Based on record review and interview, the facility failed to ensure resident assessments were accurate for one (#59) of 18 sampled residents whose resident assessments were reviewed. The Long Term Care Facility Application for Medicare and Medicaid, dated 04/22/24, documented 83 residents resided in the facility. Findings: Res #59 had diagnoses which included hyperlipidemia and non-ruptured cerebral aneurysm. A quarterly assessment, dated 04/03/24, documented the resident had received an anticoagulant during the last seven days or since admission/entry or reentry if less than seven days. There was no documentation the resident had received an anticoagulant during the last seven days or since admission/entry or reentry if less than seven days. On 04/23/24 at 2:32 p.m., the DON was made aware the resident's 04/03/24 quarterly assessment documented the resident received an anticoagulant during the last seven days or since admission/entry or reentry if less than seven days. They stated the resident received aspirin and clopidogrel bisulfate. They were coded as anticoagulants instead of antiplatelets.

Based on observation and interview, the facility failed to ensure proper food service sanitation and storage requirements were followed. The Long Term Care Facility Application for Medicare and Medicaid, dated 04/22/24, documented 83 residents resided in the facility. The CDM identified one resident received nutrition and hydration solely through a feeding tube. Findings: On 04/22/24 at 11:15 a.m., a tour of the kitchen was conducted. The following observations were made. a. a oven hood light was burned out and/or not working, b. there was an accumulation of black and brown residue on the floor and the wall in the dish wash area, c. the metal back splash was not secure to the wall in the dish wash area, d. the gasket on the walk in freezer door was split and in bad repair, e. there were two plastic storage bags of ready to eat hot dogs with open dates of April 7th and April 8th in the walk in cooler, and f. there was a plastic storage bag of ready to eat turkey with a discard date of April 20th in the walk in cooler. On 04/22/24 at 11:25 a.m., the CDM was asked what was the date marking policy. They stated the date on the hot dogs was the date they were opened. They stated the the hot dogs were to be held for seven days once opened. They stated the turkey should have been discarded. On 04/22/24 at 11:31 a.m., a tour of the long term care serving and dining area was conducted. The gasket on the Delfield one door reach in cooler was observed split and in bad repair. On 04/22/24 at 11:40 a.m., a tour of the skilled serving and dining area was conducted. The gasket on the ice cream freezer was observed split and in bad repair. On 04/24/24 at 12:22 p.m., the CDM was asked how staff ensure food service areas were kept clean and maintained in good repair. They stated they cleaned daily and maintenance concerns were reported to the maintenance department. They were made aware of the cleaning and maintenance concerns. On 04/24/24 at 12:33 p.m., there was a blanket on the floor around the garbage disposal drain. The CDM stated there were plumbing issues and water flood the floor.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to: a. document the provision of information and education regarding the risks, benefits, and potential side effects of the influenza and/or pneumococcal vaccinations, and; b. maintain a signed consent or declination from the resident or resident's representative for four (#17, 47, 53, and #60) of five residents reviewed for vaccinations. The Resident Census and Conditions of Residents, dated 03/20/23, documented 66 residents resided in the facility. Findings: The facility's Vaccination of Residents policy, dated 04/01/13, read in parts, .All residents will be offered vaccines that aid in preventing infectious diseases unless the vaccine is medically contraindicated or the resident has already been vaccinated .Prior to receiving vaccinations, the resident or legal representative will be provided information and education regarding the benefits and potential side effects of the vaccinations .Provision of such education shall be documented in the resident's medical record . 1. Resident #17 was admitted to the facility on [DATE]. The medical record for resident #17 documented an influenza vaccine was given on 10/13/22. The resident's record did not contain a signed consent, or contain documentation to indicate education was provided to the resident or their representative before administration of the influenza vaccine. 2. Resident #47 was admitted to the facility on [DATE]. The medical record for resident #47 documented no proof the resident or resident's representative had been offered, provided education, and no signed a consent or refusal for the influenza vaccination. The resident's record did not document the influenza vaccine had been given before admission. 3. Resident #53 was admitted to the facility on [DATE]. The medical record for resident #53 documented an influenza vaccine was given on 11/02/22. The resident's record did not contain a signed consent or document education was provided to the resident or resident's representative before administration of the influenza vaccine. 4. Resident # 60 was admitted to the facility on [DATE]. The medical record for resident #60 documented the pneumococcal vaccine was refused. The resident's record did not contain a signed refusal or document education was provided to the resident or resident's representative before refusal of the vaccine. On 03/23/22 at 10:00 a.m., the Administrator reported a nurse documented a vaccine consent or refusal in progress notes of the resident's medical record. The Administrator reported the vaccines administered in the facility were documented in the resident's medical record with the vaccine type, administration location, and the vaccine lot number. The Administrator reported the resident medical records did not contain a signed consent or the education provided. The Administrator reported the facility had an outside pharmacy, or other medical facility, come in to administer vaccines and the facility did not keep the vaccines in the facility. On 03/23/22 at 10:59 a.m., the IP/ADON reported no signed vaccination consents or declinations had been kept in the facility. The IP/ADON reported the pharmacy which provided resident vaccinations supplied a consent form, and the consent form contained education regarding the vaccine for residents or their representative to sign for consent or refusal of the vaccine before administration. The IP/ADON reported a facility nurse rounded with the pharmacy staff to educate and obtain consent for the vaccine, but the facility did not keep a copy of the pharmacy's form for the resident's medical record.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, it was determined the facility failed to: a. maintain documentation in the resident's medical record regarding the education provided to the resident or resident's representative regarding the benefits, risks and potential side effects associated with the COVID-19 vaccine before administration, and; b. maintain documentation of a signed consent or refusal in the resident's medical record for the COVID-19 vaccine for one (#17) of five residents reviewed for vaccinations. The Resident Census and Conditions of Residents, dated 03/20/23, documented 66 residents resided in the facility. Findings: The facility's Vaccination of Residents policy, dated 04/01/13, read in parts, .All residents will be offered vaccines that aid in preventing infectious diseases unless the vaccine is medically contraindicated or the resident has already been vaccinated .Prior to receiving vaccinations, the resident or legal representative will be provided information and education regarding the benefits and potential side effects of the vaccinations .Provision of such education shall be documented in the resident's medical record . Resident #17 was admitted to the facility on [DATE]. The medical record for resident #17 documented a COVID-19 vaccine was administered on 09/09/22. The resident's medical record documented no proof of the education provided to the resident or resident's representative on the benefits, risks, and side effects of the COVID-19 vaccine before administration. The resident's medical record contained no consent signed by the resident or resident's representative for the COVID-19 vaccine before administration of the vaccine. On 03/23/22 at 10:00 a.m., the Administrator reported a nurse documented a vaccine consent or refusal in progress notes of the resident's medical record. The Administrator reported the vaccines administered in the facility were documented in the resident's medical record with the vaccine type, administration location, and the vaccine lot number. The Administrator reported the resident's medical record did not contain a signed consent or the education provided. The Administrator reported the facility had an outside pharmacy, or other medical facility, administer vaccines and the facility did not keep vaccines in the facility. On 03/23/22 at 10:59 a.m., the IP/ADON reported no signed vaccination consents or declinations had been kept in the facility for any residents. The IP/ADON reported the pharmacy which provided resident vaccinations supplied a consent form and the form contained education regarding the vaccine for residents or the resident's representative to sign for consent or refusal of the vaccine before administration. The IP/ADON reported a facility nurse rounded with the pharmacy staff to educate and obtain consent for the vaccine, but the facility did not keep a copy of the pharmacy's form for the resident's medical record.