Health inspection·July 17, 2024

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 observation, interview, and record review, the facility failed to refrigerate unopened medication that required refrigeration before opening for 2 of 30 (R60, R73) residents reviewed during medication storage and labeling task. Findings Include: On 07/15/24 at 08:25 AM inspected the medication cart from the second floor. V9 (Licensed Practical Nurse/LPN) present during the inspection, found an unopened medication requiring to be refrigerated before opening, placed in the medication cart. Items found: R60's Lantus, two 22 units pens, labeled refrigerate before opening, stored in medication cart at room temperature unopened. R73's Novolin R 100unit/ml, one 10ml vial, labeled refrigerate before opening, stored in medication cart at room temperature unopened. R60's physician order reads in part, Insulin Glargine Solution 100 UNIT/ML Inject 22 unit subcutaneously two times a day for diabetes. R73's physician order reads in part, HumuLIN R Solution 100 UNIT/ML (Insulin Regular Human) Inject subcutaneously needed as per sliding scale: if 150 - 200 = 2 units ; 201 - 250 = 4 units ; 251 - 300 = 6 units ; 301 - 350 = 8 units ; 351 - 400 = 10 units Above 400 and below 70. call MD, subcutaneously as needed for DM related to Type 2 Diabetes Mellitus Without Complications. On 07/15/24 at 08:30 AM V9 (LPN) stated those are new, they should be in the fridge. Unopened insulin should be refrigerated to keep it more durable. On 07/15/24 at 09:27 AM V3 (Director of Nursing) stated it is important to keep unopened insulin in the refrigerator to preserve the integrity of the medication. It has to be properly stored based on recommendation by manufacturer. Drugs.com article dated 03/27/2024 reads in part, Novolin R; Brand names: HumuLIN. Drugs.com article dated 12/06/2023 reads in part, Insulin Glargine; Brand name: Lantus Solostar pen. Page 1 of 5 145778 145778 07/17/2024 Midway Neurological / Rehab Center 8540 South Harlem Bridgeview, IL 60455

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The facility pharmacy Medication Storage policy (no date) reads in part, Refrigerated Products: Upon delivery, the nurse will be responsible for storing the medication in the appropriate facility/medication refrigerator. The registered nurse and/or Director of Nursing will be responsible for following all drug specific guidelines. The facility Medication Storage in the Facility policy (no date) reads in part, Medications requiring refrigeration or temperatures between 36 degrees Fahrenheit and 46 degrees Fahrenheit are kept in a refrigerator. 145778 Page 2 of 5 145778 07/17/2024 Midway Neurological / Rehab Center 8540 South Harlem Bridgeview, IL 60455

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, interviews, and record reviews, the facility staff failed to 1. wear a hair restraint to cover a beard while in the kitchen, 2. failed to maintain sanitizing solution at 200 ppm (parts per million) of Quaternary Ammonium solution for dishes in the three-compartment sink, 3. failed to label and date food in the refrigerator. 4. failed to clean and sanitize the blender equipment and spatula after preparation of puree meal. This failure has the potential to affect all 357 residents who received oral meals from the facility's kitchen. Findings include: On 07/14/24 at 09:50 AM, V5 (Cook) oversaw the kitchen at this time. V4 (Dietary Manager) is not in the building. On 07/14/24 at 09:51 AM, Upon entrance to the kitchen observed two staff with beards in the food preparation area not wearing beard covers. V6 (Dietary Aide) was inquired of his beard. V6 said, I just didn't have it (beard covering) on. I know I'm supposed too. I have too much facial hair. On 07/14/24 at 09:52 AM, V7 (Certified Nursing Assistant/CNA) seen in the kitchen without wearing a beard cover while putting ice and water into the large water jugs. V7 was inquired of being in the kitchen without a beard cover. V7 said, I know I have to cover it, but I just started to get something. I know they were busy. On 07/14/24 at 10:04 AM, V6 (Dietary Aide) began washing dishes in the three-compartment sink. V5 (Cook) tested the sanitation level at 100 ppm (parts per million). V5 was inquired of the sanitation level. V5 didn't answer. V6 (Dietary Aide) said, It should be at 200, you have to put more (sanitizer) in. On 07/14/24 at 10:10 AM, there is a clear container with salad in the refrigerator with no label. V5 [NAME] was inquired of the container. V5 said, I don't know whose it is. On 07/14/24 at 2:46 PM, V4 said, The food that was in the refrigerator was for one of the staff. She puts her lunch in there. I told her she can't put it there; she knows now. On 07/15/24 at 9:36 AM, V17 (Cook) prepared the mechanical soft and pureed lunch of creamed chicken and noodles. On 07/15/24 at 9:43 AM, V17 (Cook) took the blender over to the food preparation sink, turned on the water, and wiped the blender out under the water with his gloved hand. V17 took the blender and lid over to the three-compartment sink and dipped the blender and lid into the sanitation water. V17 placed the blender and lid onto the drying rack. On 07/15/24 at 9:51 AM, V17 took the spatula used during the puree preparation to the food preparation sink and rinsed it off in the water while wiping it with his gloved hand. V17 placed the spatula onto the food preparation counter. There are utensils and equipment in the food preparation sink, a whisk, a four-ounce scoop, and a metal pitcher. On 07/15/24 at 9:53 AM, V17 was inquired of the food preparation sink and washing the equipment. 145778 Page 3 of 5 145778 07/17/2024 Midway Neurological / Rehab Center 8540 South Harlem Bridgeview, IL 60455

