**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, facility investigation, and interview the facility failed to prevent abuse for 1 Resident (#50) of 24 residents reviewed for abuse. The findings include: Review of facility abuse policy titled Abuse Prevention Policy & Procedure revised 9/5/2018, showed .Abuse Is the willful infliction of injury .Willful means non- accidental, Physical abuse .'abuse' means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm .Includes, but is not limited to, hitting, slapping, pinching, kicking, controlling behavior through corporal punishment, or any similar touching of a resident that does not have an appropriate therapeutic purpose . Resident #50 was admitted to the facility on [DATE] with diagnoses including Chronic Obstructive Pulmonary Disease, Acute Respiratory Failure, Hypothyroidism, Dementia with Agitation, Anxiety Disorder, and Hypertension. Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #50 had severe cognitive impairment. Review of a comprehensive care plan revised 5/6/2023 showed Resident #50 had exhibited behaviors of wandering, aggression, and agitation. Resident #61 was admitted to the facility on [DATE] with diagnoses including Major Depressive Disorder, Anxiety Disorder, Cerebral Ischemia, Disorders of the Brain, Mood Disorder, and Dementia. Review of a quarterly MDS assessment dated [DATE] showed Resident #61 had severe cognitive impairment. Review of a comprehensive care plan revised 5/6/2023 showed Resident #61 exhibited combative behaviors during care and during episodes of confusion.May grab staff if in his personal space . Review of a nursing note dated 5/6/2023 showed .male resident [#61] .began to curse her [Resident #50] and when she got beside male resident [#61] he grabbed her arm. This nurse separated the two residents [Residents #50 and #61] .found a bruise on left forearm [of Resident #50] where male resident [#61] grabbed her [Resident #50] . Review of a facility investigation dated 5/6/2023 - 5/11/2023 showed Resident #61 grabbed Resident #50's arm resulting in a bruised forearm. Resident #61 was put on 1:1 supervision following the incident. During an interview on 5/16/2023 at 1:35 PM, the administrator stated Licensed Practical Nurse (LPN) #1 was the only witness to the altercation between Resident #50 and Resident #61. During a telephone interview on 5/16/2023 at 2:07 PM, LPN #1 stated on 5/6/2023 Resident #61 was redirected from attempting to exit to an empty section of the facility, became agitated and was directed to the other end of the hallway. LPN #1 stated a few minutes later Resident #50 walked down the hall and Resident #61 began cursing Resident #50 as she got near and grabbed her left forearm causing bruising.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the facility policy, medical record review, review of the facility investigation and interview, the facility failed to prevent resident versus resident altercations (abuse) for 2 residents (#4 and #5) of 7 residents reviewed for abuse. The findings included: Review of the facility policy, Abuse, Neglect and Misappropriation of Property, effective 5/27/2016, last revised 10/17/2022 showed, .Physical abuse .Includes, but is not limited to, hitting, slapping, punching or kicking . Medical record review showed Resident #4 was admitted to the facility on [DATE], with diagnoses including Alzheimer's Disease, Dysphagia, Malnutrition, and Depression. Resident #4 was severely cognitively impaired with impaired thought processes, wandered daily, but had no history of aggression towards self or others. Resident #4 had no psychotic or delusional behaviors and required assistance of one person for all activities of daily living. Medical record review showed Resident #5 was admitted to the facility on [DATE], with diagnoses including Dementia with Agitation and Behaviors, Chronic Obstructive Pulmonary Disease, Malnutrition, and Major Depression. Resident #5 was severely cognitively impaired with a Brief Interview of Mental Status (BIMS) score of 2, had impaired thought processes but no history of aggression directed towards self or others. Resident #5 required assistance of one person for all activities of daily living. Review of the facility investigation and witness statements showed on 12/23/2022 around 9:43 PM, Resident #4 wandered into the doorway of Resident #5's room. Resident #5 became agitated with Resident #4's presence and approached her yelling at her to leave. As staff in close- proximity to both residents responded to separate them, Resident #4 slapped Resident #5 across her face with an open hand. Resident #5 retaliated, pushed Resident #4, who bumped against the door frame, then fell to the floor. Resident #4 sustained a superficial 0.5 centimeter (cm), sized skin tear to her right elbow, a 3 cm bruise to her right shoulder and redness to her right hip