Inspection·December 2, 2021

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview was conducted on December 1, 2021 at 2:10 p.m. with Certified Nursing Assistant (CNA) B. She was asked if she was assigned to Resident #32 today. She stated yes. She was asked about Resident #32's hearing ability. She stated, Oh, she doesn't hear well. I have to get close so she can hear me. She was asked if the resident wore hearing aides, and she replied, I'm not sure, but the nurses hold the hearing aides and they put them in, not us. She was asked about Resident #32's vision, and replied, She seems okay with vision. She just needs help to stand because her legs are weak, but I think she can see okay. She was asked if the resident had complained of light bothering her eyes. She stated No, I don't think so. I know she likes the shades closed. An interview was conducted on December 1, 2021 at 2:45 p.m. with Registered Nurse (RN) C. He was asked if he was assigned to Resident #32 today. He stated yes. He was asked if Resident #32 had any trouble hearing him. He stated no. He was asked if Resident #32 had ever complained about hearing loss to him, and he replied that she hadn't. He was asked if she wore hearing aides, and he said, No, I don't think so. I've never seen any for her. She would have a doctor's order, because we lock them up at night and then place them in their ears in the morning, so they don't get lost, and also charge them overnight if they are the rechargeable kind. He was asked if Resident #32 had any visual problems. He stated 'no'. He was asked if she had ever complained to him about being sensitive to the light, and he replied no. On December 1, 2021 at 3:15pm, an interview was conducted with RN D, Minimum Data Set (MDS) Coordinator. She was asked if she had created the care plan for Resident # 32, specifically the focus, goal and interventions concerning this resident's hearing deficit. She stated yes. She was asked whether she had created this section of the care plan today, and she replied yes'. She was asked if the resident had previously been care planned for a hearing deficit, and she replied no. She was asked why she created this section of the care plan today, and she replied, I was reviewing her care plan earlier today, and I saw that under her fall risk focus, she had a risk due to vision/hearing loss, so I added that as a focus today. She was asked if she had also added a care plan focus, goal and interventions for vision deficit. She stated no. She was asked where she obtained the information to create the hearing deficit focus, goals and interventions, and she replied, From her admission paperwork and her hospital discharge paperwork. She was asked if she spoke with the resident to develop the care plan regarding the focus on hearing deficit. She stated, Well, not today, but I did interview her when she was admitted . We call it a meet and greet. So, I did gather information in person then. Actually, I did have to talk loud and face her, and speak in her left ear, so I guess that should have given me a clue that she was hard of hearing then. On December 2, 2021 at 12:06 p.m., Resident #32 was observed sitting up in her bed. The shades on the window were drawn. She was asked why her shades were closed. She stated, I have the shades closed because my eyes are super sensitive. It just kills my eyes, it's so painful. There's a name for it, um, photo something, oh, photo sensitive. My eyes are getting so bad. I try to fill out my menu but the print just looks smaller and blurry, even when I use my magnifying glass. The resident pointed out the magnifying glass on her bedside table. She was asked if staff kept her shades closed. She stated, Sometimes I have to tell them; some of them don't know. When I tell them about my situation, they do close them. [RN C] came in the other day and opened them and said, You need some sunshine, but I asked him to please close them. I told him the light just kills my eyes. [Speech Language Pathologist (SLP) J] from therapy knows; she makes sure they are closed when she sees me. An interview was conducted on December 2, 2021 at 1:10 p.m. with CNA E. She was asked if she was assigned to care for Resident #32 today. She stated yes. She was asked if the resident had any issues with her hearing. She stated, Well, I speak loudly to her and make sure I'm right in front of her, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few close, so she can hear me. She was asked if the resident preferred her window shades closed. She stated, Yes, she does. She was asked if she knew why. She stated, No, I don't why. I just know she likes them closed and she will ask us to close them if they're open. An interview was conducted on December 2, 2021 at 2:36 p.m. with SLP J. She was asked if she had worked with Resident #32. She stated Yes, I saw her when she was first admitted , and I actually saw her yesterday for a new evaluation. I just certified her for speech services 4 times a week for 4 weeks for cognition. She was asked if the resident had any issues hearing her. She stated, Yes, I use amplifiers with her. I brought her in an older one I had to use with headphones, and I helped her daughter find one for over her ear, like a hearing aid but just an amplifier. Her daughter did get one for her. I have one in my office that I use with her that seems to work the best. I did try a communication board in the past, but she really didn't care for that, so I stopped. She will use gestures in her room and point to things. She was asked