Health inspection·March 6, 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, review of the Local Health Department Inspection, review of the dishwasher temperature logs, review of the dishwasher manufacture recommendations, and staff interviews, the facility failed to ensure the dishwasher was at a temperature to properly sanitize dishes. This had the potential to affect all 70 residents who received food from the kitchen. The facility identified two residents who do not receive food from the kitchen. The facility census was 74. Findings include: Observation on 03/06/24 at 7:51 A.M. of the dishwasher in the kitchen revealed dishwasher model was AF 30 S. Specifications on label on dishwasher revealed wash 45 seconds, rinse 30 seconds and dwell 15 seconds. Recommended wash temperatures is 120 degrees Fahrenheit (F) minimum and 50 parts per million (PPM) of chlorine rinse. Rinse temperature is 120 degrees F minimum. Two compartment sink observed in the dish area and one compartment sink observed in the prep area. Observation on 03/06/24 at 8:13 A.M. revealed the dishwasher in the kitchen was in use and had a wash temperature of 66 degrees F and rinse temperature of 70 degrees F and 100 PPM of chlorine. Interview on 03/06/24 at 8:18 A.M. with Dietary Manager (DM) #742 verified the dishwasher wash temperature was 66 degrees F and rinse temperature 70 degrees F. DM #742 verified the dishwasher model recommended wash and rinse temperatures be at a minimum 120 degrees F. DM #742 stated she was told the Local Health Department (LHD) had been in the facility, and they were more concerned with the chorine than the temperatures of the dishwasher. DM #742 verified the March 2024 temperature log for the dishwasher were all under the 120 degrees F which was recommended. Interview on 03/06/24 at 12:20 P.M. with Maintenance #754 verified that he had known for a while that the dishwasher had not been coming up to temperature. Maintenance #754 stated the previous maintenance man knew the dishwasher was not coming to temperature but did not fix it or call the company that fixes them. Interview on 03/06/24 at 12:31 P.M. with DM #742 verified she had been employed since February 2024 and the dishwasher temperature had not been up to the recommended 120 degrees F since her employment. DM #742 verified the dishes had been washed and rinsed and used from the dishwasher. Interview on 03/06/24 at 12:37 P.M. with the Director of Nursing (DON) and Corporate Director of Clinical Services (CDOCS) #900 verified an email was sent on 02/07/24 regarding the dishwasher. They verified a subsequent email was sent on 03/06/24 at 11:25 A.M. revealed a booster for the dishwasher was ordered and had not been received yet. They stated the meals would be served on Styrofoam going (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: 365202 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 365202 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carecore at Lima 599 South Shawnee Street Lima, OH 45804 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)