caused by her fall. Resident #5 was not injured. Interview with the Secure Unit Charge Nurse, Registered Nurse (RN) #2 on 1/10/2023 at 2:59 PM, at the secure unit nursing station, revealed on the day of the altercation neither resident exhibited any pattern of behavioral escalation or aggression prior to the incident. RN #2 reported staff members were present on the unit in close proximity to both residents escorting another resident to bed for the evening and heard Resident #5 begin to curse and yell at Resident #4 as she approached the doorway to Resident #5's room. Resident #5 was inside the room and Resident #4 approached from the hallway. As staff attempted to intercede, Resident #5 and Resident #4 met at the doorway. Resident #5 yelled at Resident #4 and without warning, Resident #4 slapped her. Immediately, Resident #5 retaliated and pushed Resident #4 who lost her balance, bounced off the door frame, and fell to the floor before a staff member behind her could get between the two residents. The residents were immediately separated with Resident #4 taken to her room and placed on 1 to 1 supervision after she was assessed for injuries. A small skin tear less than dime-sized on her arm was covered with a band aid. Resident #5 was also monitored 1 to 1 for around 30 minutes before she retired for the evening and was then placed on every 15- minute checks. Resident #4 remained on 1 to 1 supervision for about two hours as she remained awake, but once she retired for the evening, was also changed to every 15- minute checks. Both residents had no recall of the incident by the next morning and remained on every 15- minute checks for 48 hours without further incident. RN #2 reported at time of the incident on 12/23/2022, the unit was staffed with a supervising nurse and 2 Certified Nurse Assistants (CNAs) for 4 residents present. RN #2 stated the incident was reviewed in the morning shift change report as well as the morning leadership meeting on 12/24/2022. Interview with the Director of Nursing (DON) and Administrator on 1/11/2023, at 3:30 PM in the conference room, confirmed the resident versus resident altercation had occurred, both residents exhibited willful acts of aggression as documented in the facility investigation. The Administrator confirmed the facility failed to prevent resident abuse. Facility corrective actions included: 1. 12/23/2022, Resident #4 and Resident #5 were immediately separated and placed on 1 to 1 supervision. Both were assessed for injuries by the supervising nurse. Resident #4 had a band aid applied to a superficial skin tear on her arm. Resident #4 was placed on 1 to 1 supervision until she calmed and fell asleep. Afterwards she was maintained on every 15- minute checks. Resident #5 was also placed on 1 to 1 supervision until she calmed and retired for the evening. After she was asleep, she too was placed on every 15-minute checks. Both residents remained on every 15- minute checks for 48 hours with no further behaviors or altercations. Review of facility documentation and medical record review confirmed 15-minute checks were completed. 2. Plans of care were updated for both Residents on 12/23/2022. A stop sign was added to the door for Resident #5's room to deter others from wandering into the room. Interventions to redirect and use snack items to reduce wandering in Resident #4 were added to her care planned interventions as previously identified triggers for wandering in Resident #4, included hunger. Review of the care plans confirmed the care plans were updated and interview with staff confirmed their knowledge of the care plan updates. 3. Skin Assessments for all other persons on the secure unit were performed on 12/23/2022 with no negative findings. Review of documentation confirmed skin checks were completed. 4. On 12/24/2022 Resident #5 demanded the stop sign on her door be removed. The request was honored. The care plan was updated again to reflect removal of the barrier. Review of the care plan confirmed the care plan was updated to reflect the change. 5. On 12/25/2022 every 15- minute checks for both residents were discontinued, close monitoring by secure unit staff continued. No further altercations or problem behaviors were present in either resident. 6. On 12/26/2022 the facility held an ad hoc QA (Quality Assurance) meeting related to the incident. A root cause analysis (RCA) was completed. Psychiatric services were ordered to evaluate both residents post incident. Staff training in relation to the incident was formulated and implementation of the training started. Training included review of the abuse policy and review of all updated interventions implemented for both residents on the care plans. Review of facility documentation confirmed completion of the QA meeting and review of training records confirmed completion of training. Staff interviews conducted confirmed staff's knowledge of implemented interventions. 