Based on surveyor observation, record review and staff interview, it has been determined that the facility failed to ensure that each resident receives adequate supervision to prevent accidents relative to falls for 1 of 2 residents reviewed, Resident ID #25 Findings are as follows: Review of the record revealed the resident was admitted to the facility in August of 2018 with diagnoses, including but not limited to, repeated falls, multiple fractures of ribs on the right side, fracture of upper end of left humerus (long bone in the upper arm), fracture of greater trochanter of left femur (upper part of the thigh), dementia and abnormalities of gait and mobility. Review of a document titled, Order Summary Report, revealed a current order dated 7/6/2022, for supervision on/off unit with rollator (a mobility device similar to a walker with 4 wheels) for all activity and ambulation. Review of the care plan, revised on 9/6/2022, revealed that s/he has interventions, including but not limited to, supervision on/off the unit with rollator for all activity and ambulation relative to potential falls and poor safety awareness. Review of a fall risk assessment, dated 12/29/2022, revealed that s/he is at high risk for falls. Surveyor observation of the resident on 1/30/2023 at 3:01 PM revealed the resident was ambulating in the hallway with his/her rollator without any staff present for supervision. Additional observations of this resident on 2/1/2023 revealed the following: - 10:52 AM: S/he was ambulating down the hallway without staff supervision then entered a room for church services. - Approximately 12:00 PM: S/he was observed ambulating in the hallway after exiting the church service, continued down to another hallway and then into a dining room without staff supervision. During an interview with Nursing Assistant's Staff A and B, on 2/1/2023 at approximately 2:00 PM, they revealed that the resident usually ambulates independently without staff supervision. Review of the January 2023 progress notes, revealed in part: - 1/17/2023 at 5:47 PM: Resident had an unwitnessed fall around 1505 [3:05 PM] .complained of pain to [his/her] left side/shoulder .did not recollect how [s/he] fell. Resident verbalized [s/he] will like to be sent to the hospital . During a surveyor interview with Licensed Practical Nurse Staff C, on 2/1/2023 at 2:22 PM, it was revealed that the unwitnessed fall on 1/17/2023 occurred in the hallway on the unit. She further revealed that her expectation would be that staff would either walk with the resident, or be within a short distance away to visualize him/her, when s/he is ambulating for supervision. During a surveyor interview with the Director of Nursing Services on 2/1/2023 at 4:28 PM, she was unable to provide evidence that the plan of care and the order for supervision were followed.

Based on surveyor observation, record review, and staff interview, it has been determined that the facility failed to ensure that food is stored, served, and distributed, in accordance with professional standards for food service safety, relative to the main kitchen. Findings are as follows: The Rhode Island Food Code 2018 Edition 3-501.19 Time as a Public Health Control reveals in part; .the food shall have an initial temperature of 5 degrees Celsius (41 degrees Fahrenheit) or less when removed from cold holding temperature control . Record review of the facility policy titled HOT & COLD FOOD HANDLING POLICY states in part, .It is the policy .to maintain food safety by proper .cold food holding .The food shall have an initial temperature control of 41 degrees or less if removed from cold holding temperature control .The temperature of cold food will be logged in the kitchen when removed from cold holding temperature . Additional record review of the facility policy titled FOOD PURCHASED & STORAGE states in part, .FOOD STORAGE .food is kept covered, labeled, dated and stored at a maximum of 41 degrees F [Fahrenheit] . 1. During the initial tour of the main kitchen in the presence of the Dietary Supervisor on 1/30/2023 at 8:30 AM revealed the following observations: In a reach-in freezer; - a one gallon resealable freezer bag with frozen blueberries covered with a thick layer of frost, not labeled, or dated - a one gallon resealable freezer bag with frozen peeled bananas, not labeled or dated - one unopened container of Cool Whip with an expiration date of 1/11/2023 In a walk-in dairy cooler/refrigerator; - one half block of sliced cheese, opened and not dated During a surveyor interview with the Dietary Supervisor on 1/30/2023 at approximately 8:35 AM she acknowledged the above findings. 