if the resident had any issues with vision. She stated, I personally have no issues with her because I tend to keep everything I use in black and white, and I print everything in large scale because this population generally needs plain larger print, so I'm just proactive. She was asked if the resident had complained about being sensitive to the light. She stated Yes, she has. She is light sensitive. She does have sunglasses in her room, but she prefers to keep the blinds pulled, so the sunlight doesn't come in. If she and I are in my office for therapy, I'll close the blinds and use a desk lamp, which she prefers because she says that doesn't bother her. A review of the Minimum Data Set (MDS) assessment, dated September 13, 2021, revealed that Resident #32 was evaluated for hearing, speech, and vision. Ability to hear was marked: Minimal difficulty (difficulty in some environments, e.g., when person speaks softly or setting is noisy) Hearing aid or other appliance used? Yes. A review of the Nursing admission Assessment, dated September 9, 2021, revealed: Uses hearing aide left, uses hearing aide right. Hearing Care Plan with baseline Focus (Resident has problems hearing), Goal (Resident will be able to hear as needed/as desired, and Intervention (Resident is hard of hearing. Speak loudly, clearly and slowly. Be conscious of resident position when in groups, activities, dining room to promote proper communication with others. Take care to not startle the resident when approaching or entering the room). A review of a Monthly Summary, dated November 12, 2021, revealed: Hearing, Speech, Vision with hearing listed as hard of hearing and vision listed as impaired. A review of an eye exam consultation for Resident #32 with a service date of November 12, 2021 revealed: Chief complaint: Possible blurred vision reported per staff. The consultation revealed a prescription attached for an ophthalmology consult for diabetes and photophobia. A review of a Speech Therapy Evaluation and Plan of Treatment with a Start of Care date of September 11, 2021 revealed: Chart review/Patient interview: Hearing = functional with increased volume. A review of exams performed by the Nurse Practitioner and dated September 17, 2021, September 27, 2021 and November 12, 2021 revealed the following as part of the physical exam: September 17, 2021: ENT (ears, nose, throat): Reported: Hearing impairment. HOH (hard of hearing) September 27, 2021: Eyes: Reported: vision loss, blurry vision. ENT: Hearing impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0656 November 12, 2021: Eyes: Reported: blurry vision. ENT: Hearing impairment. Level of Harm - Minimal harm or potential for actual harm A review of the current physician's orders for Resident #32 revealed the following: 10/13/21: Ophthalmology consult Residents Affected - Few 11/24/21: MD appointment Central Florida 12/28/21 at 10:15 a.m. 10/13/21: Audiology consult and treat as needed 09/09/21: Ophthalmology/podiatry/dental as needed A review of the Care Plan revealed no focus/goal/intervention entries for hearing deficit or vision deficit/photophobia. A review of the facility's policy/procedure titled, Standards and Guidelines: Hearing and Vision (January 15, 2021) included Guideline #4: Review of the resident's care plan to assess for any special needs of the resident and #16: Hearing and vision deficits should be addressed in the person-centered plan of care. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm 3. On 11/30/21 at 10:30 AM, Resident #78 was observed lying in bed with the covers off and her feet exposed, revealing very long, jagged toenails. Residents Affected - Few On 12/1/21 at 9:10 AM, the resident's toenails remained untrimmed and jagged. On 12/2/21 at 10:20 AM, during an interview with LPN F, she was asked how often the podiatrist visited. She said she wasn't sure, but she thought he visited monthly. She was asked how the podiatrist knew which residents to see. She said nursing kept a book at the nursing station, and the residents' names were placed in the book if they needed to be seen. The Social Worker (SW) was at the nursing station and stated she checked the book and then called the podiatrist and let him know who was to be seen. She was asked when the podiatrist last saw Resident #78. She said she would review the record. After her review, she said that the last visit was on 3/12/21. When asked if Resident #78 was on the list to receive care from podiatry this month, she said she did not see her name on the list but would add her name. On 12/2/21 at 10:30 AM, LPN F was asked to observe Resident # 78's toenails. LPN F confirmed the nails were very long and needed the podiatrist. She said she would let the SW know. Based on observations, staff and resident/resident representative interviews, and a review of resident and facility records, the facility failed to ensure residents who were dependent for grooming and hygiene, received the appropriate nail care to prevent soiled, jagged or excessively long nails for three (Residents #9, #35 and #78) of five residents reviewed for activities of daily living (ADLs), from a total of 41 residents in the sample. The findings include: 1. A record review for Resident #9 found an Annual Minimum Data Set (MDS) assessment with an assessment reference date (ARD) of 8/27/21. It noted Resident #9 was not able to make himself understood. He had memory problems to include no recall of staff names, the current season, his room location or that he was in a nursing facility. Resident #9 