7. On 12/28/2022 Psychiatric Evaluations of both residents were completed by the Psychiatric Nurse Practitioner with no negative findings and no changes to the psychiatric regimens of either resident. Follow-up evaluations by the medical staff were also completed with no negative findings or changes to the medical regimens for both residents. Review of the medical records confirmed psychiatric evaluations were completed. 8. On 12/29/2022 the meal tray orders for Resident #4 were adjusted to include increased portions in addition to extra evening snacks to reduce hunger. Review of facility documentation confirmed the updates to the resident's meal tray orders. 9. On 12/30/2022, all mandatory staff training implemented in response to the incident, with post testing, was completed. All staff passed testing as required. Review of facility documentation confirmed education was completed and interviews with staff confirmed staff's knowledge and understanding of received education. 10. On 12/30/2022 the Interdisciplinary Team (IDT) team and QAPI (Quality Assurance and Performance Improvement) team implemented plans for ongoing monitoring of the interventions, to be performed by nursing management as designed by the DON or Administrator, during the morning whiteboard and 24- hour report meeting, Mondays through Fridays and report any significant findings to the QAPI committee for 4 weeks. The findings will be reported to the full QAPI committee for 2 months with the first review held at the end of January 2023. The QAPI committee will evaluate the need for continued monitoring after the second report in February 2023.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, observation, and interview, the facility failed to revise the care plan to include the use of the back and collar brace for 1 resident (#35) of 25 residents reviewed for care plans. The findings include: Review of the facility policy, Comprehensive Care Plans, revised 7/19/18, revealed .Each resident's Comprehensive Care Plan is designed to .incorporate identified problem areas; incorporate risk factors associated with identified problems . Medical record review revealed Resident #35 was admitted to the facility on [DATE] with diagnoses including Dementia, Alzheimer's Disease, Pain, and Muscle Weakness. Medical record review of Resident #35's Current Comprehensive Care Plan, dated 6/28/19, revealed no documentation of the back and collar brace. Medical record review of the admission Minimum Data Set, dated [DATE] revealed Resident #35 had a Brief Interview for Mental Status (BIMS) score of 00, indicating severe cognitive impairment, and was unable to complete the interview. Medical record review of Physician Order Report revealed .7/11/19 .Back and collar brace .Special Instructions: Resident needs to wear her back and collar brace . Observation of Resident #35 on 10/14/19 at 2:46 PM, in the main dining room revealed Resident #35 was smiling and engaged in a group bingo activity. Interview with the Unit Manager (UM) #1 on 10/15/19 at 2:42 PM, confirmed she was unaware of the brace. Further interview confirmed it was UM #1's responsibility to apply the brace. Interview with Corporate Nurse #1 on 10/16/19 at 9:13 AM, in the conference room, confirmed it was her expectation that the brace intervention be care planned. Further interview confirmed the brace was not included on Resident #35's Current Comprehensive Care Plan .it's not on there .

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on facility policy review, medical record review, review of the facility's falls documentation, observation, and interview, the facility failed to implement appropriate interventions to prevent falls, failed to complete a fall risk assessment, and failed to complete a fall investigation for 1 resident (#70) of 3 residents reviewed for accidents. The findings include: Review of the facility Falls Policy, dated 7/16/19, revealed .All residents will have a comprehensive fall risk assessment on admission/readmission, quarterly, annually and with significant change of condition .Appropriate care plan interventions will be implemented and evaluated as indicated by assessment .If a fall occurs the following actions will be taken .Evaluate resident .Document the evaluation, pertinent facts and incident . Medical record review revealed Resident #70 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses including Vascular Dementia with Behavioral Disturbance, Emphysema, Encephalopathy, and Osteoarthritis. Medical record review of Resident #70's admission Minimum Data Set (MDS) dated [DATE], revealed the resident had severe cognitive impairment. Continued review revealed the resident required extensive assist of 1 staff member for bed, transfer, and dressing. Medical record review of Resident #70's Fall Risk