Based on observations and staff interviews, the facility failed to discard food items with signs of spoilage and liquid nutritional supplements that were past the expiration date in 1 of 1 walk-in cooler and label and date prepared food items in 1 of 1 reach-in cooler. These practices had the potential to affect food and drink items served to the residents. Findings included: a. An initial observation of the walk-in cooler on 11/18/24 at 8:50 AM revealed the following: a) A bag of fresh parsley dated 10/2024 that had a dark brown, slimy substance on some of the parsley leaves. b) A tray containing 30, eight-ounce cartons of liquid nutritional supplements with an expiration date of 11/01/24. During an interview on 11/18/24 at 8:50 AM, the Nutrition Services Manager confirmed the bag of fresh parsley had visible signs of spoilage on some of the leaves, the nutritional supplements were past the expiration date and stated both should have been removed from the cooler and discarded. The Nutrition Services Manager stated that all dietary staff were responsible for checking the cooler and discarding any food items with signs of spoilage or past the expiration date. During an interview on 11/19/24 at 4:54 PM, the Administrator revealed she expected dietary staff to check the coolers and discard any items that were expired or had visible signs of spoilage. b. An initial observation of the reach-in cooler on 11/18/24 at 8:57 AM revealed an unlabeled and undated clear storage container with plastic wrap covering the top that was half-way filled with a white liquid mixture with brown specks throughout the liquid. During an interview on 11/18/24 at 8:57 AM, the Nutrition Services Manager revealed the liquid in the container was a mixture for making French Toast. She was unsure when the mixture was prepared and stated the container should have been labeled with the name of the product, date prepared and use by date. During an interview on 11/19/24 at 4:54 PM, the Administrator revealed she expected dietary staff to label and date all prepared food items stored in the kitchen coolers and/or refrigerators.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and staff interviews the facility failed to remove an expired medication prior to being prepared for resident administration on 1 of 2 medication carts reviewed for medication storage (Willowbrooke Medication Cart). Findings included: During an observation on [DATE] at 9:22 AM Nurse #1 removed a package of carvedilol (medication used to lower blood pressure) from the medication cart and compared the label to the Medication Administration Record then removed one tablet from the package into a small cup being used to prepare medications for administration. During an interview on [DATE] at 9:22 AM Nurse #1 was asked to review the expiration date on the package of carvedilol and revealed the medication had expired on [DATE]. Nurse #1 removed the medication from the cup she was preparing and appropriately discarded it. Nurse #1 stated she should have reviewed the expiration date before preparing to administer the carvedilol. An interview was conducted with Director of Nursing (DON) on [DATE] at 11:06 AM. The DON revealed third shift checked the medication carts for expired medicine three times a week, but she didn't know the exact date when the Willowbrooke Cart was last checked. The DON stated reviewing expiration dates was part of the check before administering medications to residents and would expect Nurse #1 to check the expiration date on the label prior to removing it from the package. An interview was conducted on [DATE] at 11:07 AM with the Administrator. The Administrator stated he would expect Nurse #1 to review the medication label for the expiration date and not remove the medicine as if ready to administer when the medication had expired.