; 4/28/19 - pain of 10 on the evening shift; 4/30/19 - pain of 5 on the evening shift. There was no documentation that the resident received any as needed pain (prn) medication for the pain levels. The eMAR dated 5/2019 documented a Pain Scale routine every shift to monitor for pain. Pain levels documented: 5/3/19 pain of 5 on the evening shift; 5/4/19 pain of 7 on the evening shift; 5/7/19 pain of 5 on the day shift. There was no documentation that the resident received any as needed pain (prn) medication for the pain levels. The Physician's (MD) progress note dated 4/12/19, documented the resident was seen for follow-up to her polyneuropathy (damage or disease affecting peripheral nerves (peripheral neuropathy) in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain), spinal stenosis, Parkinson's disease and colon cancer. We will discontinue the patient's Fentanyl (treats severe pain) at this time, and will continue her other chronic medications. The patient will be continued on Lyrica (used to treat pain caused by nerve damage due to diabetes, shingles (herpes zoster) infection, or spinal cord injury, this drug works best when the amount of medicine in your body is kept at a constant level), patient has been seen by Orthopaedic Surgery for anticipation of possible spinal surgery. During an interview on 05/06/19 at 10:55 AM, Resident #42 stated that she had constant pain. She had neuropathic pain and was on 300 mg Lyrica twice per day for that. She stated she had a botched back surgery in the past couple years and it left her in constant pain to her low back and hips, she was awaiting a Orthopedic appointment to schedule another back surgery. She stated the nurses do not give her anything for pain when it gets bad. , During an interview on 05/08/19 at 10:00 AM, the Occupational Therapist stated that the resident's pain fluctuated day to day, some days the pain would be greater than other days. A couple of days she was unable to do therapy. She had neuropathic pain in her extremities that never got better, and she had back and hip pain. PT would give her moist heat treatments in therapy. During an interview on 05/08/19 at 10:15 AM, Certified Nursing Assistant (CNA) #1 stated she is in pain more days than she is not. Sometimes her pain is so bad that I help her with total care, even though she is a limited assist. There are times she can have a good day. During an interview on 05/08/19 at 11:28 AM, the MD stated in my opinion her pain is under control. My last conversation with her she said she feels so much better. The resident came in with a Fentanyl patch order and it was discontinued per the resident request, she did not like the way it made her feel. The nurses should be offering something when she has pain, or call the MD. The MD was not aware there were times of pain documented and nothing was done for her. During an interview on 05/08/19 at 11:28 AM, the Registered Nurse Manager (RNM) #3 stated when the resident complains of pain it is due to her behavior, she tends to exaggerate. She is on the Lyrica for her pain and that is effective. The therapy department provides hotpacks for her pain, she asked for one the other day. She does not have an order for any prn medication or any other non-pharmaceutical intervention. During an interview on 05/09/19 at 08:25 AM, the Physical Therapist (PT) stated the resident would have intermittent pain during therapy and PT would do moist heat for her. Since she was discontinued from therapy the PT thinks her pain has increased due to immobility. I gave her a hot pack this past week, don't know what they do for her on the unit when she has pain. During an interview on 05/09/19 at 08:45 AM Licensed Practical Nurse (LPN) #4 stated the resident often says she has no pain, she is more needy of wanting things when her husband is here. If she did have pain I would check her meds and let the Nursing Supervisor know and the MD would be called. LPN did not know why pain was documented and nothing was given to the resident. The resident's husband came to me and requested a hot pack the other day and Physical Therapy came up with one. There are no interventions on the treatment record for her pain. During an interview on 05/09/19 at 12:45 PM, the Director of Nursing (DON) stated the staff should have been addressing her pain with or without meds. The Standing Medical Order for Tylenol could have been used for her pain. The Lyrica would not help with breakthrough pain, she would have needed something more. The staff could have used different options to make her comfortable. Resident #70: The resident was admitted to the facility on [DATE], with diagnoses of dementia with behavioral disturbance, and wedge compression fractures of T11-T12, and readmitted on [DATE] status post fracture of the left femur. The Minimum Data Det (MDS) dated [DATE], documented the resident had moderately impaired cognition, could usually understand others, and could sometimes make self understood. Observations during the following dates and times: On 5/07/19 at 8:59 AM, the resident was screaming ow during care. On 5/07/19 at 10:30 AM, the resident was lying in her bed yelling, help, who is out there? On 5/08/19 at 9:48 AM, the resident refused