Inspection·August 4, 2022

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some understand us and let us know something is wrong with her; she use gestures sometimes. No she does not have a communication board. 2. R4's MDS (Section G) dated 07/19/2022 documents R4 requires one person physical assist for feeding. Review of R4's current plan of care does not include any focus area or interventions related to R4's needs related to eating/feeding assistance. On 8/01/2022 at 12:28 PM, R4 was observed to be struggling to eat his lunch with his hands. R4 had food all over his clothing. No staff were observed to be assisting R4 with his meal. On 8/02/2022 at 12:08 PM, R4 was in his room eating with his hands; there were pieces of mechanically ground ham in R4's lap. There was no one assisting resident to eat. On 8/04/2022 at 11:33 AM, V2 (DON) said, Yes (R4) should have feeding assistance because sometimes he is so messy, you have to help him. Every day he should have assistance. He is a one person assist with feeding. Resident should be checked every two hours, as needed, and at resident request. I expect for them (staff) to acknowledge the resident and then take them to the bathroom. Depending on the situation, if I am in the room and the resident asked to go to the bathroom, and I am in the room talking to another resident I should say 'excuse me, I will right back.' If staff are providing care, and they can wait they should say 'excuse me, I will be right back' and take the other resident to the bathroom and start back. The rooms are small, so you can put the resident on the toilet and then start back caring for the other resident until they are done. Staff have to prioritize. It depends on the situation, for example, if I'm in the room cutting fingernails and a resident needs to use the bathroom, I will tell the resident please hold on with the nail,s and take the other resident to the bathroom. It depends, if the resident has a problem with their bladder and can only hold it for like few minutes and some can be right away. Some people don't have control over their bladder so you have to assume they have to go right away. Even if they start to or have already gone you still have to assume that they need to go and take them. Some resident still have the urge even if they started, they should be allowed to go because they can dribble but want to finish in the toilet. Yes, it is important to maintain their ability to use the bathroom all of our residents are here because they need some type of assistance they are not able to take care of themselves; that's why we are here. Yes that is a priority, they should be taken immediately (to the bathroom). If they urinate on themselves, that can make them feel uncomfortable. If you urinate on yourself you will feel uncomfortable. With (R28) she will begin to cry and will not stop until she get what she needs. Yes, I expect staff that is working with her to be able to understand her and make sure all her needs are being met. 3. On 8/01/2022 at 12:25 PM, R12 was lying in bed. Observed urinary catheter collection bag hanging on bed frame not within a privacy bag, with approximately 100ml clear dark yellow urine within collection bag. On 8/2/22 at 11:11 AM, R12 was lying in bed watching television. Observed urinary catheter collection bag hanging on bed frame, not within a privacy bag, with approximately 100ml clear yellow urine within bag. On 8/03/2022 at 10:14 AM, observed R12 lying in bed, with urinary collection bag hanging on bed frame, not in a privacy bag with approximately 50cc of clear yellow urine in collection bag. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 2 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 0550 Level of Harm - Minimal harm or potential for actual harm 4. On 8/01/2022 at 11:19 AM, R43's urinary collection bag was hanging on bed frame and not in privacy bag. Noted approximately 200ml dark yellow urine noted in bag. On 8/02/2022 at 11:10 AM, R43 was lying in bed asleep, noted urinary collection bag hanging on bed frame not in a privacy bag with approximately 500ml of dark yellow urine observed in bag. Residents Affected - Some Record review of document submitted by the facility titled Dignity, with a revision date of 4/23/2018, under guidelines states: The facility shall promote care for resident in manner and in an environment that maintains or enhances each resident each resident's dignity and respect in full recognition of his or her individuality. The facility shall consider the