Assessment, dated 3/21/19, revealed a score of 24, a score of 10 or greater, indicated the resident was at high risk for falls. Review of the facility Falls Investigation, dated 4/18/19, revealed Resident #70 had a fall without injury. Review of a facility Falls Investigation, dated 6/20/19, revealed .Fall without injury . Continued review revealed the fall investigation had not been completed. Medical record review of Resident #70's Fall Risk Assessment, dated 7/18/19, revealed a score of 18, a score of 10 or greater, indicated the resident was at high risk for falls. Review of a facility Falls Investigation, dated 8/20/19, revealed the resident had an unwitnessed fall without injury. Medical record review of the Comprehensive Care Plan dated 9/19/19, revealed a new fall intervention had not been implemented after the falls on 6/20/19 and 8/20/19. Medical record review of the Fall Risk Assessment revealed a quarterly falls risk assessment had not been completed for 9/24/19. Observation of Resident #70 on 10/15/19 at 7:40 AM, in the residents room, sleeping in bed. Interview with the Interim Director of Nursing on 10/16/19 at 12:05 PM, in the conference room, confirmed the facility failed to follow their falls policy, failed to complete a falls investigation, failed to complete falls risk assessments and failed to implement appropriate falls interventions to prevent falls for Resident #70.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to complete an annual Minimum Data Set (MDS) for 1 resident (#1) of 25 residents reviewed. The findings include: Medical record review revealed Resident #1 was re-admitted to the facility on [DATE] with diagnoses including Dementia with Behavioral Disturbance, Major Depressive Disorder, and Anxiety. Medical record review of the MDS history, revealed Resident #1 had an entry MDS assessment completed on 3/26/18, a quarterly assessment was completed on 4/13/18, and no further assessments were noted in the system. Telephone interview with the Clinical Reimbursement Consultant on 9/19/18 at 5:10 PM, confirmed an annual MDS with an assessment reference date of 7/14/18, was initiated and not completed, and no further assessments have been completed for Resident #1.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, medical record review, observation, and interview, the facility failed to revise the Comprehensive Care Plan to address post fall interventions for 1 resident (#22) of 25 residents reviewed. The findings include: Review of the facility's Falls Policy Statement, undated, revealed .If a fall occurs the following actions will be taken: Update care plan . Medical record review revealed Resident #22 was admitted to the facility on [DATE] with diagnoses including Bipolar Disorder, Anemia, Hypertension, and Dementia. Medical record review of the quarterly Minimum Data Set, dated [DATE] revealed the resident was severely cognitively impaired, required maximum to total assistance with all activities of daily living, and had previously fallen. Medical record review of the Nursing Assessment for description of falls and the post fall interventions initiated dated: on 4/12/18 revealed the resident fell out of bed, and the post fall intervention was to assess the resident's normal routines; 4/30/18 the resident fell from the wheel chair, and the post fall intervention was to offer to assist the resident to bed after the evening meal; 5/14/18 the resident fell from the bed, and the post fall intervention was to monitor pain, place fall mats next to bed; 5/18/18 the resident fell from the bed, and the post fall intervention was to place fall mats to both sides of the bed; 6/12/18 the resident fell from the wheel chair, and the post fall intervention was to remove the wheel chair foot rests; 6/29/18 the resident fell from the bed, and the post fall intervention was to place fall mats next to the bed; 7/31/18 the resident fell from the bed, and the post fall intervention was to keep the resident close to the nurse's station; and on 8/5/18 the resident fell from the wheel chair, and the post fall intervention was to keep the resident close to the nurse's station and to assess the resident's routines. Medical record review of the Comprehensive Care Plan dated 4/17/18 revealed .At risk for fall related injury .assist resident with transfers as needed .anticipate resident needs .monitor for pain . with no further interventions to prevent further falls. Observation of Resident #22 on 9/17/18 to 9/19/18 at various times from 8:00 AM to 5:00 PM, revealed the resident was in the bed with a curved mattress, was very restless, but made no attempts to climb out of the bed. Interview with the Interim Director of Nursing on 9/19/18 at 7:25 PM, in the conference room, confirmed Resident #22's Comprehensive Care Plan had not been revised to address the post fall interventions.