had moderately impaired cognitive skills for daily decision making. There was no rejection of care over the assessment look-back period. Resident #9 required extensive assistance with hygiene. His diagnoses included non-Alzheimer's dementia (a disease that progressively destroys memory) and Parkinson's disease (a disorder of the central nervous system affecting movement and often causing tremors). Resident #9 was care planned on 8/20/21 for his multiple medical and care needs, including for his activities of daily living (ADL)/self-care performance deficit. The focus noted his needs and participation varied. The goal was for Resident #9 to have no complications related to the deficit, and to maintain his current level of functioning through the next review date. Interventions included explaining procedures prior to starting and encouraging Resident #9 to participate to the fullest extent possible. (Photographic evidence obtained) A telephone interview was conducted with Resident #9's family member on 11/29/21 at 10:45 AM. The family member reported that during the last visit with Resident #9, his toenails were thick and had black matter under the nails. They were so long, they rolled over the end of Resident #9's toes. An observation of Resident #9 conducted on 11/29/21 at 11:36 AM, found his fingernails were long (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0677 and jagged. Level of Harm - Minimal harm or potential for actual harm Upon a second observation on 11/30/21 at 10:20 AM, Resident #9's fingernails were still long and jagged. Residents Affected - Few On 12/1/21 at 9:30 AM, Resident #9 was asked to show his fingernails. He held his hands out. Both thumb nails were excessively long. The right thumbnail extended approximately 1/2 inch beyond the nail bed and was broken off. The edges were jagged and un-filed. The left index fingernail was so long it curved around the tip of his finger toward the finger pad. On 12/1/21 at 10:05 AM, verbal consent to photograph Resident #9's fingernails was obtained from the resident's representative via telephone. An interview was conducted with Resident #9 on 12/1/21 at 10:40 AM. He was asked if he wished to have his fingernails cut. He looked at them and said, Si (Yes in Spanish). He also granted permission to photograph his hands and fingernails. (Photographic evidence obtained) 2. A record review for Resident #35 found a Quarterly MDS assessment with an ARD of 9/21/21. Resident #35 was noted as being rarely understood. He had severely impaired cognitive skills for daily decision making, and required extensive assistance with personal hygiene. His diagnoses included cancer, Alzheimer's disease and non-Alzheimer's dementia. Resident #35 was care planned for an ADL/Self Care Performance Deficit related to his limited mobility. The goal was to be free from complications related to the deficit through the next review date. Interventions included explaining procedures prior to performing tasks and reporting changes in self-performance to the nurse. Interventions also noted Resident #35 required extensive assistance with ADLs. There was no indication this resident refused ADL care. (Photographic evidence obtained) Resident #35 was observed on 12/1/21 at 10:31 AM. He was unable to respond verbally, but was able to make, and maintain, constant eye contact. Resident #35 reached out his hand. At this time, his fingernails were observed to be long, un-filed and with dark matter under the nails. During an observation of Resident #35 on 12/22/21 at 10:01 AM, his fingernails were in the same condition as the prior day's observation. Licensed Practical Nurse (LPN) F stated in an interview on 12/1/21 at 2:51 PM, that Resident #35 was dependent on staff for all ADL care. An interview was conducted with Resident #35's representative on 12/2/21 at 10:28 AM. He reported he had visited multiple times and found Resident #35's fingernails long and un-filed. He had to go find a nurse and ask them to take care of Resident #35's fingernails. The resident representative gave permission to photograph Resident #35's hands and nails. (Photographic evidence was obtained on 12/2/21 at 10:45 AM.) Resident #35's spouse, who shares the room with him, was present when photographs were taken. She volunteered that staff did not do Resident #35's nails very often. His fingernails were often too long. She explained it was important for his nails to stay trimmed and filed as he scratched at his face and eyes. An interview was conducted with Certified Nursing Assistant (CNA) I on 12/1/21 at 2:07 PM. She stated the CNAs performed fingernail care for the residents. This included cleaning them and trimming/ (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0677 filing as needed. The podiatrist (foot doctor) did resident toenails. Level of Harm - Minimal harm or potential for actual harm Activities Assistant (AA) G was interviewed on 12/2/21 at 11:00 AM. She was in the common area painting a resident's fingernails. She had a plastic bin full of nail polishes, nail clippers and a cuticle pusher. AA G explained activities went around and did resident nails about three days a week. Additional nail care was performed on an as-needed basis, or when the CNA or nurse reported the need. There was no set schedule, and she depended on others to make her aware that there was a need. Residents Affected - Few CNA H was interviewed on 12/2/21 at 11:03 AM. She said fingernail care, which included cleaning, trimming and filing for non-diabetic residents, could be done