**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, record review, observation, and interview the facility failed to revise the comprehensive care plan for 1 resident (Resident #99) related to an indwelling urinary catheter of 6 residents reviewed for indwelling urinary catheters. The findings include: Review of the facility's policy titled, Patient Care Plans, dated November 2023, showed .Care plans are updated as needed but are reviewed completely by the interdisciplinary team on a quarterly bases within 7 days of the completion of the clinical .assessment .new problems are handled as they arise and are to be added to the current care plan . Resident #99 was admitted to the facility on [DATE] with diagnoses including Adult Failure To Thrive, Hypertension, Chronic Kidney Disease, and Atrial Fibrillation. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], showed Resident #99 was cognitively intact and had an indwelling urinary catheter. Review of the Comprehensive Care Plan dated 12/7/2023, showed Resident #99 had an indwelling urinary catheter, and the diagnosis was Stage III Pressure Ulcer. Review of the current Physician's Orders showed an indwelling urinary catheter diagnosis of .Neuromuscular dysfunction of bladder . During an observation on 12/13/2023 at 7:15 AM, in the residents room with the Wound Care Nurse showed Resident #99 had an indwelling urinary catheter and the resident did not have a Stage III pressure ulcer. During an interview on 12/13/2023 at 8:25 AM, MDS Coordinator #2 stated the diagnosis for the indwelling urinary catheter for Resident #99 was Stage III pressure ulcer. During an interview on 12/13/2023 at 9:50 AM, the Director of Nursing (DON) stated the diagnosis for Resident #99's indwelling urinary catheter was a neurogenic bladder. The DON confirmed Resident #99 did not have a Stage III Pressure Ulcer and the care plan had not been revised to include the diagnosis of neurogenic bladder.

Based on facility policy review, observations, and interviews, the kitchen failed to store refrigerated food in a safe manner to prevent cross-contamination and failed to ensure refrigerated foods were dated to ensure expired foods were discarded, which had the potential to affect 111 of 111 residents. The findings include: Review of the facility's policy titled, Refrigerator and Freezer Storage, dated 11/2017, showed .all items are to be stored at least 6 [inches] off floor of walk-in units .Leftovers will be placed in .approved containers, covered, labeled .dated . Observation of the walk-in cooler with the Certified Dietary Manager (CDM) on 12/11/2023 at 8:05 AM, showed Four 5-pound containers of Pulled Pork stored on the floor of the walk-in cooler. Observation of the walk-in cooler with the CDM on 12/11/2023 at 8:05 AM, showed the following items were not labeled and dated: Three individual bowls of apple sauce Three individual bowls of chocolate pudding One individual bowl of salad Observation of the walk-in freezer with the CDM on 12/11/2023 at 8:08 AM, showed One ½ full bag of french-fries not labeled or dated. Observation of the reach-in freezer with the CDM on 12/11/2023 at 8:11 AM, showed One ½ lemon pie not labeled or dated. Observation of the reach-in cooler with the CDM on 12/11/2023 at 8:13 AM, showed One ½ full container of cottage-cheese not dated. During an interview on 12/12/2023 at 12:05 PM, the CDM stated all refrigerated and freezer food items were to be dated and stored properly. The DM confirmed the food items had not been stored and dated per the facility policy for refrigerator and freezer storage. Review of the manufacturer's guidelines titled, Ready Care, undated, showed .frozen shake .nectar consistency .Shelf life: 1 year from production date in frozen state. Once thawed, refrigerate for up to 14 days . During an observation on 12/12/2023 at 7:30 AM, on the 400-hall medication cart, showed five 4-oz cartons of nectar thickened liquid supplement stored at room temperature. During an interview on 12/12/2023 at 7:35 AM, Licensed Practical Nurse (LPN) #1 stated the nectar thickened liquid cartons were pulled from the unit refrigerator to use during medication administration. LPN #1 stated as referenced on the product label, the thickened liquids should be stored on ice or in the refrigerator. During an interview on 12/12/2023 at 7:45 AM, the Director of Nursing (DON) stated the thickened liquid supplement should not be stored at room temperature during medication administration. DON confirmed the thickened liquid supplement was not stored per manufacturer guidelines. During an interview on 12/12/2023 at 7:50 AM, the Certified Dietary Manager (CDM) stated the nectar thickened liquid supplements are stored in the freezer upon arrival to the facility and then placed in unit refrigerators for the floor staff to use during medication administration. CDM stated per manufacturer guidelines, the thickened liquid supplement should be stored in the refrigerator or on ice to maintain temperature during medication administration.

Based on review of the facility policy, observation, and interview, the facility failed to label, date, correctly store resident foods, and discard expired food items, potentially affecting 105 of 105 residents residing in the facility. The findings include: Review of the facility policy titled, Safety & Sanitation Best Practice Guidelines revised 11/2017 showed .Foods will be stored in their original container or .wrapped tightly in moisture-proof film, film, foil .Clearly labeled with the contents and the use by date . Observation and interview on 2/3/2020 at 10:38 AM, with the Dietary Manager (DM), in the walk-in refrigerator, revealed 65 half pint whole milk cartons with an expiration date of 1/30/2020, and 9 chicken tenders in a plastic container with no open date or expiration date. The DM confirmed the milk was expired, the chicken tenders were unlabeled, and available for resident use. Observation and interview on 2/3/2020 at 10:45 AM, with the DM, in the walk-in freezer revealed a box of 160 sausage links and a 12 pound box of whole hog sausage patties open to air. The DM confirmed the sausage links and sausage patties were stored incorrectly, open to air, and available for resident use. During an interview on 2/5/2020 at 1:15 PM, the Registered Dietician stated all open foods were to be labeled, dated, and expired foods were to be discarded.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the Resident Assessment Instrument (RAI) Version 3.0 Manual, review of the Minimum Data Set (MDS) and interview the facility failed to complete a timely quarterly assessment for 1 resident (#4) of 3 residents reviewed for MDS assessments of 32 sampled residents. The findings include: Medical record review revealed Resident #4 was admitted to the facility on [DATE] with diagnoses including Anxiety, Hypertension, Osteoarthritis, and Peripheral Vascular Disease. Review of the RAI Version 3.0 Manual Chapter 2: Assessments for the RAI revealed .The next non-comprehensive assessment is due within 92 days after the ARD [Assessment Reference Date] of the most recent .assessment . Medical record review for Resident #4 revealed an annual MDS had been completed with an ARD date of 10/9/18. Further review revealed a quarterly MDS assessment had not been completed 1/2019. Interview with the MDS Coordinator, Licensed Practical Nurse on 2/27/19 at 8:45 AM, in the MDS office, confirmed the quarterly assessment had not been completed timely for Resident #4.