therapy, and stated to the Certified Nursing Assistant (CNA), I don't want therapy, I want to go to bed. Staff did not assist the resident to bed. On 5/08/19 at 9:51 AM, the resident was sitting in a geri chair in her room. The resident stated I want to go to bed, I feel like I'm going to vomit. A CNA offered the resident a bucket. The resident stated I don't feel good today, I feel sick to my stomach. Staff shut the door to the resident's room. The resident was heard yelling ow. A nurse entered the room to address the residents daughter and left the room. The resident's complaints of nausea and pain were not addressed. A CCP titled At risk for Pain dated 3/4/19, documented; medications as ordered by the MD, to monitor for non-verbal signs of pain i.e. restlessness, irritability, and grimacing, and monitor and document for probable cause of pain for each pain episode. It did not document that the resident had a fractured hip. A Pain Management questionnaire dated 5/3/19, documented that the resident reported a pain level of 7 out of 10 at the time of the questionnaire, and that at best the pain is a 3 and at worst the pain is an 8 out of 10. It documented that the current regime for pain was to administer Norco (narcotic pain medication) and that the administration of Norco was effective. A Medical Doctor's order dated 5/3/19, documented Norco 5 milligrams (mg)-325 mg one time order; give one by mouth one time only for pain. A Medication Administration Record (MAR) dated 5/3/19, documented that Norco 5/325 mg was administered at 9:32 AM for a pain level of 6. The MAR did not include a post pain level follow-up. A Progress Note dated 5/3/19, by the DON, stated the MD was notified of the resident's pain and that the one-time dose of Norco was effective. A new order was obtained for Norco 5/325 mg three times a day for pain. A New Orders/Changes sheet (a form the nurse documents MD orders that need to be checked for accuracy and implemented by a second nurse), dated 5/3/19, documented to discontinue Tylenol and add Norco 5/325 mg; 1 three times a day for pain. The eMAR from 5/3/19 - 5/7/19, documented an MD order for Tylenol 500 mg; one tablet three times a day. The eMAR did not include documentation for Norco 5/325 mg three times a day. During an interview on 5/08/19 at 10:30 AM, the Director of Physical Therapy stated the resident was having pain, and it was interfering with her progress in physical therapy. During a telephone interview on 5/08/19 at 11:09 AM, CNA #6 stated the resident always yelled. During an interview on 5/08/19 at 12:28 PM, the DON stated she did not know what happened with the resident's orders. They got the order last week, but it never showed up on the eMAR and no one picked up on it. Nurses were supposed to check orders to make sure they were correct and should have ensured the orders were on the MAR. During an interview on 05/09/19 10:48 AM, RN #1 stated she was not aware that the resident's orders were not entered on the MAR. The facility's system for importing orders was fairly new and there was no follow up check of the New Orders/Changes sheet to ensure that the nurse's were doing the second check and sending the orders to the MAR and Treatment Administration. Record (TAR). Resident #91: The resident was admitted to the nursing home on 4/21/17, with diagnoses of chronic back pain secondary to advanced osteoporosis with pathological fracture of L1, degenerative disc disease, and osteoarthritis. The Minimum Data Set (MDS) dated [DATE], assessed the resident as having mod cognitive skills for daily decision making. It documented that the resident understood and was understood by others. During an observation on 5/07/19 at 4:03 PM, the resident was yelling out for help from her room. When the surveyor entered the room the resident was lying on her back in bed. The resident was crying and holding her right lower back. The resident stated she was having back pain and had asked for pain medication, but they had not brought it to her yet. Within a minute, CNA #9 and CNA #10 entered the room. When the resident was crying, CNA #10 told her she would get her pain medication around 5:00 PM. CNA #9 stated to the resident that she could report it to the nurse if she wanted. The surveyor informed the CNA that she should report the resident's pain to the nurse. At 4:07 PM, CNA #9 came back into the resident's room after reporting the resident's pain to Licensed Practical Nurse #7. CNA #7 told the resident she could not have another pill until 5:00 PM, but they could sit her up. Review of the Medical Doctor (MD) orders documented the following: 10/17/17 - Norco (a narcotic pain medication 7.5/325 milligrams (mg); give one four times a day for low back pain; 09/28/17 - Tizanidine HCL 4 mg; 1 daily as needed for muscle spasms. A Comprehensive Care Plan for At Risk for Pain dated 4/21/17, documented administer medications per MD order; monitor for non-verbal signs and symptoms of pain i.e. grunting, moaning, restlessness, irritability and grimacing and monitor the location, intensity, and duration of the pain. On 5/2/19, the following interventions were added; use the pain scale; administer warm packs and /or ice per physical therapy recommendation