2. During a surveyor observation in the main kitchen of the 2nd floor salad bar tray, in the presence of Dietary Staff D, on 01/30/2023 at 11:33 AM, revealed the following observations: - cottage cheese with an initial temperature of 41.9 degrees F when removed from cold holding temperature. - carrot raisin salad made with mayonnaise with an initial temperature of 44 degrees F when removed from cold holding temperature. During a subsequent surveyor observation of the temperatures for the 1st floor salad bar items on 1/30/2023 at 11:48 AM in the presence of Staff D revealed the following observations: - cottage cheese with an initial temperature of 46 degrees F when removed from cold holding temperature. - carrot raisin salad made with mayonnaise with an initial temperature of 47.6 degrees F when removed from cold holding temperature. During a surveyor interview with Staff D immediately following the above-mentioned observations, she acknowledged that the temperatures obtained were the initial temperatures when the food was removed from cold holding temperature. Additionally, she acknowledged that the temperatures were greater than 41 degrees and indicated the food was ready to be sent out and served for the lunch meal. During a surveyor interview with the Dietary Supervisor on 1/30/2023 at approximately 12:00 PM, she acknowledged that the initial temperatures of food should be 41 degrees or less if removed from cold holding temperature. 3. During a surveyor observation of the main kitchen on 1/31/2023 at 10:55 AM in the presence of Dietary [NAME] Staff E, revealed the following observations: - yogurt in an approximately one-quart sized plastic container retrieved from cold holding with a temperature of 46 degrees F obtained with the facility's thermometer and 46.9 degrees F with the surveyor's thermometer. - a small plastic container of yogurt with a temperature of 44.9 degrees F obtained with the facility's thermometer and 45 degrees F with the surveyor's thermometer when removed from cold holding temperature. - a container of carrot raisin salad made with mayonnaise that was stored in the back of the walk-in cooler/refrigerator with a temperature of 46.8 degrees F with the facility thermometer. - a sample of yogurt from a newly opened container with a temperature of 43.8 degrees F with the surveyor's thermometer when removed from cold holding temperature. - carrot raisin salad made with mayonnaise with a temperature of 46 degrees F with the facility's thermometer when removed from cold holding temperature. During a surveyor interview with Staff E at the time of the above-mentioned observations she acknowledged the findings and indicated that the items had not previously been removed from cold holding. During a surveyor interview with the Dietary Supervisor on 1/31/2023 at 11:10 AM, she indicated she would discard the items that did not have an initial temperature of 41 degrees or less when removed from cold holding. 4. During a surveyor observation of the main kitchen on 1/31/2023 at 11:35 AM in the presence of the Dietary Supervisor revealed the following observations: - carrot raisin salad made with mayonnaise that was retrieved from the dairy walk-in cooler with a temperature of 46.9 degrees F with the facility's thermometer and 47.1 degrees F with the surveyor's thermometer. - Oreo cream pie with a temperature of 46.0 degrees F with the facility's thermometer and 46.8 degrees F with the surveyor's thermometer. During a surveyor interview with the Dietary Supervisor immediately following the above-mentioned observations she acknowledged that the temperatures were greater than 41 degrees F when removed from cold holding and indicated she would discard the potentially hazardous food items and replace them with an alternate. During a surveyor observation of the main kitchen on 1/31/2023 at 2:09 PM in the presence of the dietary Supervisor revealed the following observations: - a container of facility prepared turkey salad made with mayonnaise that was retrieved from a walk-in cooler with a temperature of 50.7 degrees F when removed from cold holding. - a container of mayonnaise with a temperature of 44.9 when removed from cold holding. - a pan of cooked macaroni and cheese with a temperature of 42.9 degrees F when removed from cold holding. During a surveyor interview with the dietary supervisor immediately following the above-mentioned observations, she acknowledged the temperatures were above 41 degrees F. Additionally, she was unable to provide evidence that the facility ensured that food is stored, served, and distributed, in accordance with professional standards for food service safety.