Health inspection·February 16, 2024

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 properly label, date, seal, and store food items in the kitchen. This applies to all residents that receive oral nutrition and foods prepared in the facility kitchen. Findings include: The facility's Long-Term Care Facility Application for Medicare and Medicaid (Form CMS-Centers for Medicare and Medicaid Services-671) dated 2/13/24 documents that the total census was 68 residents. On 2/14/24 at 11:41 AM, V4 (Dietician) said all 68 residents eat from the facility kitchen. On 2/13/24 from 10:41 AM through 11:40 AM, the facility kitchen was toured in the presence of V5 (Director of Food and Nutrition) and V6 (Executive Chef) and the following was found: In the Dairy Cooler: 1. A large sized opened bag of sliced pepperoni, no label or date. 2. A medium sized opened bag of sliced salami, no label or date. 3. An opened 3.5 pound pre-cooked buffalo chicken breast, not sealed and placed back in cardboard box, with the chicken touching the cardboard box packaging. Dry Storage: 4. Two 6 pound 15 ounce cans of tomato paste with large dents on the circulation rack 5. Three 6 pound 9 ounce cans of fancy concentrated crushed tomatoes, without a received date on circulation rack 6. Two 6 pound 8 ounce cans of mandarin oranges with large dents found on the circulation rack. 7. Two 6 pound 9 ounce cans of small whole beets without a received date on circulation rack 8. One 6 pound 11 ounce can of pineapple chunks without a received date on the circulation rack. 9. A 22 Quart container of semolina with prepare date of 5/28 and a use by date of 11/28. V6 said Page 1 of 3 146128 146128 02/16/2024 Plymouth Place 315 North LA Grange Road LA Grange Park, IL 60526

F 0812 the semolina was expired on 11/28/23 and should have been discarded. Level of Harm - Minimal harm or potential for actual harm 10. Four 1 gallon containers of honey mustard dressing with received date of 6/16/23. V6 and V5 said these dressings have a six month shelf life and were expired on 12/16/23 and should have been discarded. Residents Affected - Many In the produce refrigerator: 11. A medium sized silver bin of mashed potatoes, not labeled or dated. 12. A medium sized silver bin of green beans, not labeled or dated. 13. A small silver bin of watermelon, not labeled or dated. 14. A small silver bin of mashed potatoes, not labeled or dated. 15. An opened large bag of mixed greens- not sealed, not dated, and not labeled and browning/wilted. 16. A bag of pureed bacon mix not sealed with ingredients open to air, and outside of bag is sticky. In the freezer: 17. A large opened plastic bag of 20+ frozen hot dogs dated 1/12/24, not sealed with a large build-up of freezer burn on meat. 18. A large resealable bag of 15+ sausages dated 1/27/24 with a large amount of freezer burn build-up on meat. V6 (Executive Chef) said the freezer burn could have happened from the staff putting the meat in the freezer when they were still warm. For the duration of the kitchen tour, V5's (Director of Food and Nutrition) hair net was not worn appropriately to restrain her hair. V5's bangs were exposed, and the hair net was only restraining the hair on her head from the top middle of her head and back down to the top of her neck. The top front of V5's hair was not restrained. On 2/14/24 at 11:41 AM, V4 (Dietician) said all food items in the kitchen should be labeled and dated so foods can be rotated and outdated foods discarded. V4 said expired foods should be discarded to prevent foodborne illness of residents, especially because the age group that the facility serves is vulnerable. V4 said all opened items need to be sealed/wrapped well and dated with an opened date and expiration date. V4 said sealing opened food items is important to conserve freshness/quality and prevent contamination from pests. V4 said all canned items should be inspected upon delivery and dented cans should be removed from circulation. V4 said dented cans should be put in designated dented can area and returned to supplier. V4 said the risk with serving food from a dented can is bacteria growth, spoiled food, and contamination. V4 said all freezer burned food items should be discarded right away because that food item has been damaged by the freezer and would be a risk to serve. V4 said while wearing a hairnet, all hair needs to be restrained, including bangs, because that hair 146128 Page 2 of 3 146128 02/16/2024 Plymouth Place 315 North LA Grange Road LA Grange Park, IL 60526

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many can fall out and into food causing contamination. V4 said hair is a contaminate and we try in food service to prevent contamination. The facility's policy titled Labeling and Dating dated 10/19 states, Purpose: All foods will be appropriately wrapped, labeled and dated based on food storage guidelines . Procedure: 1. All foods will be labeled, dated, and securely wrapped or covered. 2. Labels with use-by dates will be clearly displayed on each item, and the dates will follow shelf-life guidelines. All products past the use by date will be discarded . The facility's policy titled, Receiving Goods and Storage of Goods dated 10/19 states, Purpose: Proper storage procedures will be utilized for all dry and refrigerated food storage. Procedure: .2. Food is inspected upon arrival, especially perishables .6. Products must be checked to detect unacceptable items, i.e. dented, swollen, or rusted cans, thawed or refrozen items, crushed cases, etc . The facility's policy titled, Food Safety/HACCP dated 10/19 states, Purpose: The Dining Services Department will adhere to food safety standards and education. Procedure: .4. Employees must wear clean uniforms, approved hair restraints .10. All foods prepared in the facility must be covered, labeled and dated indicating the contents, date of preparation, use-by date . 146128 Page 3 of 3