and /or MD order; monitor the effectiveness of pain medication regime; monitor for changes in sleep patterns; decreased functional abilities; or resistance to care and utilize diversion techniques. A Progress Note dated 4/1/19 at 6:09 AM, documented that the resident was throwing things, yelling and hit staff. When the LPN asked her why she was acting that way, the resident stated she was in pain. The pain level documented on the MAR for 4/1/19 at 6:00 AM, was 0. Review of the eMAR for the date of 5/7/19 at 6:00 PM, included documentation that the resident's pain level was 0. Review of the progress for the date of 5/7/18, did not inlude documentation that the resident was crying from pain. A Progress Note dated 5/6/19 at 10:35 AM, written by the Social Worker (SW) documented the resident reported that her back hurt and the SW reported it to the Nurse Manager. The progress notes did not include documentation that the resident had been assessed by a nurse or that non-pharmacological interventions were attempted to alleviate the resident's pain. The eMAR dated from 4/1/19 - 5/8/19 documented the resident received Norco on 152 occasions. Of the 152 occasions there were 23 occasions when the resident's pain level was between 5-10, and of those 23 occasions, 6 occasions were documented in the progress notes and on 22 occasions follow-up pain levels were documented. An MD annual progress notes dated 4/5/19, documented the only concern was that the resident continued to have back pain. The resident was in significant pain due to chronic back pain and the plan was to continue the resident's current chronic medications. During an interview on 5/07/19 a 04:05 PM, CNA #10 stated she knew the resident had a lot of pain and that the resident received medication for pain at 5:00 pm and a pain patch at night. During an interview on 5/07/19 a 04:07 PM, CNA #9 stated the resident cried in pain from her back everyday. During an interview on 5/08/19 at 10:42 AM, Licensed Practical Nurse (LPN) #7 stated she did not know what diagnoses the resident had that caused the resident pain but thought most it was behavioral. The resident will have behaviors and complain when she wanted to go to bed. She worked the day shift and it was not usual for her to ask for pain medication during the day. She did not feel she should have gone down to check the resident when CNA #9 reported the resident was complaining of pain because she was giving medications to other residents. She told the CNA to tell the resident she could get a pain pill at 5pm. During an interview on 5/08/19 at 11:07 AM, RN #1 stated that she expected the nurse to see the resident when she complained of pain. The nurse should have come in checked on the resident and an RN assessment should have been done. The resident did have chronic pain but would have behaviors when she wanted things immediately. There should be follow-up pain levels after pain medication is given and the MD should have been made aware the resident was experiencing increased pain. During an interview on 5/08/19 at 12:32 PM, the DON stated staff should have assessed the resident when she complained of pain. During an interview on 5/08/19 at 3:11 PM, the DON stated that they had not ever had an IDT meeting with the family, the MD and the IDT team to discuss dealing with the resident's pain. During an interview on 5/08/19 at 12:46 PM, the MD stated that staff should report the resident's pain to the nurse, the nurse should assess and document the pain. He was aware that the resident was having pain but the son who is the HCP, adamantly refused for the facility to give her any additional pain medications. 10NYCRR415.12

Based on observation, record review and interview during the recertification survey, the facility did not ensure a policy was developed regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption. Specifically, the facility did not ensure the policy for bringing food(s) in from outside of the facility included a process for assisting residents in accessing and consuming the food if a resident is unable to do so on his/her own and the facility did not provide information for family and visitors on safe food preparation and handling practices. This will be evidenced by: A Policy and Procedure (P&P) titled Bringing Food(s) in From Outside the Facility dated 10/2017, documented foods brought in by family memberes or guests will be reported to the Charge Nurse, who would notify Food and Nutrition Services (Diet Technician or responsible staff) for these foods to be received, appropriately stored, and added to the resident's daily menu if appropriate. The food would be stored in the kitchen with the resident's name and date it was received. The P&P did not include education to families on safe food handling and storage practices, and did not include information regarding residents that can't access and consume foods on his/her own. During an interview on 5/09/19 at 7:23 AM, the Dietetic Technician (DT) stated she is unsure of the process for foods brought to residents from home. During an interview on 5/09/19 at 7:35 AM, the Food Service Director (FSD) stated there is no education provided to families on safe food handling. 10NYCRR415.14(h)