resident's life style and personal choices identified through the assessment processes to obtain a picture of his or her individual needs and preferences. Under maintaining a resident's dignity should include but not limited to the following: Bullet point number six states Refraining from practices demeaning to residents such as leaving urinary catheter bags uncovered , refusing to comply with a residents request to for the bathroom assistance during meal times, and restricting from use of common areas open to general public such a lobbies and restrooms, unless they are on transmission-based isolation precautions or are restricted according to their care planned needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 3 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to follow their policy for monitoring and assessing signs of involuntary movement disorder by not observing and reporting tongue thrusting for a resident who is taking psychotropic medications. This failure applied to one (R22) of six residents in a total sample of 26 residents reviewed for unnecessary medications. Residents Affected - Few Findings include: R22 is a [AGE] year-old female with a diagnoses history of Schizophrenia, Bipolar Disorder, Major Depressive Disorder - Recurrent, and Altered Mental status who was originally admitted to the facility 05/24/2022. On 8/01/22 at 11:15 AM, observed R22 in her room lying in bed watching television, with visible tongue thrusting. On 8/01/22 at 3:23 PM, R22 stated she hears voices, with noticeable tongue thrusting. On 8/03/22 at 11:22 AM, surveyor observed R22's tongue thrusting while sitting in her wheelchair in her room watching television. R22's current face sheet does not include an involuntary movement disorder. R22's Admissions Abnormal Involuntary Movement Scale (AIMS), dated 5/24/2022, and quarterly AIMS, dated 7/12/2022, documents no abnormal tongue movement. R22's Current physician order sheet documents an active order, effective 5/24/2022, for 200 mg antipsychotic medication tablet by mouth one time daily, for diagnosis of schizophrenia, and 10 mg antipsychotic tablet by mouth twice daily for diagnosis bipolar disorder. R22's Quarterly Psychotropic Medication Review, dated 7/12/2022, documents 200 mg antipsychotic and 10 mg antipsychotic for diagnosis of schizophrenia and bipolar disorder; no side effects noted. R22's July 2022 and August 2022 Medication Administration Record documents she received 200mg antipsychotic medication tablet by mouth daily for schizophrenia, and 10 mg antipsychotic medication tablet by mouth twice daily for bipolar disorder. On 8/03/22 at 11:46 AM, V8 (Certified Nursing Assistant) stated she has been working for the facility since December, and noticed R22's tongue thrusting some time ago. V8 stated she reported R22's tongue thrusting to V14 (Licensed Practical Nurse), who then observed R22 and stated he had no concerns, but will continue monitoring her. On 8/03/22 12:15, PM V4 (Registered Nurse) stated R22 is her patient and does take psychotropic medications. V4 stated she is not sure how long R22 has been thrusting her tongue. V4 stated no one has ever reported R22's tongue thrusting to her, and she personally has never observed her doing so. V4 stated tongue thrusting is concerning, and if observed the facility would let the physician know R22 was exhibiting this involuntary movement and the physician would advise on how to address it. V4 stated if tongue thrusting is exhibited and not reported to the physician, R22 could be uncomfortable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 4 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and there could be a need to change her medication. V4 stated tongue thrusting is a side effect of psychotropic medication. On 8/03/22 at 12:58 PM, V9 (Psychiatrist) stated he did observe R22 thrusting her tongue today. V9 stated this was his first time seeing R22. V9 stated R22's tongue thrusting is a sign of an involuntary movement disorder. V9 stated R22 is taking high doses of psychotropic medications. V9 stated R22's schizophrenia is well managed, and therefore her dosage may be decreased. V9 stated he is going to reduce her psychotropic medications to determine if there is an improvement in her tongue thrusting and keep her condition stabilized. V9 stated any signs of involuntary movement observed in an individual taking psychotropic medications should be addressed. V9 stated signs of an involuntary movement disorder include tongue thrusting, and involuntary movements