Health inspection·April 28, 2022

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 observation, interview, and record review, the facility failed to date opened food, date food received or thawed, date thawed health shakes, clean the convection oven, ensure a covering for a food cart to keep food warm, and failed to wear a hair net in the kitchen. These failures have the potential to affect all 61 residents except R32 who is NPO (nothing by mouth). Findings include: Facility Food Receiving and Storage policy, revised 2017, documents, All foods stored in the refrigerator or freezer will be covered, labeled, and dated ('use by' date). Facility Sanitization policy, revised 2008, documents, The food service area shall be maintained in a clean and sanitary manner. All kitchens, kitchen areas and dining areas shall be kept clean. The Food Services Manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. Food service staff will be trained to maintain cleanliness throughout their work areas during all tasks, and to clean after each task before proceeding to the next assignment. Facility Resident Council minutes, dated January 20, 2022, September 16, 2021, August 19, 2021, July 15, 2021, June 24, 2021, May 20, 2021, and April 22, 2021, document Resident Council complaints on cold food. On 4/26/22 at 10:15am, R25 verified there were complaints on cold food at the resident council meetings. On 4/26/22 between the hours of 10:00am and 11:00am, a tour of the kitchen was conducted with V5 Dietary Manager/DM. In the drink cooler there were four 64 fluid ounce apple juice containers opened and undated; 59 four fluid ounce containers of Ready care vanilla shakes no sugar added that had no expiration dates, no received dates, and no pull dates from the freezer. The outside of the Ready care vanilla shakes documents, Storage and handling- Store frozen. Thaw under refrigeration 40 degrees or below. After thawing, keep refrigerated. Use within 14 days after thawing. There was a note posted in the cooler hanging on a shelf that documents Put date on all liquids when opened. At that same time, V5 DM stated I posted the paper in the cooler because we have had a problem with staff dating things that are opened. It is a work in progress. V5 verified the apple juices had no open dates, and the vanilla shakes had no dates on them. The cooks' cooler had a five-pound sour cream container opened (half empty) and undated; a whole roast beef (no weight) in plastic packaging had no expiration date or pull date noted on the package. At that same time, V5 stated, I don't know when we had roast beef last, but I see no dates on the beef and the sour cream needs an open date. I will have to talk to staff. I have had a lot of things I have been working on getting fixed here. Facility single convection oven had a large amount of brown sticky substance on the sides and Page 1 of 2 145697 145697 04/28/2022 Knox County Nursing Home 800 North Market Street Knoxville, IL 61448

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many bottom of the oven. V5 stated, We use this oven every day and I have this on the list to be cleaned. I am working on getting staff to wipe up spills as they happen so cleaning is easier. Facility tall refrigerator had a four-pound butter tub that was half gone, undated, and had no expiration date; and a two- pound turkey breast package had no expiration date and no received date. A large metal tray storage cart was in the kitchen and was missing the door. At that same time, V5 stated, We need to do better with dating our product. The meal tray cart is used to serve meals to residents down the hallways that don't eat in the dining room. I fixed the cart once but the door fell off again and I haven't gotten it put back on the cart but it needs to be. The dry storage room had a room full of multiple canned goods, and multiple dry storage bags/containers of food that had no expiration dates or received dates. V5 verified that the dry storage canned goods and dry storage bags/containers of food had no expiration dates or received dates and should have. During the tour of the kitchen on 4/26/22 between the hours of 10:00am and 11:00am, V5 did not have V5's hair secured in a hair net. V5 had no hair on top of his head but V5 had hair on the sides and facial hair. V5 stated, I do not wear a hair net. Am I supposed to? I usually shave my head bald including the sides. Facility was unable to provide any daily cleaning sheets to document the kitchen appliances/areas were being cleaned. On 4/26/22 at 11:15am, V5 stated, I do not have the staff fill out daily cleaning sheets, they are to wipe down surfaces after and during meals, but the deep cleaning of the stove and ovens are done about once a month. I do not have anything to show you that was done. Resident Census and Conditions of Residents (Centers for Medicare and Medicaid/CMS 672) form dated 4/26/22, documents 61 residents reside in the facility. 145697 Page 2 of 2