Inspection·April 7, 2023

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, record review and Center for Medicare and Medicaid Services (CMS) food temperature guidance the facility failed to ensure temperatures of food leaving the kitchen were at the appropriate temperature to prevent food borne illness, and failed to keep the can opener clean. This had the potential to affect all 85 residents receiving food from the kitchen. Residents #1, #8, #10, #12, #14, #15, #28, #30, #31, #36, #50, #51, #54, #57, #58, #61, #62, #74, #78, #105, and #106 did not receive food from the kitchen. The facility census was 106. Findings included: 1. Interview on 04/05/23 at 12:08 P.M. with Dietary Supervisor #209 revealed the facility documented temperature checks on the menus and not all food that had been temperature checked prior to leaving the kitchen. Interview on 04/05/23 at 12:10 P.M. with Registered Dietitian (RD) #202 verified every meal from the kitchen should be temperature checked prior to being served to confirm it has reached a safe temperature to prevent food-borne illness. Review of food temperature logs from 01/29/23 to 04/01/23 revealed food temperatures were not taken during preparation or during holding. The following dates had one meal with no temperature checks: 02/11/23, 03/06/23, 03/07/23, 03/09/23, and 03/11/23. The following dates had two meals with no temperature checks: 02/05/23 and 02/18/23. The following dates had all three meals with no temperature checks: 02/06/23, 02/08/23, 02/09/23. 02/10/23, 02/14/23, 02/15/23, 01/26/23, 02/17/23, 02/26/23, 02/27/23, 02/28/23, 03/01/23, 03/02/23, 03/03/23, 03/04/23, 03/25/23, and 03/26/23. From 01/29/23 to 04/01/23 was 63 days resulting in a total of 189 meals with food which should have been temperature checked. Sixty meals during this time did not have temperature checks resulting in 31.74% of meals with food not temperature checked. The meals which were not temperature checked included chicken, pork, beef, and fish. Review of facility form titled, Food Temperature: CMS Interpretive Guidance, undated, provided by RD #202 revealed poultry should reach a final cooking temperature of 165 degrees Fahrenheit, and ground meat should reach a final cooking temperature of 155 degrees Fahrenheit, and fish and other meats (beef, pork, veal) should reach a final cooking temperature of 145 degrees Fahrenheit. 2. Observation on 04/05/23 at 12:00 P.M. of the large can opener revealed a black dried substance on the piece that punctures the can. Further observation revealed the table base which holds the piece that punctures the can to be dirty. (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: 365195 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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)