Health inspection·August 27, 2021

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 8/25/2021 at 2:40 p.m., an interview with the Wound Care Nurse/100-200 Unit Manager revealed she had provided wound care and a dressing change to Resident #54 at the beginning of the 7 AM to 3 PM shift. She revealed she had changed the dressing on the left foot and right leg. The wound care nurse was not aware of any area on the right arm but stated she would check on it. On 8/26/2021 at 7:09 a.m. and at 11:50 a.m., this surveyor, a Registered Nurse (RN) surveyor, and the facility's wound care nurse, visited Resident #54 in her room. Resident #54 gave permission to view her right arm. As the resident was trying to move up her right sleeve with her left hand, she began to call out, ow, ow, ow. She was able to get her sleeve pushed up past her elbow. Resident #54 revealed the area on her arm was hurting and burning. Observations of the area revealed a reddened nodule about the size of a nickel or about 1 inch by 1 and a half inches and raised about ¾ of an inch. The raised area was observed with some dried blood/scabbing on the left side of the wound. During the observation, Certified Nursing Assistant (CNA)/Staff B was present in the room assisting the resident's roommate. Staff B looked at Resident #54's right arm and reported she was not aware of the raised reddened area. Staff B reported that she had not provided care to Resident #54 that day but expressed that if she saw something like that, she would report it immediately to the nurse. She revealed that she had never noticed that area on the resident's arm before. On 8/26/2021 at 1:30 p.m., a phone interview with Staff C, CNA revealed she normally works the 3 PM to 11 PM shift and has Resident #54 on her assignment routinely. Staff C revealed that she was responsible for things such as changing the resident, assisting to the toilet if needed, changing clothing, and was also responsible for showering/bathing the resident during her shift. Staff C reported showering the resident most recently on or around 8/24/2021. Staff C reported that the only skin area of note for Resident #54 was the wound on her leg and foot. Staff C confirmed that she routinely does skin checks during showers but had not noticed any area of concern on the resident's right inner arm. She stated that if she had seen anything that was raised, reddened, bleeding or bruised, she would report it to the nurse immediately. Staff C again revealed she had not noticed anything out of the ordinary on Resident #54's arms. She also did not know about a bandage on her arm and did not see one during her last shift. On 8/26/2021 at 2:10 p.m., an interview with Staff D, the RN assigned to the 300 hall revealed she had Resident #54 on her assignment routinely and knows the resident well. Staff D knew about Resident #54's wounds on her left foot and right leg, but was unaware of any wounds, reddened areas, open areas, or areas that were scabbed over on her arm. Staff D reported that the resident wears long sleeve shirts most days, and she has had no reason to pull up the sleeves to look at her arms. Staff D also reported that the resident had not brought any type of itchy areas, reddened areas or areas that burned on her arm to her attention. Staff D reported that the aides were to report to the nurse any areas of concern to the nurse, and the nurse will assess and identify. Staff D indicated that no staff had ever reported to her any type of areas on Resident #54's arm so she was unaware of anything at this time. On 8/27/2021 at 1:00 p.m., the Director of Nursing (DON) confirmed, after review of Resident #54's medical record and the wound log book, that no documentation or assessments would reflect the presence of a wound on the right upper extremity for Resident #54. The DON confirmed the resident did have a reddened and raised area with scabbing and that nursing should have caught that during skin checks and/or showers. Review of Resident #54's medical record revealed she was most recently readmitted to the facility in December of 2020. Review of the current annual Minimum Data Set (MDS) assessment, dated 7/12/2021, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 2 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 revealed a Brief Interview of Mental Status (BIMS) score of 12, indicating moderate cognitive impairment. Level of Harm - Minimal harm or potential for actual harm Review of the current Physicians Order Sheet (POS) dated for the month of August 2021 revealed no treatments or other indications of a wound area on the right arm. Review of the weekly skin grid pressure-non pressure assessments dated (5/5/2021, 6/16/2021, 6/23/2021, 6/30/2021, 7/7/2021, 7/14/2021, 7/21/2021, 7/28/2021, 8/4/2021, 8/11/2021, 8/18/2021, and 8/25/2021) all did not indicate any wounds, reddened areas, or scabbed areas on the resident's right medial arm at the bend. Review of the progress notes dated 6/15/2021 to 8/26/2021 revealed no indications of any reddened raised areas and with scabs/bleeding on the right medial arm located on the bend. Residents Affected - Few Review of the current care plans with next review date of 10/18/2021 and with the last review date of 7/30/2021 reflected any type of skin impairment related to the right arm skin nodule and/or reddened area. Further, review of