of the trunk and upper and lower extremities. V9 stated once an involuntary movement disorder associated with psychotropic medications has developed, it is permanent. On 8/03/22 at 2:30 PM, V10 (Medical Director) stated an involuntary movement disorder is a side effect of psychotropic medication, and the medication has to be stopped if causing side effects. V10 stated if a resident develops signs of an involuntary movement disorder, he would send them out to the hospital to be evaluated and monitored closely to make sure they don't get worse. V10 stated the facility should be monitoring for signs of abnormal involuntary movements, and if he receives a call this has been observed in one of the resident's, he would recommend the facility contact the psychiatrist because it is a psychiatric issue. On 8/03/22 at 2:30 PM, V7 (Minimum Data Set Coordinator/Registered Nurse) stated all nurses are responsible to conduct an Abnormal Involuntary Movement Scale (AIMS) Assessment. V7 stated AIMS assessments are conducted on admission, every six months, and upon any acute changes in a resident's condition. V7 stated tongue thrusting is considered an acute change. V7 stated no one in the facility had observed or notified her or V2 (Director of Nursing) R22 is thrusting her tongue. V7 stated she did become aware of R22's tongue thrusting today, and notified V9 (Psychiatrist) while he was in the facility today. V7 stated any involuntary movements observed in a resident taking psychotropic medications should be immediately reported to the physician. V7 reported Extrapyramidal Symptoms (repetitive, involuntary facial movements, such as tongue twisting, chewing motions and lip smacking, cheek puffing, and grimacing) associated with psychotropic medications are repetitive movements. V7 stated if staff observe a resident with tongue thrusting, they should report it to the nurse as well as V2 Director of Nursing and herself. The facility's Abnormal Involuntary Movement Scale (AIMS) Policy, reviewed 8/03/2022, states The purpose of the Policy - Abnormal Involuntary Movement Scale (AIMS) - records the occurrence of abnormal involuntary movement disorder (a neurological disorder characterized by involuntary movements of the face and jaw) of residents receiving psychotropic medications. To assess the presence of movement and non-movement side effects, and to follow the severity of abnormal involuntary movement disorder over time. The psychiatrist/Nurse Practitioner shall work with the resident to determine the most appropriate course of treatment, considering both the effects of Tardive Dyskinesia and the resident's psychiatric condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 5 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to follow physician orders by not giving medications as ordered and not following their medication administration policy for four (R4, R8, R26, and R42) of 27 residents reviewed during the medication administration survey task. Residents Affected - Some Findings include: Twenty-six opportunities of medication administration were observed, and six of the twenty-six medications were not administered in accordance with physician's orders, resulting in a medication error rate of 23.08%. 1. On 8/02/2022 at 9:32 AM, V3 (Licensed Practical Nurse) dispensed and administerd the following medications to R8: amlodipine 5mg tablet, aspirin 81mg chewable tablet, metoprolol tartrate 25mg tablet, pyridoxine 100mg tablet, Aricept 5mg two tablets, quetiapine fumarate 100mg tablet, senna 8.6mg 2 tablets, namenda 10mg tablet, and thiamine 100mg tablet. V3 (Licensed Practical Nurse) said several medications were unavailable, but had been ordered. R8's Physician's Order report, dated 8/03/2022, showed R8 has current orders for amlodipine besylate 5mg one tablet daily, aspirin 81mg chewable tablet daily, metoprolol tartrate 25mg tablet daily, pyridoxine 100mg tablet daily, Aricept 5mg two tablets daily, quetiapine fumarate 100mg tablet twice daily, senna 8.6mg tablet 2 tablets twice daily, namenda 10mg tablet twice daily, and thiamine 100mg tablet daily. R8 was not administered pyridoxine 100mg, quetiapine fumarate 100mg, and two senna 8.6mg tablets by V3 (Licensed Practical Nurse). 