by the CNA or Activities staff. There was no particular schedule. CNAs did it when they had time, however, they were often busy providing other needed care. CNAs could tell Activities staff if nail care was needed, but they were really busy too. In a second interview with LPN F on 12/2/21 at 11:13 AM, she confirmed nail care could be done by either the CNAs or Activities staff. She was shown the condition of Resident #9 and Resident #35's nails. She stated Resident #35 often refused nail care, but she was not stating the condition observed was acceptable. LPN F acknowledged that both Resident #9 and #35's excessive nail growth had progressed over an extended period of time. A review of the facility Standards and Guidelines: Nail Care, implemented 1/15/21 and revised 1/15/21, found: Standard: It will be the standard of this facility to provide nail care to residents per resident preferences and to maintain dignity. Guidelines: 1. Review resident's medical record to assess for any special needs of the resident. 2. Assemble equipment and supplies needed. 3. Nail care includes regular cleaning and trimming, unless contraindicated by resident condition, specific behaviors or resident refusal. 4. Proper nail care can aid in the prevention of skin problems around the nail bed. 5. Unless otherwise permitted, do not trim the nails of diabetic residents or residents with circulatory problems. 6. Trimmed and smooth nails can help prevent the resident from accidentally scratching and injuring his or her skin . .10. Notify the supervisor if the resident refuses the care. Document history of refusal of provision of care in the clinical record. (Photographic evidence obtained) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations and staff interview, the facility failed to ensure oxygen therapy was administered as ordered by the physician for one (Resident #65) of nine sampled residents reviewed for oxygen therapy from a total sample of 41. Residents Affected - Few The findings include: A review of Resident #65's medical record revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: cerebral infarction, aphasia, chronic obstructive pulmonary disease, and atrial fibrillation. She required total assistance with all activities of daily living (ADLs) except eating. She was ordered continuous oxygen at 1 liter per minute via nasal cannula. An observation of Resident #65's oxygen concentrator on 11/29/21 at 10:55 AM, found the oxygen rate was set at 2 liters per minute. An observation of the oxygen concentrator on 11/30/21 at 12:20 PM, found the flow rate set at 2.5 liters per minute. On 12/2/21 at 2:15 PM, the oxygen flow rate was set at 2.5 liters per minute. An interview was conducted with Licensed Practical Nurse (LPN) F on 12/1/21 at 2:20 PM. She was asked what oxygen flow rate was ordered for Resident #65. She reviewed the record and stated the order was for 1 liter per minute. She was asked to observe the resident's oxygen concentrator, and she confirmed that the flow rate was set at 2.5 liters per minute and needed to be adjusted. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 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 105930 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Healthcare & Rehabilitation Center 120 Chipola Ave Deland, FL 32720 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations and employee interviews, the facility failed to distribute and serve food in accordance with professional standards for food service safety, by failing to practice appropriate hand hygiene and glove use during food preparation activities to prevent cross-contamination. This failure potentially affected all residents receiving food from the facility's kitchen. The findings include: A food service observation was conducted in the kitchen at 11:55 AM on 12/2/2021. At 12:00 PM, the Chef was observed setting up the food items for lunch service. The Chef was observed with a pair of gloves on during the set up. He was observed pouring the sauce for the meal from a pot into a stainless steel pan, then taking the pot to the dishwashing area and rinsing it out with the hand-held nozzle. He then returned to the food service area and began to stir the sauce in the the stainless steel pan without doffing the gloves, washing or sanitizing his hands, and donning a new pair of clean gloves. At 12:07 PM on 12/2/2021, the Chef was interviewed about hand hygiene while in the kitchen. When asked what should have taken place prior to returning to the service area, the Chef stated he should have changed his gloves. He then doffed his gloves, walked over to the handwashing station located next to the 3-compartment sink and across from the dishwasher, washed and dried his hands, and donned a new pair of gloves. An interview was conducted with the Certified Dietary Manager (CDM) at 12:56 PM on 12/2/2021. During the interview, the CDM stated all staff received training on hand hygiene during orientation, and there were reminders posted in each hand washing area of the kitchen. He stated he brought the Chef from his previous facility, and did not know why the cook did not change his gloves and wash his hands prior to returning to the serving station. The Hand Hygiene policy was requested at 1:00 PM on 12/2/2021. A review of the facility's Hand Hygiene policy entitled Standards and Guidlines: Hand Hygiene, did not address hand hygiene during food service, however, Guideline 2 read, All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 105930 If continuation sheet Page 9 of 9