Inspection·February 25, 2025

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and review of facility policy, the facility did not ensure palatable food was served to all residents receiving meals from the kitchen. This affected six residents (#24, #28, #29, #32, #43 and #87) of six residents reviewed for food service. The facility census was 113. Residents Affected - Some Findings include: An observation was conducted on 02/25/25 at 12:35 P.M. to 1:33 P.M. of the kitchen food production, kitchen environment and lunch tray line meal service. The lunch consisted of chicken cutlet, spinach, chocolate chip cake and substitutes available were hamburger or ham slices, mixed vegetables, potato salad and ice cream. All hot foods on tray line reached acceptable temperature above 165 degrees Fahrenheit ( F) prior to the start of meal service. A second set of temperatures were not taken to monitor the temperatures of the food on tray line throughout the observation. A test tray was requested as the last resident's food was plated and ham slice, potato salad and mixed vegetables were placed for the test tray. The food cart left the kitchen at 1:33 P.M. with the test tray and arrived to the unit at 1:40 P.M. When the test tray reached the floor at 1:40 P.M. the test tray was placed in the dining room where food temperatures were taken by Dietary Manager (DM) #503 using a calibrated facility thermometer. The temperature of the ham slice was 106 degrees F and was barely warm to taste. The cold potato salad was 75 degrees F and was not cold. The mixed vegetables were 136 degrees F and tasted warm. DM #503 verified the food temperatures at the time of the test tray. An interview was conducted on 02/25/25 at 1:46 P.M. with Resident #28 who revealed he did not like the food, and the hot food was not hot. An interview was conducted on 02/25/25 at 1:48 P.M. with Resident #87 who stated the food is horrible. An interview was conducted on 02/25/25 at 1:51 P.M. with Resident #32 who revealed hot foods were served cold. An interview was conducted on 02/25/25 at 1:52 P.M. with Resident #24 who revealed the food did not taste good. An interview was conducted on 02/25/25 at 4:48 P.M. with Resident #29 who revealed they ordered food out because the food is not good. An interview was conducted on 02/25/25 at 5:07 P.M. with Resident #43 who stated the hot food is always cold. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 365033 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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)