Based on observation, interview, record review, and policy review, the provider failed to ensure that staff were able to verify the dishwasher rinse cycle temperature to confirm that the dishes were sanitized at the proper temperature. Failure to ensure that increased the potential risk of foodborne illnesses for the entire resident population who received meals prepared in the kitchen. Findings include: 1. Observation on 12/12/23 at 8:30 a.m. in the kitchen revealed: *The dishwasher rinse cycle temperature gauge was not working. *The December 2023 Dishwasher Temp Log documented a breakfast rinse temperature on 12/12/23 of 192 degrees Fahrenheit. Observation on 12/13/23 at 12:15 p.m. of the dishwasher in the kitchen revealed that the rinse cycle temperature gauge was not working through two full washing and rinsing cycles. Interview at that time with dietary aide (DA) G and F revealed: *DA G was not aware that the temperature gauge was not working. When asked how he was measuring the temperature of the dishwasher rinse cycle, he shrugged his shoulders and pointed to DA F. *DA F was not aware that the dishwasher rinse temperature gauge was not working. -She stated that the food service supervisor had given her the Dishwasher Temperature Sensor Labels that morning. Staff were using them to measure dishwasher temperatures. -She demonstrated how staff use the sensor labels by placing them on a dish and running it through the dishwasher. -She explained that there were three temperature boxes on the label for 160, 170, and 180 degrees Fahrenheit. If the temperature box turned black after the full dishwasher wash and rinse cycle, that corresponding temperature was achieved. *Upon closer inspection of the Dishwasher Temperature Sensor Labels, it was noted that they expired on 5/30/2015. Observation and interview on 12/13/23 at 2:15 p.m. in the kitchen with DA G and cook E revealed: *The dishwasher rinse temperature gauge was still not functioning after observing three full wash and rinse cycles. *DA G was again asked how he measured the dishwasher temperatures. He pointed to the gauges and stated that he documented the temperatures from the gauges onto the Dishwasher Temp Log once per meal. *The rinse temperatures on the Dishwasher Temp Log were recorded as follows: -12/12/23 breakfast, 192 degrees Fahrenheit. -12/12/23 lunch, 188 degrees Fahrenheit. -12/12/23 supper, 190 degrees Fahrenheit. -12/13/23 breakfast, 190 degrees Fahrenheit. -12/13/23 lunch, 180 degrees Fahrenheit. *He was unable to explain what process would have been required if the rinse temperature gauge was not functioning. *He was not aware of the sensor labels that were to have been used secondary to the rinse temperature gauge. *Cook E was not aware that the rinse temperature gauge was not working and stated that she did not usually wash the dishes. Interview on 12/13/23 at 2:22 p.m. with food service supervisor (FSS) D revealed: *She was not aware that the dishwasher rinse temperature gauge was broken and the sensor labels had expired. *She explained that the dishwasher servicing company had sent those labels last year and the dishwasher was last serviced in October 2023. 2. IMMEDIATE JEOPARDY Interviews with dietary staff throughout the survey indicated that no one was aware that the dishwasher rinse cycle temperature gauge was not functioning, the staff somehow were still recording the rinse temperatures on the Dishwasher Temp Log. At least two dietary staff interviewed were unaware of the secondary sensor labels. The staff that were aware of the temperature sensor labels were not aware that they were expired. Staff were not aware of any process to follow when the rinse temperature gauge was not functioning. At the time of the survey, staff could not accurately verify the final rinse temperature of the dishwasher to ensure proper sanitation due to the non-functioning rinse gauge and the expired sensor labels. IMMEDIATE JEOPARDY NOTICE Notice of immediate jeopardy was given verbally and in writing on 12/13/23 at 3:05 p.m. to administrator A and FSS D. They were asked for an immediate removal plan. Interview at that time with administrator A and FSS D about the rinse gauge revealed: *FSS D said, no one can tell me when it wasn't working, when referring to the broken rinse gauge. -She also indicated that staff might have been guessing what they think the temp should be when they wrote the temperatures on the Dishwasher Temp Log. *DA F had told FSS D that the gauge had been working on 12/11/23. *Other staff had told her that when the rinse gauge was not working on previous occasions, they would flick the gauge which sometimes made it work again. IMMEDIATE JEOPARDY REMOVAL PLAN On 12/13/23 at 5:29 p.m., administrator A provided the survey team with a final written immediate jeopardy removal plan. The removal plan had been approved by the survey team on 12/13/23 at 6:27 p.m. with guidance from the long-term care advisor for the South Dakota Department of Health. The provider gave the following acceptable immediate jeopardy removal plan on 12/13/23 at 5:29 p.m.: *On 12/13/2023 at 4:08 p.m. our facility did the following to ensure safety/compliance . 1. The [dishwasher servicing company] technician was called at 3:15 p.m. about the faulty gauge and he said that he will be here right away on the morning of 12/14/2023 to change out the gauge with a new one. 2. We will be serving supper and breakfast on paper plates and plastic silverware to ensure sanitation until the gauge is fixed in the morning. 3. All prep items to include: pots/pans/other to be washed in the 3 bin sink at the proper regulated temperatures. Those temperatures will be logged and dated by the dietary staff each time they use it. 4. We took [a] meat thermometer and placed [it] in the dishwasher during the rinse cycle and it temped out at 180 degrees. 5. Dietary staff were instructed to notify Certified Dietary Manager right away if there is a faulty piece of equipment so proper safety/protocols can be implemented to ensure safety. 6. New test strips have been ordered today when we found out ours were expired. 7. Certified Dietary Manager provided all dietary staff with the following education: foodborne illnesses, how it is caused, how to prevent food born illnesses, and the importance of sanitizing food contact surfaces. All Dietary staff will sign and date that they have read the education prior to working their shift. Observation and interview on 12/14/23 at 8:15 a.m. with administrator A and the dishwasher company's technician I in the kitchen revealed: *Dishwasher technician I was installing the new rinse temperature gauge. *Administrator A was stressing that there was no potential for harm at all because the temperature of the rinse cycle was just fine. *Administrator A questioned why the surveyors had not informed him that the rinse gauge was not working. *Surveyors questioned why staff decided to flick the gauge to make it work again temporarily rather than informing management that the gauge was malfunctioning. *After administrator A had left the kitchen at 8:20 a.m., dishwasher technician I stated, I can understand your concern, when mentioning the rinse gauge malfunctioning. The immediate jeopardy was removed on 12/14/23 at 12:30 p.m. after verification that the provider had implemented their removal plan. After the removal of the immediate jeopardy, the scope and severity of the citation level was F. 3. Review of an electronic communication sent by administrator A to the survey team on 12/13/23 at 5:29 p.m. revealed: *Administrator A denied that any of [the] residents were negatively affected by this practice. 4. Review of the provider's documentation on when the dishwasher was last serviced revealed: *Dishwasher technician I visited the facility on 10/26/23. *He noted the rinse temperature of the dishwasher was at 184 degrees Fahrenheit.