Health inspection·July 19, 2024

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 observations, resident interview, staff interview, and facility policy review, the facility failed to ensure food served was palatable for all residents. This affected four residents (#45, #47, #50, and #62) of five residents observed for food palatability and had the potential to affect all residents receiving food from the facility. The facility census was 90. Residents Affected - Some Findings include: Observations on 07/19/24 from 12:25 P.M. to 12:54 P.M. revealed six total pre-prepared plates were sent up from the kitchen to the second-floor dining room; four with a hot dog and French fries and two with grilled cheese and French fries. The plates were not covered in warming containers; they were covered in plastic wrap and sat on an open-air cart until they were delivered to the resident's hallway. Interview with Registered Dietitian #204 and Culinary Manager #120 on 07/19/24 at 1:05 P.M. confirmed the pre-prepared plates were left on the open-air cart from the time it left the kitchen at 12:25 P.M., until the time the carts were taken to the hallways to be served. They confirmed the pre-prepared plates did not have a warming base or top on them; they only had plastic wrap to keep them covered. Interview with Resident #47 on 07/19/24 at 1:10 P.M. revealed he ate his hot dog but confirmed that it was not warm. He would have preferred it to be much warmer than it was. Observation on 07/19/24 at 1:15 P.M. revealed Resident #45 was not in her room, but her plate of food (hot dog and French fries) was delivered, waiting for her to return. The temperature of her food was taken, and the hot dog was 91 degrees Fahrenheit (F), and the French fries were 100 degrees F. The temperatures were taken and confirmed by Registered Dietitian #204. Interview with Resident #62 on 07/19/24 at 2:05 P.M. revealed she asked the aide to take her plate back (hot dog and French fries) because it was cold when she got back from dialysis. Interview with Resident #50 on 07/19/24 at 2:47 P.M. revealed her grilled cheese was very cold. She asked if there could be anything done to make the food warmer when she gets it. Review of the facility Food Preparation and Service policy, dated April 2019, revealed food and nutrition service employees prepare and serve food in a manner that complies with safe food handling practices. The danger zone for food temperatures is between 41 and 135 degrees F. This temperature range promotes the rapid growth of pathogenic microorganisms that can cause foodborne illnesses. Palatability of food determines appropriate temperature at bedside and tableside food. Generally, hot food (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 2 Event ID: 365129 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 365129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastbrook Healthcare Center 17322 Euclid Ave Cleveland, OH 44112 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)