the shower skin sheets, dated 8/14/2021 and 8/21/2021, revealed a skin tag area on the front right medial inner arm. Review of these skin sheets revealed that the right arm area was identified by a CNA, however, the sheets were not reviewed and there was no indication that a nurse was made aware of the area. On 8/27/2021 at 1:00 p.m., an interview with the Infection Control Nurse confirmed that the unit nurse and the unit manager should have been aware of the area on Resident #54's arm, and from review of the skin sheets, it appeared as though the area had been there from at least 8/14/2021. The Infection Control Nurse did not know why this information was not reviewed by a nurse, and why the area was not properly identified with treatment started. Interview with the DON on 8/27/2021 at 1:45 p.m. revealed the facility did not have a policy related to identification of wounds or areas of unknown origin. She further confirmed there had not been a more recent comprehensive MDS assessment since 7/12/2021. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 3 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff and resident interview, the facility failed to ensure that one of one (#319) sampled dialysis resident of two facility residents receiving dialysis received care consistent with professional standards of practice and the resident's plan of care. The facility failed to ensure communication with the dialysis facility in order to ensure antibiotics were provided in accordance with physician's orders for Resident #319. Residents Affected - Few The findings included: Clinical record review for Resident # 319 revealed an admission record with an admission date of 08/16/21 with diagnoses to include: end-stage renal disease (ESRD), pneumonia, cellulitis unspecified, and acute osteomyelitis of the left ankle and foot. A review of the most recent minimum data set (MDS) assessment dated [DATE] documented a brief interview for mental status (BIMS) score of 12 indicating moderate cognitive impairment. Section N of the MDS documented that Resident # 319 received an antibiotic for five days since admission and Section O documented that Resident # 319 received IV medications while not a resident and Dialysis while not a resident and while a resident. Review of the physician's orders revealed Resident #319 received hemodialysis treatment three times per week at a local dialysis center on Tuesday-Thursday-Saturday and vancomycin 750 mg intravenously (IV) at dialysis every other day for 7 days active as of 08/17/21. During an interview with Staff E, Registered Nurse on 08/25/21 at 3:30 p.m. it was confirmed that the most recent documentation from the dialysis facility was dated 08/21/21 and it did not include a confirmation that the antibiotic vancomycin was administered. Further review of the Dialysis Communication Forms dated 8/17/21, 8/19/21, and 8/24/21 also revealed no evidence that vancomycin was administered as ordered. On 08/25/21 at 4:08 p.m., the ordering physician confirmed that she had ordered the vancomycin per the reconciliation of the admission orders from the hospital. The physician stated that it was her expectation to receive a telephone call from nursing if there was a problem with one of her orders. She stated that she did not receive any such information, and she signed off her orders while at the facility on 08/21/21. The physician stated that she expected that Resident # 319 was receiving vancomycin after each dialysis treatment, as was documented on her physician progress notes. Review of the physician's progress notes revealed an entry on 08/19/21 at 3:47 p.m.Left 5th proximal phalange and metatarsal osteomyelitis: cultures + methicillin-resistant staphylococcus aureus (MRSA): on Vanco [mycin] IV with hemodialysis (HD) until 8/20/21 . Another physician progress note on 08/23/21 at 4:29 p.m. documented the vancomycin was Completed. However, a more recent physician progress note dated 08/26/21 at 4:15 p.m. documented .It came to light yesterday after speaking with nursing that the dialysis center hasn't been giving him his vancomycin .as was ordered. He was supposed to be done with antibiotics 08/20/21, but now will extend to 09/02/21. An interview with Resident #319 was conducted on 08/25/21 at approximately 3 p.m. Resident # 319 stated that he didn't know if he was taking any antibiotics. Follow-up interview on 08/27/21 at 10:00 a.m. with Resident # 319 revealed that he was told by the dialysis nurse that he would be getting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 4 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 antibiotics after his next dialysis treatment, which was scheduled for 08/28/21. Level of Harm - Minimal harm or potential for actual harm On 08/26/21 at 10:43 a.m., the Director of Nursing (DON) stated that after speaking with the dialysis center, she confirmed that Resident # 319 never received the vancomycin to date. The DON was asked for the facility's policy on communications with the dialysis treatment centers, she stated that they did not have such a policy. The DON could not say why nursing did not verify the completed administration of the vancomycin. Residents Affected - Few Review of the Skilled Nursing Facility (SNF) Outpatient Dialysis Services Agreement effective May 13, 2013 between the facility and the dialysis treatment