Based on interview, record review, and observation, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. Specifically, cross contamination was observed in the kitchen during the dish cleaning process, the dishmachine did not reach the appropriate temperature, meals were not served appropriately, and multiple areas of the kitchen were observed to be soiled or in disrepair. Resident identifiers: 4 and 11. Findings include: 1. On 9/26/22 at 7:00 AM, Dietary Staff Member (DSM) 1 was observed in the kitchen next to the steam table area containing food. DSM 1 did not have a mask on. On 9/26/22 at 7:15 AM, an interview was conducted with DSM 1. DSM 1 stated that he did not like to wear masks because they were itchy. 2. On 9/26/22 at 7:05 AM, the dining area was observed. Multiple residents were observed to have been served a portion of bread crumbs, including residents 4 and 11. On 9/26/22 at approximately 7:20 AM, an interview was conducted with DSM 1. DSM 1 stated that if residents were on a mechanical soft diet, and there was bread on the menu, he would toast the bread and then blend it up to make bread crumbs to serve the residents. DSM 1 then stated that he had a list of the therapeutic menus, and how to adjust the menu for residents on a mechanical diet. The list was subsequently reviewed, and indicated that if a resident was on a mechanical soft diet, no adjustments were required to the bread. 3. On 9/26/22 at approximately 7:10 AM, an observation was made of the facility kitchen. The following observations were made: a. A large gouge on the counter in the dry storage area rendered the counter unsanitizable. The gouge was approximately 2 inches long and 1 inch high. b. The freezer in the dry storage area had a stack of approximately 6 small tortillas on the shelf. The tortillas were not in any container, but were completely open to air. c. The freezer in the dry storage area had a pie crust on the shelf that was open to air. d. The refrigerator in the dry storage area had 8 containers of an unknown substance that appeared to be pudding. The containers were not labeled or dated. e. The container of powdered milk had a scoop hung on the outside of it. The scoop was touching the shelving below it. The shelving was observed to have dust and grime on it. f. The microwave was observed to have spills and debris on it, both inside and out. g. The conduits next to the ice machine were observed to have dust and grime on them. 4. On 9/26/22 at approximately 7:15 AM, the dishmachine was observed. The dishmachine had instructions on the top portion of it, indicating that both the wash and rinse cycle needed to reach 120 degrees Fahrenheit (F). At 7:15 AM, the dishmachine was observed to reach a temperature of 80 degrees Fahrenheit (F) for the wash cycle, and 85 degrees F for the rinse cycle. After the wash and rinse cycles were complete, Dietary Staff Member (DSM) 1 was observed to open the machine, and pull the tray of clean dishes out of the machine. DSM 1 then went to the other side of the dishmachine and loaded dirty dishes into a tray. DSM 1 then walked to the three compartment sink and put the tips of his contaminated fingers under a stream of water that was going down into a container of thawing meat. DSM 1 was then observed to walk to the tray cart, and move it into the dry storage area, without appropriately washing his hands. DSM 1 then began loading soiled dishes into a tray and placed them in the dishmachine. After loading soiled dishes in the tray and starting the dishmachine, DSM 1 was observed to move to the other side of the dishmachine, and pick up clean trays with his contaminated hands, and put the trays away. At this time, the dishmachine was observed to reach a temperature of 89 degrees F for the wash cycle, and 90 degrees F for the rinse cycle. DSM 1 was then observed to open the garbage can lid to throw something away, and then proceed to put away a clean pot and several bowls without first washing his hands. At this time, the dishmachine was observed to reach a temperature of 98 degrees F for both the wash and rinse cycles. The next cycle of dishes was then observed. The dishmachine was observed to reach a temperature of 105 degrees F for the wash cycle, and 110 degrees for the rinse cycle. DSM 1 was observed to load the next load of soiled dishes into the machine, and was then asked what the temperature the dishmachine was supposed to reach. DSM 1 looked at the dishmachine, and stated that the temperature was currently 118 degrees on the wash cycle but that it was supposed to be 120 degrees. When asked what the protocol was for the dishmachine not reaching the correct temperature, DSM 1 stated that I just wash everything twice. The next cycle of dishes was then observed. The dishmachine was observed to reach a temperature of 110 degrees Fahrenheit for both the wash and rinse cycle. On 9/28/22 at 11:00 AM, an interview was conducted with the facility Registered Dietitian (RD). The RD stated that all DSMs are supposed to run the dishmachine until it reaches 120 degrees before processing dishes. The RD also confirmed that the DSMs are supposed to wash their hands between handling soiled dishes, and handling clean dishes. The RD confirmed that bread is not supposed to be placed in the blender to make bread crumbs for residents on a mechanical soft diet. The RD also confirmed that she had seen the uncovered tortillas and uncovered pie on 9/26/22, after the surveyor had entered the kitchen. The RD stated that she had subsequently educated DSM 1 about dishmachine temperatures and appropriate covering of food.

Based on observation and interview it was determined that the facility did not store and distribute food in accordance with professional standards for food service safety. Specifically, there were condiments in a metal baskets on the dining room tables that were not sanitized between meal service. In addition, there was peeling paint in the kitchen. Resident identifiers: 2, 10, 18 and 35. Findings include: 1. On 4/12/21 at 11:53 AM, an observation was made of the dining room. There was a meal schedule hanging in the dining room that revealed there were two meal services in the dining room. Tables were observed with one chair per table, with a caddy container of condiments located in the center of the table. The container included salt, pepper, butter packets, mayonnaise, ketchup and hot sauce. The first dining service began at 11:53 AM. On 4/12/21 at 11:53 AM, an observation was made of residents eating lunch in the dining room. Resident 2 was observed to be sitting at a table with a condiment caddy. Resident 2 was observed to cough toward the condiment caddy. Resident 2 was eating and did not have a mask on. At 12:10 PM, an observation was made of the housekeeping staff wiping the tables. At 12:15 PM, an observation was made of resident 10 sitting at the same table with the same condiment caddy. The condiment caddy had not been sanitized between meal services. On 4/12/21 at 11:53 AM, an observation was made of resident 18. Resident 18 was observed to be eating alone at a table that was set with a condiment caddy. At 12:11 PM, an observation was made of the house keeping staff wiped down the table. At 12:16 PM, resident 35 was observed sitting at a table which had been previously used by resident 18. Resident 35 was observed using the mayonnaise from the condiment caddy. On 4/13/21 at 12:24 PM, Licensed Practical Nurse (LPN) 1 was observed removing condiment caddies from the tables and placing them onto a storage cart without sanitizing condiment containers. On 4/13/21 at 12:33 PM, the cart containing the condiment caddies was observed to be stored within the kitchen. On 4/13/21 at 12:33 PM, an interview was conducted with the Dietary Manager (DM). The DM stated that the condiments and metal baskets were sanitized every night. The DM stated they were not sanitized between meals. 2. On 4/13/21 at 12:25 PM, an observation was made of the facility kitchen. There was paint peeling in the cabinet with the domes that were used to cover the food. The DM was interviewed immediately. The DM stated he had tried to fix the peeling paint in the cabinet a few months ago and it was peeling again.