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many V17 said, I clean the blender and spatula in the sink. I'm not to wash any dishes in the sink. It's only water for the food. There's no soap over here. I'm supposed to wash them in the three-part sink. I didn't use soap. The stuff in the sink is dirty and has to be washed. On 07/15/24 at 9:55 AM, V4 (Dietary Manager) was inquired of the food preparation sink. V4 said, It's the cook sink. They can rinse vegetables and fill pans with water. They're not supposed to be cleaning in this sink. V17 did not take the dirty blender, lid, and spatula to the three-compartment sink to be properly washed and sanitized. The food preparation sink is not to be used for washing any dishes or utensils. Dirty utensils and equipment should not be inside the food preparation sink. On 07/15/24 at 12:00 PM, V4 (Dietary Manager) was inquired of the three-compartment sink sanitation level. V4 said, I make sure the staff make fresh water throughout the day. They fill the water to the line and push the button one time for the Qaut (Quaternary Ammonium solution). There is a button on the wall above the sanitation sink with tubing that dispenses the quaternary ammonium solution into the water for sanitation. Observed a moderate amount of the solution remained in the tubing while dispensed. On 07/17/24 at 11:04 AM V4 (Dietary Manager) was inquired of sanitation of kitchen equipment and utensils. V4 said, All equipment has to be sanitized because it can have bacteria. Empty the food debris in the garbage. Then wash, rinse, sanitize, and air dry. It should be done in the three-compartment sink. The policy and procedure manual section: food safety & sanitation policy: three compartment sink use dated 4/2017 states in part: Policy: The facility will clean and sanitize food service equipment, utensils, dishes, and tableware using the proper procedure. Procedure: Food service employees are trained on the use of the 3-compartment sink according to the chemical manufacturer's specifications and instructions. A test kit will be available and used to accurately measure the sanitizer concentrations and water temperature per chemical manufacturer's specifications. A daily log of chemical concentration will be maintained. The policy and procedure manual section: food safety & sanitation policy: general preparation & cooking dated 4/2017 states in part: Policy: The facility will follow sanitary practices in food preparation and cooking to keep food safe. Identification of potential hazards in the food preparation process and adhering to critical control points can reduce the risk of food contamination and thereby prevent foodborne illness. Procedure: The food service employee will ensure workstations, cutting boards, and utensils are clean and sanitized. 145778 Page 4 of 5 145778 07/17/2024 Midway Neurological / Rehab Center 8540 South Harlem Bridgeview, IL 60455

F 0812 Level of Harm - Minimal harm or potential for actual harm The policy and procedure manual section: food safety & sanitation policy: employee health & personal hygiene dated 4/2017 states in part: Policy: Food service employees shall maintain good personal hygiene and free from communicable illnesses and infections while working in the facility. Residents Affected - Many Beards should be well trimmed and covered with an appropriate hair restraint. The policy and procedure manual section: food safety & sanitation policy: storage of refrigerated/frozen food dated 4/2017 states in part: Policy: The facility will follow safe handling and storage of refrigerated and frozen foods. Procedure: Foods in the refrigerator will be covered, labeled, and dated. 145778 Page 5 of 5