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to attempt a Gradual Dose Reduction (GDR) of psychotropic medications for 1 resident (#38) of 5 residents reviewed for unnecessary medications of 25 residents sampled. The findings include: Medical record review revealed Resident #38 was admitted to the facility on [DATE] with diagnoses including Dementia with Behavioral Disturbance, Psychotic Disorder with Delusions, Insomnia, and Depression. Medical record review of the quarterly Minimum Data Set, dated [DATE] revealed Resident #38 was easily annoyed and rummages through items, received antipsychotic, antidepressant, and antianxiety medications 7 days each week, and no GDR had been attempted. Medical record review of the Physician's Order Sheet revealed on 12/12/17: Ativan (antianxiety) 0.5 milligrams (mg) by mouth three times daily for anxiety; Zyprexa (antipsychotic) 20 mg by mouth daily at bedtime for mood and behaviors; Lexapro (antidepressant) 20 mg by mouth daily at bedtime for mood; and mirtazapine (antidepressant) 30 mg by mouth daily at bedtime for mood. Continued review revealed a Physician's Order for Depakote DR (Delayed Release) 125 mg by mouth 2 times daily for behaviors. Medical record review of the monthly pharmacist reviews, revealed the pharmacist initialed each month the resident's medications were reviewed, with no recommendations for GDR of psychotropic medications. Observation on 9/19/18 at 2:30 PM, on the secure unit revealed Resident #38 was seated at the table in the day area with a busy cloth (promotes self-directed activity). Continued observation revealed the resident was calm and observed the activity taking place. Interview with the Corporate Regional Nurse on 9/19/18 at 5:30 PM, in the conference room confirmed no GDRs of Resident #38's Ativan, Depakote, Lexapro, Mirtazapine, and Zyprexa had been attempted since the resident's admission to the facility on [DATE].

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of facility policy, observation, and interview, the facility failed to distribute and serve food under sanitary conditions for 1 unit of 3 units observed for dining, and failed to perform proper hand hygiene after providing peri-care for 1 resident of 2 residents observed for peri-care. The findings include: Review of the facility policy, Handwashing/Hand Hygiene, revised 8/2015 revealed .All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .Use an alcohol-based hand rub .or, alternatively, soap .and water for the following situations .Before and after assisting a resident with meals .After contact with objects (e.g., [for example] medical equipment} in the immediate vicinity of the resident .After removing gloves . Observation on 9/17/18 from 1:00 PM-1:07 PM, on the [NAME] Unit revealed Certified Nursing Assistant (CNA) #2 delivered a lunch tray to Resident #29 in the resident's room, moved the resident's bedside table and exited the room without performing hand hygiene; CNA #2 then delivered a lunch tray to Resident #62, moved the resident's bedside table, touched the resident's bed and the privacy curtain, and exited the room without performing hand hygiene; CNA #2 proceeded to deliver a lunch tray and pour coffee for Resident #42, and exited the room without performing hand hygiene. Further observation revealed CNA #2 delivered a lunch tray to Resident #58, moved a soiled shirt from the bedside table, touched the linen on the resident's bed, moved the resident's bedside table, touched the call light which was laying on the bedside commode, placed the soiled clothes in a plastic bag, and carried the soiled clothes to the soiled utility room. Continued observation revealed CNA #2 did not perform hand hygiene and proceeded to the cart to retrieve another tray. Interview with CNA #2 on 9/17/18 at 1:07 PM, on the [NAME] hallway, confirmed CNA #2 had failed to perform hand hygiene between residents and after contact with objects in the resident's rooms during the lunch meal tray pass. Interview with the Interim Director of Nursing (DON) on 9/17/18 at 3:00 PM, in the hall outside of the DON's office, confirmed staff was expected to perform hand hygiene between residents during the meal tray pass and after touching objects in the resident's room. Observation on 9/19/18 at 3:48 PM, in a resident's room of Certified Nursing Assistant (CNA) #1 providing peri-care for a resident revealed after CNA #1 completed the peri-care, the CNA touched the resident's blanket to place the blanket over the resident, repositioned the call light, and washed the bedpan, and then removed the contaminated gloves. Continued observation revealed CNA #1 did not perform hand hygiene after she removed the contaminated gloves, donned one new glove, and adjusted the resident's head of the bed. Interview with CNA #1 on 9/19/18 at 3:55 PM, on the [NAME] hallway, confirmed she had not removed the contaminated gloves and performed hand hygiene after providing resident care prior to donning one new glove. Interview with the Interim Director of Nursing on 9/19/18 at 5:10 PM, in the conference room confirmed the facility failed to follow their facility policy regarding hand hygiene after resident care and before donning new gloves

