On 05/10/23 at 11:45 a.m., an Immediate Jeopardy situation was determined to be in existence related to the facility failing to ensure residents were served hot liquids at a safe temperature to prevent injury or harm. On 05/10/23 at 11:55 a.m., the Oklahoma State Department of Health verified the existence of the Immediate Jeopardy situation. On 05/10/23 at 12:00 p.m., the Administrator was notified of the IJ situation. On 05/10/23 at 4:00 p.m., an acceptable plan of removal was submitted to the Oklahoma State Department of Health. The plan of removal documented: Preparation and/or completion of this plan do not constitute admission or agreement by the provider that immediate jeopardy exists. This response is also not to be construed of fault by the facility, its employees, agents or other individuals who draft or may be discussed in this response and immediate jeopardy removal plan. This immediate jeopardy removal plan is submitted as the facility's immediate actionable plan to remove the likelihood that serious harm to a resident will occur, or recur. 1. Identification of Residents Affected or Likely to be Affected: Include actions that were performed to address the citations for recipients who have suffered, or are likely to suffer, a serious adverse outcome as a result of the facility's noncompliance and the date the corrective actions were completed. (Completion Date: 05-10-23 @ 1600) List of all residents that drink hot liquids. 2. Actions to Prevent Occurrence/Recurrence: Include actions the facility will take to alter the process or system failure to prevent a serious adverse outcome from occurring or recurring, by whom and when those actions were completed. (Completion Date: 05/10/23) 1. Hot liquid safety evaluation on residents that drink hot liquids upon adm and quarterly 2. Individual temperature log on residents identified 2 a. Each identified resident will have a temp log for staff to record temp of hot liquid before serving 3. Inservice all employees on hot coffee temps (115 degrees), hot liquid eval; no coffee pots except one in kitchen; weekly hot liquid log 4. New coffee pot with temp regulation 5. Hot liquid policy update 6. Res #10 has non spill cup Res #22 (name omitted) 7. Employees not in-serviced will not be allowed to work until notified 8. C.P. updated 9. Hot liquid assess/eval completed on all current residents that drink hot liquids Review/modify current policies as applicable to ensure appropriate procedures are in place to prevent harm/potential harm. Person Assigned, staff, [name omitted], Date Completed, 05/10/23 New policies written/implemented when applicable to insure additional serious harm will be prevented. Person Assigned, staff [name omitted], Date Completed, 05/10/23. Checklists and monitoring tools used to verify compliance. Person Assigned, [name omitted] RN, Date Completed, 05/10/23. Educate necessary staff on facility procedures with return demonstration where applicable. Person Assigned, [name omitted] RN, [name omitted] DON, [name omitted] LPN, Date Completed 05/10/23. The IJ was lifted, effective 05/10/23 at 4:45 p.m., when all components of the plan of removal had been completed. The deficiency remains at a pattern with actual harm. Based on observation, record review, and interview, the facility failed to ensure hot liquids were served at a safe temperature to prevent burns for two (#10 and #22) of two residents sampled with burns from hot coffee. The administrator identified 32 residents who drank hot liquids. 1. Res #10 was admitted with diagnoses which included left-sided hemiplegia (a severe loss of strength) and unspecified convulsions. A progress note, dated 07/20/22, read in part, .1015 called to residents room .noted reddened areas to abdomen, Silvadene applied to areas . An Incident Report Form, dated 07/20/22, read in part, .upon investigation, it is determined that resident frequently refuses coffe cup with lid. New cups have been ordered for use . A progress noted, dated 10/11/22, read in part, .up in wheelchair, in dining room, drinking coffee . A dietary note, dated 11/02/22, read in part, .only drinks coffee for fluids . A progress note, dated 11/21/22 at 9:01 p.m., documented the resident stated they spilled coffee on theirself that morning. The note documented a red area to the right inner thigh measuring 14.0 cm by 0.3 cm and an open blister measuring 4.0 cm by 0.6 cm. The