Health inspection·July 3, 2024

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and resident interviews, record review, and review of facility policy and procedure, the facility failed to ensure 2 (Residents #22 and #30) of 19 residents with bed rails were assessed for alternative interventions prior to the use of the bed rails. The findings included: The facility policy Proper Use of Bed Rails, effective 10/20/22 documented, It is the policy of the Renaissance two utilize a person-centered approach when determining the use of bed rails. Appropriate alternative approaches are attempted prior to installing or using bed rails. Alternatives include but are not limited to: Roll guards, foam bumpers, lowering the bed, and concave mattresses. Alternatives that are attempted should be appropriate for the resident, safe and address the medical conditions, symptoms or behavioral patterns for which a bed rail was considered. If no appropriate alternatives are identified the medical record should include evidence of the following purpose for which the bed rail was intended and evidence that alternatives were tried and were not successful. 1. Review of the clinical record revealed Resident #22 had an admission date of 2/12/24 with diagnoses including falls, dementia and syncope. On 7/2/24 at 8:35 a.m., Resident #22 was observed in bed with 1/4 bed rails in the raised position on both sides of the bed. Review of the Side Rail assessment dated [DATE] failed to document the alternate interventions that were attempted prior to the use of the bed rail. 2. Review of the clinical record revealed Resident #30 had an admission date of 1/11/23 with diagnoses including Parkinson's disease, anxiety, and major depressive disorder. On 7/1/24 at 11:37 a.m., Resident #30 was observed in bed with 1/4 bed rails on both sides of the bed in the raised position. Review of the Side Rail assessment dated [DATE] documented ¼ rails bilaterally were used. The assessment failed to document the alternate interventions that were attempted prior to the use of the bed rail. Page 1 of 5 106104 106104 07/03/2024 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

F 0700 On 7/2/24 at 1:36 p.m., in an interview the Director of Nursing confirmed no alternate interventions were attempted for Resident #22 and #30 prior to the use of the bed rails. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 106104 Page 2 of 5 106104 07/03/2024 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of facility policy and procedure and staff interviews, the facility failed to prepare, and store food in a sanitary manner by failing to cover and date food in 1 walk-in dairy refrigerator and 1 refrigerator and failed to clean surfaces on food preparation equipment including ovens and ice machine to prevent potential contamination. Additionally, the facility did not ensure staff wear hair restraints during preparation of food. The lack of sanitation in the kitchen had the potential to affect all residents consuming an oral diet. The findings included: 1. On 7/1/24 at 9:09 a.m., during an initial observation of the kitchen in the presence of the Director of Food and Beverages, the following was observed: The outside of the ice machine had a layer of dust with debris on the top of the machine. There was a brown colored substance on the outside top of the machine. Observation of the ice machine lid was dusty and grimy with brown substance and debris. The inside of the ice machine where the lid closes had a layer of dust, debris and had a brown substance along the ridge where the door opens and closes. The air filter on the top of the ice machine had a thick layer of dust. There was a black substance on the inside upper part of the lid. The scoop for the ice machine was lying on top of the dusty machine. The filter for the ice machine was dated 3/31/23. Photographic evidence obtained. Dietary [NAME] Staff B was observed cleaning peeling raw shrimps over an uncovered trashcan and was placing the raw shrimp in a strainer. The metal strainer was positioned over the trash with the handles resting on the rim of the trashcan to keep it from falling into the can. Staff B said, I do it to keep the water from the shrimp going on the floor. On 7/1/24 at 9:15 a.m., Dietary Staff A was observed chopping vegetables. Dietary Staff C and D were observed preparing food for the lunch meal. Dietary Staff A, C, and D did not wear a hair net. The Executive Chef verified the observation and provided a hair net to the staff. The findings of the ice machine were confirmed by the Director of Food and Beverages and the Registered Dietitian. The Director of food and beverages said the ice machine filter should be changed at least yearly and confirmed the filter was dated 3/31/23. Review of the Preventive Maintenance Contract effective September 1, 2022 through August 31, 2023 for the ice machine specified the company would Replace ice machine filters two times per year. 106104 Page 3 of 5 106104 07/03/2024 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many The facility policy personal hygiene documented, All dietary employees shall practice optimal personal hygiene to minimize cross contamination and foodborne illnesses. Eating, drinking, chewing gum or using any form of tobacco shall be prohibited in the Dietary Department. Effective hair restraints shall be worn at all times. Dietary employee personal items, drink cups and bottled water were observed on clean shelves and racks in the kitchen. Photographic evidence obtained. In a plastic bin containing uncooked rice there was a scoop on top of the rice. Photographic evidence obtained. Review of the facility policy Cross Contamination Overview specified clean and sanitize work surfaces and food contact equipment between uses. Observation of drying rack for the clean pots, pans and other items. The shelves were dusty and had a brown substance on the metal. On the bottom shelf the lid to a red trash can was noted on top of a clean serving tray. Photographic evidence obtained. On the top shelf of the drying rack were wet stacked pans, stacks of drip trays from the juice and coffee machines that were wet nesting (wet dishes are stacked, preventing them from drying, creating conditions for microorganisms to grow). Several of the drip trays were noted to have a white food substance in the cervices. Photographic evidence obtained. On a clean storage rack next to the walk-in freezer were clean pots, lids and other items. A blue jacket was observed hanging from the rack and in was contact with the clean items. The Director of Food and Beverages said it was the jacket staff use to keep warm when going into the walk-in freezer. Photographic evidence obtained. Review of the facility policy Refrigerated Storage specified refrigerated items shall bear a label indicating product name and date product was received used or first opened. a) Observation of the serving refrigerator contained a pitcher of iced tea dated 6/27/24. The part of the sticker for the use by date was blank. Photographic evidence obtained. b) There was an uncovered tin serving dish with grated cheese that was hard and dry. Photographic evidence obtained. 106104 Page 4 of 5 106104 07/03/2024 Renaissance at the Terraces 26475 South Tamiami Trail Bonita Springs, FL 34135