Based on facility policy review, observation, and interview the facility failed to maintain a sanitary kitchen with undated, unlabeled foods, expired foods, opened to air food items, and dirt and/or debris in 1 of 3 food storage bins, and improper cleaning of 1 of 3 food storage bins in the kitchen. The facility failed to maintain sanitary resident nourishment refrigerators with undated, unlabeled foods and expired foods, in 3 of 3 food nourishment refrigerators affecting 75 of 76 residents. The findings include: Review of facility policy Food Storage with a revised date of 9/14/18 revealed . Food items should be stored .with good sanitary practice .Any expired or outdated food products should be discarded .Use use-by-dates on all food stored in refrigerators .Remember to cover, label, and date .Dry storage .Clean and sanitize outside of food bins daily . Review of the facility policy Foods Brought by Family/Visitors with a review date of 6/27/18, revealed, .Perishable foods will be stored in re-sealable containers with tight fitting lids in the refrigerator .Containers will be labeled with the resident's name .Staff will discard perishable foods on or before the use by date . Observation and interview with the Dietary Manager (DM) on 9/17/18 at 9:28-9:55 AM, in the kitchen, of the 2nd milk cooler, revealed: Seven 6 fluid ounce cartons of apple cranberry nutritional juice drinks, undated and available for resident use. Nine 6 fluid ounce cartons of orange nutritional juice drinks, undated, and available for resident use. Interview at this time with the DM confirmed the nutritional drinks were not dated, and the DM was unsure how long the nutritional drinks had been in the milk cooler, and was unaware of how to read the code (expiration date) on the nutritional drinks. Further interview confirmed the nutritional drinks were expired. Observation and interview with the DM on 9/17/18 at 9:42 AM, in the kitchen, revealed dark black and brown debris around the top of the sugar, flour, and cornmeal storage bins. Continued observation revealed dark brown and black debris in the cornmeal storage bin. Interview confirmed the facility failed to maintain the sugar, flour, and cornmeal storage bins in a sanitary manner. Observation and interview with the DM on 9/17/18 from 9:57-10:02 AM, at the walk-in refrigerator, in the kitchen revealed: 3 pound bag of shredded cheddar cheese undated, open to air, and available for resident use. 1 half pound bag of shredded mozzarella cheese open to air, undated and available for resident use. 1 pound of sliced provolone cheese open to air, undated, and available for resident use. 8 pancakes in a plastic bag open to air, undated, and available for resident use. Interview with the DM at this time confirmed all items identified in the refrigerator were undated and open to air. Observation and interview with the DM, on 9/17/18 from 10:05-10:06 AM, in the kitchen, revealed 2 slices of bread in a partially closed plastic bag open to air and available for resident use on the bread rack. Interview confirmed the facility failed to secure the open bread. Observation and interview with the DM on 9/18/18 at 9:56-9:58 AM, of the secure unit nourishment refrigerator in the nursing station, revealed: Three, 4 ounce, low fat strawberry/banana yogurt cups with an expiration date of 9/17/2018 and available for resident use. Interview with the DM at this time confirmed the yogurt cups were expired and available for resident use. Observation and interview with the DM on 9/18/18 at 10:02-10:08 AM, of the 200 hall, nursing station, nourishment refrigerator revealed: Half a gallon carton of whole cultured buttermilk approximately 3/4th full labeled with a resident's name and expired date of 9/9/18 available for resident use. Two opened, 24-ounce favored yellow sodas, 1/3 full, unlabeled without the resident's name, undated when opened, and available for resident use. Interview with the DM at this time confirmed the cultured milk had expired and the facility failed to discard the expired milk. Further interview confirmed the facility failed to label, and date sodas available for resident use. Observation and interview with the DM on 9/18/18 at 10:11-10:16 AM, of the 300 hall, resident nourishment refrigerator, revealed: One, 20 ounce bottle of fruit punch electrolyte replacement drink, approximately 1/2 full, undated and unlabeled with a resident's name. Interview with the DM at this time confirmed the facility failed to label and date the fruit punch electrolyte replacement drink.