center revealed under section A. Obligations of Nursing Facility and/or Owner, sub-section 1. End Stage Renal Disease (ESRD) Residents Information. The nursing Facility shall ensure that all appropriate medical and administrative information accompanies all ESRD Residents at the time of referral to the ESRD Dialysis Unit. This information, shall include, but is not limited to, where appropriate, the following: E. treatment presently being provided to the ESRD Resident, including medications, and G. Prescription for treatment by any other prescribing physician, as appropriate . and 2. Interchange of Information. The Nursing Facility shall provide for the interchange of information useful or necessary for the care of the ESRD Residents, including a Registered Nurse as a contact person at the Nursing Facility whose responsibilities include oversight of provision of Services to the ESRD Residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 5 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, staff and resident interviews, medical record review and policy review, the facility failed to ensure medications to include one tube of Anti-itch cream was properly stored and secured to ensure one (#54) of 34 sampled residents could not access it, during two (8/24/2021 and 8/25/2021) of four days observed. Findings included: On 8/24/2021 at 12:15 p.m., Resident #54 was observed in her room . She was noted with bandage dressing that was unraveled on her right lower leg. Upon interviewing Resident #54, she expressed that staff had put the dressing on and she does have itching in the area where the dressing was placed. During the interview, the surveyor observed a full 35 gram tube of Extra Strength Anti-Itch Cream, Ban-Itch topical analgesic and skin protectant on the resident's wall dresser. Resident #54 was asked where the tube of itch cream came from and she said that they gave it to her and she uses it when she needs it. Resident #54 could not remember a specific person who gave her the tube of cream, but did reported that it was from a nurse. She said that she has had the tube of itch cream for about a week. There was no pharmacy label on the tube of cream. Photographic evidence was obtained. On 8/24/2021 at 3:30 p.m., Resident #54 was again observed in her room, and the tube of anti-itch cream was still placed in the same place on the wall dresser. On 8/25/2021 at 7:10 a.m., Resident #54's room was approached and the door was half open. Resident #54 allowed the surveyor to come in the room and there were observations of the same tube of anti-itch cream placed on the wall dresser. Photographic evidence was obtained. On 8/25/2021 at 9:30 a.m., Resident #54 was again visited while in her room. The wall dresser was now observed without the tube of anti-itch cream. Resident #54 was asked about the tube of anti-itch cream and she stated, Oh, I don't know where it went, but I can sure use it now. On 8/25/2021 at 9:50 a.m., an interview with the floor nurse, Employee A revealed she had Resident #54 on her assignment today and normally has her routinely. Employee A revealed that the resident had a wound on her leg and that wound care was just in the room to redress her right leg. Employee A was asked if Resident #54 was able to self administer medications and or treatments. She revealed that Resident #54 was not assessed to do so. When asked if the resident used anti-itch cream she did not know about any tube of creams in her room. She did look at the room and no anti-itch cream was present at that time. On 8/25/2021 at 2:35 p.m., a follow up interview was obtained with Employee A. She was shown the photographic evidence taken on 8/24/21 and 8/25/21. She agreed that the tube of cream was there but stated she did not put them there. She stated that when the resident had wound care that morning, perhaps the wound care nurse saw the tube of cream. Employee A reported that she does keep tubes of anti-itch cream in the medication cart, but did not know anything about the one that was in the resident's room. On 8/25/2021 at 2:40 p.m., an interview with the wound care nurse/100-200 Unit Manager revealed she had provided the resident with wound care that morning at the beginning of the 7 AM to 3 PM shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 6 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few She stated that she changed the dressing on the resident's left foot and right leg. She reported that she did not see any cream/ointment in the room when she was in there. She confirmed that the cream should not be in the room and also confirmed that Resident #54 does not self administer medications/creams/ointments. Review of Resident #54's medical record revealed the current Minimum Data Set Annual assessment, dated 7/12/2021, had a Brief Interview Mental Status (BIMS) score of 12, which indicated moderate cognitive impairment. Review of the current Physician's Order Sheet dated for the month of August 2021 did not reveal or indicate any order to utilize any type of Anti Itch cream. On 8/26/2021 at 10:00 a.m., the 200/300 Unit Manager again confirmed that Resident #54 did not have an order for any type of anti-itch cream and that the tube of anti-itch cream should not have been in the room unsecured for any amount of time. The Unit Manager reported that Resident #54 finds things around the facility and brings them to her room. She revealed that floor staff who go in the room should have seen the tube of cream and not have left it in the room for at least two days. Review of the Storage of Medications policy and procedure, last revised 8/2014 revealed the following: Policy: Medications and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medications supply is accessible only to licensed nursing personnel, pharmacy personnel, or state members lawfully authorized to administer medications. Procedures revealed the following: b. Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aides) permitted to access medications. Medication rooms, carts, and medication supplies are locked when not attended by persons with authorized access. c. All medications dispensed by the pharmacy are stored in the container with the pharmacy label. d. Orally administered medications are kept separate from externally used medications and treatments such as suppositories, ointments, creams, vaginal products, etc. Eye medications are stored separately per facility policy. f. Medications labeled for individual residents are stored separately form floor stock medications when not in the medication cart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 7 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, review of temperature recording logs and review of policies and procedures, the facility failed to ensure that cold Time/Temperature Control for Safety (TCS) food was held at 41 degrees Fahrenheit (F) or below during the lunch meal service on 8/26/21. The affected food was intended to be served to 8 residents out of 104 residents who consumed the facility's prepared food. The findings included: On 08/26/21 at 12:06 PM, during the lunch meal service, there was a tray of approximately 17 individual butterscotch puddings held without ice or cooling device. The surveyor took the holding temperature of an individual butterscotch pudding from this tray, using the facility's thermocouple, and the temperature was 55 degrees F, rather than at 41 degrees F or below. Photographic evidence obtained. Butterscotch pudding is a TCS food. Interview with the Food Service Director (FSD) at that time revealed that the butterscotch pudding came from a can that was refrigerated overnight. During an interview on 08/26/21 at 12:07 PM with Dietary Aide, Staff H, she said she prepared the butterscotch pudding that morning. She dished up the butterscotch pudding into individual portions at 10:30 AM and then put them in the walk-in refrigerator until the lunch service. She said she took the tray of butterscotch puddings out of the walk-in refrigerator at 11:30 AM for the lunch meal service. At 12:15 PM on 8/26/21, the temperature was taken of another individual serving of butterscotch pudding on the other end of the tray line with the facility's thermocouple, and it was 57 degrees F. Photographic evidence obtained. Review of the August 2021 Prepared Food Temperature Record (food holding temperature log) showed that the temperature of the butterscotch pudding was 38 degrees F at the beginning of meal service. Photographic evidence obtained. On 8/26/21 at 12:16 PM, the surveyor shared the findings for the elevated holding temperatures of the butterscotch puddings with the FSD and the FSD had witnessed the second temperature taken of the butterscotch pudding. The surveyor asked the FSD what she planned to do with the remaining butterscotch puddings on the tray. She said she could put them back in the freezer, but they would not cool down fast enough for the service, so she put the remaining individual puddings on ice in a pan. On 8/27/21 at 1:08 PM, the surveyor asked the FSD which residents were served the butterscotch pudding, since this item was not on the regular or modified menus. She responded that the butterscotch pudding was served to residents prescribed thickened liquids. The number of residents receiving thickened liquids was requested. Later, the FSD provided a list of residents receiving thickened liquids and the total number was 8 residents. She also provided the facility policy on holding temperatures of foods. The facility's Holding foods policy, undated, but was copyrighted in 2015 stated: Cold foods (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 8 of 9 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 105636 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belleair Health Care Center 1150 Ponce DE Leon Blvd Clearwater, FL 33756 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 1. Utilize cold-holding equipment that can keep foods at 41 degrees F or lower. Cold holding equipment may include: Level of Harm - Minimal harm or potential for actual harm - Refrigerators Residents Affected - Some - Freezers - Coolers - Ice bath . . 3. Cold temperatures will be taken prior to meal service and record and halfway through service. . 5. Cold food items should be taken from cold-holding equipment one tray at a time. Photographic evidence obtained. Review of the facility August 2021 Prepared Food Temperature Record (temperature log), the facility did not take holding temperatures halfway through service according to their policy. The temperature record showed only one set of temperatures taken at each meal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105636 If continuation sheet Page 9 of 9