note documented an order from the physician was obtained. On 11/21/22, a diagnosis of second degree burn of lower limb was documented. An Incident Report Form, dated 11/21/22, read in part, .upon investigation of incident, cup was dropped and the lid spilled coffee, resulting in a burn. Additional types of spill proof cups are being ordered to potentially prevent further incidents . A progress note, dated 11/22/22, read in parts, . left side weakness, assist x 1 for all adls .set up assist with meals . A progress note, dated 11/25/22 at 7:49 p.m., read in part, . pcp contacted at this time . coffee burn to (r) inner thigh has erythema (redness) noted to surrounding skin from approx. 0.5 cm to 4.0 cm in varying areas, very warm to touch; wound bed yellow, scant exudate (drainage) noted, surface of wound is sticky with exudate; order clarification received to continue silvadine bid . new order to start cephalexin (an antibiotic) 500 mg po tid x 10 days for dx: wound infection to (r) inner thigh .contact office Wednesday to bring resident in for eval and possible debridement of wound. resident c/o pain to area, very painful to touch . A progress note, dated 12/06/22 at 12:21 p.m., read in parts, .doctor visit n: 1030 am out of facility . appointment .for debridement of wound . 1220 pm retuned [sic] .wound to thigh debrided with dressing in place . A progress note, dated 01/05/23, read in parts, .continues with burn wound to posterior right thigh measuring 2.0 x 0.4 cm . 2. Res #22 was admitted with diagnoses which included cerebral infarction. A care plan, dated 09/18/22, documented Res #22 required setup assistance with meals. A progress note, dated 12/28/22 at 7:15 a.m., read in parts, .cna reports that as i was putting a throw blanket around resident shoulders, in the dining room, i spilled coffee on her lap .7.5 cm x 4.5 cm red area noted to l anterior thigh, 6 cm x 2.5 cm red area noted to l inner thigh, 3 cm x 3 cm red area noted to r anterior inner thigh, skin intact to all areas, no blistering noted @ this time, notified pcp, received order to cleanse areas with ns, pat dry and apply silvadene every day . An untitled document, dated 12/28/22, read in parts, .DON ordered small red cups for drinking coffee with a lid. CNA will place blanket before bringing to dine. Resident has treatment with Silvadene until healed. Resident only drinks coffee on occasion not every day drinker. Resident will have 1 on 1 during meals. The document was signed by the DON. A physician's order, dated 12/28/22, documented to cleanse red area to bilateral thighs with NS, pat dry, and apply silvadine every day for coffee burn. A progress note, dated 12/30/22, documented to continue with Silvadene treatment to thighs for coffee burn. On 05/10/23, at 7:30 a.m., multiple staff members were observed serving coffee in cups without lids or added ice to multiple residents in the dining room. On 05/10/23 at 8:30 a.m., Res #10 was observed in the dining room drinking coffee. On 05/10/23 at 10:15 a.m., a sample cup of coffee was requested, served in the same manner as to residents. The DM served the cup of coffee, upon receipt of the cup of coffee, the DM was requested to check the temperature of the coffee. The DM placed the thermometer into the cup, the temperature of the coffee was 180 degrees Fahrenheit. The DM asked if the 180 degree coffee was a safe temperature, the DM reported it was too hot. The DM also reported they had made the Administrator aware of the coffee being too hot in November 2022. On 05/10/23 at 10:25 a.m., the Assistant Administrator and Nurse Consultant were informed by the surveyor of the 180 degree coffee. The surveyor asked the Assistant Administrator if the coffee temperature was a safe temperature and the Assistant Administrator reported they were not aware of safe temperatures for hot liquids. The Assistant Administrator reported Res #10 was served coffee in a cup with a lid on it and other residents were served coffee with ice. The Assistant Administrator reported they were not aware of the amount of ice or the temperature of the coffee before it was served to residents. On 05/10/23 at 10:45 a.m., the Assistant Administrator provided a Resident Census/Roster, the roster documented 21 residents drank coffee and 16 of the 21 residents were served coffee without ice. The roster did not document residents who drank coffee from cups with lids.