Based on record review, observation and interview, the facility did not ensure Resident #19's room was free from safety hazards that could potentiate fall risk. This affected one resident (#19) of four residents reviewed for accident hazards. The facility census was 27. Findings include: Medical record review was conducted for Resident #19 revealing a diagnosis of pain, malnutrition, and debility. Resident #19 had altered visual depth perception and was a fall risk. Observation of Resident #19's room on 08/07/23 at 3:32 P.M., 08/08/23 at 8:30 A.M. and 08/09/23 at 9:43 A.M. revealed both wooden doors to her clothing closet full of her clothing were off track at the bottom and leaning against her clothing. The top of the wooden closet doors were attached to the closet door frame, but the bottom of the doors swung loosely back and forth upon opening and there was no bottom track placement to safety secure the doors. Interview was conducted on 08/08/23 at 9:47 A.M. with STNA #301 who stated Resident #19 made her own choices and was able to go into her own closet to pick out her own clothes. Interview was conducted on 08/08/23 at 9:57 A.M. with Maintenance Director #332 who verified Resident #19's closet doors were not safely secured at the bottom so there was nothing to prevent the doors from falling out. Interview was conducted on 08/09/23 at 9:43 A.M. with Physical Therapy Assistant #335 who verified the loose closet doors and added this was not safe for Resident #19 because she was at risk for falls.

Based on observations, interview and policy review, the facility failed to ensure safe food handling to prevent cross contamination. This had the potential to affect all 27 residents receiving meals from the kitchen. The facility did not identify any residents who did not eat by mouth. Findings include: Observation was conducted on 08/08/23 at 11:30 A.M. of the lunch tray line. The cook serving on tray line was observed grabbing plates on the tray line then using the same gloved hand to grab sandwich buns out of a plastic bag. After throwing away the plastic bag in the trash can, the cook proceeded to touch another sandwich bun out of a new plastic bag with the same gloved hands. The cook then changed into new gloves without performing hand washing before applying the new gloves and proceeded to use her gloved hands to grab more buns, fresh lettuce and fresh tomato slices for sandwiches for the residents. Observation was conducted on 08/09/23 at 11:45 A.M. of the luch tray line, and it was noted the tray line cook used a gloved hand to grab a hamburger bun out of a plastic bag then touched loose potato chips , a serving scoop handle and another hamburger bun. After discarding a plastic bag in the trash can, the cook proceeded to touch loose open chips for serving to residents with the same gloved hand. The cook made no attempt to wash her hands or change into clean gloves when moving between touching the food items and touching the scoop handles and plastic bags. Interview was conducted on 08/09/23 at 12:00 P.M. with Culinary Director (CD) #338 whoverified the tray line cook did not practice proper glove usage or proper hand hygiene. CD #338 revealed the cook should have used tongs to grab the buns and other food items instead of directly touching the food with her gloved hands that had also touched utensils and plates. Review of the Ohio Living Rockynol Cross Contamination Dietary policy, undated, revealed all employees must wash hands when changing jobs.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain shower rooms located on the first and second floor in a clean and sanitary manner. The facility also failed to ensure hot water was available in the shower of the first floor. This affected one resident (#15) and had the potential to affect 27 residents (#2, #6, #10, #15, #17, #18, #22, #23, #26, #32, #36, #38, #47, #48, #49, #51, #52, #53, #56, #57, #63, #64, #66, #158, #313, #314, and #315). The facility census was 56. Finding include: Review of the medical record for Resident #15 revealed an admission date of 08/10/20. Diagnoses included fibromyalgia, age related osteoporosis, and obesity. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition and bathing activity did not occur. Interview with Resident #15 on 08/09/21 at 10:04 A.M. revealed the shower rooms looked awful and the water was too cold in the alcove shower room. Resident #15 stated the shower rooms were not in good shape. Interview on 08/11/21 at 1:57 P.M. with Director of Environmental Services (DEVS) #403 and Assistant Director of Environmental Services (ADEVS) #402 revealed there was only one shower room in use on the first floor which was located near the rehab unit. Observation of this shower room revealed the tub looked dirty and was stained. Wash cloths and towels were being stored in the tub. The shower curtain behind the tub also looked dirty and stained. Interview on 08/11/21 at 2:02 P.M. with DEVS #403 verified the observation of the tub and shower curtain. DEVS #403 stated the tub was maintained by a contracted company. On 08/11/21 at 2:07 P.M., ADEVS #402 turned on the hot water to the shower located in the first floor shower room and let it run. The water felt cold to touch. ADEVS #402 confirmed the water felt cold and stated it had been recently fixed. Further observation with DEVS #403 on 08/11/21 at 2:08 P.M. revealed a black rectangular trash bin located near the tub was filled about halfway with water and plastic gloves. Observation of the second floor shower room on 08/11/21 at 2:34 P.M. revealed it was cluttered with shower chairs and unlined trash bins with trash bags hanging on sides. One unlined trash bin contained used plastic gloves and a tied off trash bag with soiled incontinence briefs was on the floor. The bath tub was stained. These observations were confirmed with ADEVS #402 at the time of the observations. Review of the Resident council minutes dated 07/26/21, under the area of environmental services, revealed the shower room on the first floor needed attention, deep cleaning, and upkeep. Residents #2, #6, #10, #15, #17, #18, #22, #23, #26, #32, #36, #38, #47, #48, #49, #51, #52, #53, #56, #57, #63, #64, #66, #158, #313, #314, and #315 resided on the first and second floors and utilized the shower rooms. This deficiency substantiates Complaint Number OH00110874.