2. On 8/02/2022 at 9:57 AM, V3 (Licensed Practical Nurse) dispensed and administered the following medications to R26: potassium chloride extended release 20meq tablet, tamsulosin 0.4mg capsule, furosemide 40mg tablet, Tylenol 325mg two tablets, and metoprolol succinate extended release 50mg tablet. V3 said multiple stock meds are on back order, only calcium carbonate 75mg tablet is available, and V3 would notify R26's physician to administer stock on hand. R26's Physician's Order report, dated 8/03/2022, showed R8 has current orders for potassium chloride extended release 20meq tablet daily, calcium carbonate tablet chewable 1000mg tablet daily, tamsulosin 0.4mg capsule daily, furosemide 40mg tablet, Tylenol 325mg two tablets three times daily, and metoprolol succinate extended release 50mg tablet daily. R26 was not administered calcium carbonate 1000mg chewable tablet. 3. On 8/02/2022 at 10:15 AM, V3 (Licensed Practical Nurse) dispensed and administered the following medications to R4: amlodipine besylate 2.5mg tablet and aspirin 81mg tablet. At 10:26 AM, V3 said if a medication is unavailable, she would call the pharmacy for status of medication, then the resident's physician. When asked if the facility has an automated medication dispensing system, V3 (Licensed Practical Nurse) said, Yes but I don't like to use it, the other one we had was better and didn't require two nurses to remove a medication. R4's Physician's Order report, dated 8/03/2022, showed R4 has current orders for amlodipine besylate 2.5mg tablet daily, aspirin 81mg tablet daily, and colace 100mg capsule daily. R4 was not administered colace 100mg capsule. 4. On 8/02/2022 at 10:33 AM, V3 (Licensed Practical Nurse) dispensed and administered the following (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 6 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medications to R42: carbidopa-levodopa extended release 25-100mg tablet, donepezil 10mg tablet, amlodipine 10mg tablet, memantine 10mg tablet, losartan potassium 25mg tablet, and acetaminophen 500mg two tablets. R42's Physician's Order report, dated 8/03/2022, showed R4 has current orders for carbidopa-levodopa extended release 25-100mg tablet three times daily, donepezil 10mg tablet daily, amlodipine besylate 10mg tablet daily, memantine 10mg tablet daily, losartan potassium 25mg tablet daily, acetaminophen 500mg two tablets three times daily, and senokot S 8.5-50mg two tablets twice daily. R42 did not receive two senokot 8.5-50mg tablets. On 8/04/2022 at 11:58 AM, V2 (Director of Nursing) said her expectations of nursing when administering medications, is to do the five rights and make sure the medication is available. She said if the medication is not available, they should check to see if available in our medication dispensing system or emergency box, then call pharmacy if unavailable to see when the medication is coming. V2 (Director of Nursing) also said if a medication is missed, staff should inform their doctor, because it's an order that must be given. She said staff should ask the physician if the medication can be given when delivered. When asked if an antipsychotic medication is a significant medication, V2 (Director of Nursing) said all medications are significant and should be given as ordered. Medication Administration policy, revised date of 1/01/2015, provided by facility that showed documentation of medication administration includes the date, time, and initials of the licensed nurse who administered the medication. Policy also showed medications must be administered in accordance with a physician's order, e.g., right medication, right time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 7 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 observation, interview, and record review, the facility failed to follow their policy and procedures for preparing food under sanitary conditions and safe food storage by not discarding opened and unused foods past their expiration date, not using hand hygiene after contact with surfaces and upon re-entry into the kitchen, not thoroughly washing hands, and not ensuring cleaning linens contained appropriate levels of cleaning and sanitation solutions before use. This failure has the potential to affect all 55 residents currently in the facility. Findings include: On 8/1/22 at 10:31 AM, observed a 32 oz container of thickened dairy milk, with a labeled open date of 1/12/2022, and a use by date of 5/20/2022; a 46 ounce container of thickened cranberry cocktail, with a labeled open date of 1/12/2022, and a use by date of 4/26/2022; a 46 ounce container of thickened cranberry cocktail, with a labeled received date of 12/28/2021, and a use by date of 4/26/2022, which had been opened per V11 (Cook); and an unopened 32 ounce container of thickened dairy drink, labeled as received 