F 0812 c) There was a covered serving tin of a white cream substance without a description of the food and with no date. Level of Harm - Minimal harm or potential for actual harm Photographic evidence obtained. Residents Affected - Many d) A plastic container of Micro Fiesta Blend with no date on it. Photographic evidence obtained. The findings in the serving refrigerator were verified with the Executive Chef. The facility policy Cross Contamination specified All raw meat shall be stored separately and in drip proof containers to avoid cross contamination of other food in the refrigerator. In the walk-in dairy cooler there was a rolling rack with sheet pans of undated and uncovered shrimp, grouper and [NAME]. On the bottom of the rack was a sheet pan with thawing, raw turkey sitting in red tinged liquid. Photographic evidence obtained. There was another rolling rack with three sheet pans of uncovered and undated raw meat. The Director of Food and Beverage [NAME] said the meat was meatloaf for the nights dinner. No meatloaf was listed on the menu for the week. The meat appeared to be brisket on the menu for the next night's dinner. Photographic evidence obtained. The findings in the walk-in dairy refrigerator were verified by the Director of Food and Beverage. Observation of the cooking area, where the ovens were noted to have a thick layer of grime and debris on the handle and temperature knobs. There was a thick brown, dried substance that had dripped down the front of the oven doors. Photographic evidence obtained. 2. On 7/2/24 at 11:51 a.m., during an observation with the Registered Dietitian (RD) of the ice machine in the main kitchen, the machine had grime on the front door and on the inner ledge of the door. There was a black substance lining the entire upper inner frame of the ice machine. The RD said the ice machine was cleaned every quarter. The RD confirmed the observation of the ice machine. 3. On 7/3/24 at 10:51 a.m., during a tour of the kitchen the Executive Chef was without a beard covering for his facial hair. A female staff member with long hair walking in the kitchen without a hair net on. The cook had on a baseball cap but no hair net. The Director of Food and Beverage was present in the kitchen and did not provide instruction to the staff regarding required hair coverings. There were no hair nets available outside of the kitchen door or on the inside of the kitchen. 106104 Page 5 of 5