3/22/2022, and a use by date of 5/15/2022. V11 stated the thickened beverages are used for residents receiving honey thickened beverages. On 0/02/22 from 9:50 AM to 10:35 AM, V13 (Dietary Manager) stated she is the Dietary Manager. Surveyor observed: *V13 entered the kitchen without performing hand hygiene, and laid down meal tickets on the top level of the food prep table. *V11 (Cook) washed her hands for less than 20 seconds, then donned gloves to make puree. *V11 wipeed food prep area with a wet towel, and laid the towel over the side of the sink area where the sanitizer solution and soap buckets are located. *Cleaning towels stored on side of the sink where the sanitizer solution and soap buckets are located. *A dusty fan blowing air towards the food prep area and on the cleaning towels stored over the side of the sink where the sanitation and soap buckets are located. *V11 grabbed her mask with gloved hands then continued to place meal cards on clean trays. *V12 (Dietary Aide) doffed gloves, washed hands for less than 20 seconds, donned gloves then begin handling clean dishes. *V11 removed a large pan of Brussels sprouts from the hotbox, set it down on the food prep area where the dusty fan was blowing air, and remove the plastic wrap from over the Brussels Sprouts. *V11 grabbed a wet towel stored on the side of the sink, wiped the food prep table, placed it underneath the hotbox door while removing food, then grabbed that towel and began wiping the steam table and steam tray lids. *V11 washed her hands for less than 20 seconds, grabbed her apron with bare hands, then grabbed a tray of ham from the refrigerator, placed it in the hot box, wiped food prep area with a wet towel then donned gloves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 8 of 9 Printed: 05/15/2026 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 145913 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459 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 On 8/03/22 at 1:44 PM, V11 (Cook) stated, The drink cartons that had been opened and past the used by date should have been tossed out. V11 stated she used the towel that contained sanitizer solution to wipe the food prep areas yesterday. V11 stated, The sanitizer solution cleans and sanitizes. The towels stored on the side of the sink in the food prep area are used to clean up excess water and clean. Cleaning towels for the kitchen can be stored inside or outside of the sanitation and soapy water buckets. V11 stated, Hands should be washed at least 20-30 seconds. V11 stated when preparing the purees yesterday, there were a couple of times where she may have cleaned her hands for approximately 10 seconds. V11 stated there is no specific reason that she cleaned her hands under 20 seconds. V11 stated, Hands should be washed for 20-30 seconds to ensure there is no contamination from bacteria etc. when coming in and out of the kitchen and while working in the kitchen performing different tasks. The fan used in the kitchen is cleaned once weekly. If the fan has dust on it, it should be turned off and cleaned. Someone does clean the fan weekly, however, any staff can clean it if they notice it needs cleaning. The fan needs to be cleaned when used in the kitchen to prevent dust particles and contamination from encountering food. V11 stated she should have washed her hands yesterday after touching her apron to prevent contamination of food if there was anything on the apron. On 8/04/22 at 12:36 PM, V13 (Dietary Manager) stated, Cleaning towels can be stored on the inside or outside of the sanitizer an soapy water buckets, but should be reinserted in the sanitizer solution or soapy water before using them for infection control purposes to prevent contamination. The facility's Proper Hand Washing and Glove Use Policy, states: The proper procedure for washing hands is as follows: Scrub 15 to 20 seconds or more. All employees will wash hands upon entering the kitchen from any other location, and between all tasks. Employees will wash hands before and after handling foods, after touching any part of the uniform, face. Hands are washed before donning gloves and after removing gloves. Gloves are changed any time hand washing would be required. This includes if the gloves become contaminated by touching the face, uniform, or other non-food contact surface. The facility's Food Storage Policy states: Discard food that has passed the expiration date. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145913 If continuation sheet Page 9 of 9