Health inspection·November 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, medical record review and review of facility policy, the facility failed to ensure pureed foods were prepared in a manner to maintain nutritive value. This affected one (#46) of three residents reviewed for diet orders. The facility identified two residents with physician ordered pureed diets. The facility census was 112. Residents Affected - Few Findings include: Review of the medical record for Resident #46 revealed an admission date of 08/02/24. Diagnoses included cerebral infarct (stroke), epilepsy, malnutrition, dementia and heart disease. Review of a physician order dated 08/02/24 revealed Resident #46 had an order for pureed diet. Review of the care plan dated 08/02/24 revealed Resident #46 had a nutritional risk related to mechanically altered diet and requiring assistance with meals. Interventions included to provide diet as ordered (regular diet, puree texture.) Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #46 was severely cognitively impaired and required supervision/touch assistance with eating. The assessment also revealed the resident received a mechanically altered diet. Observation on 11/12/24 at approximately 3:00 P.M. of puree turkey burger preparation revealed Kitchen Manager (KM) #60 placed an unmeasured amount of turkey meat in the blender, along with one and a half hamburger buns, an unmeasured amount of broth (the container the broth was poured from contained approximately one quart of broth and over half of the broth was poured in the blender) and an unmeasured amount of thickener. Concurrent interview with KM #60 revealed he was preparing two servings, to have extra available, and estimated he used six to eight ounces of turkey meat, two and one-half cups of broth and two tablespoons of thickener. While blending the mixture, KM #60 added two more tablespoons of thickener, followed by an additional two tablespoons of thickener and finally added one more tablespoon of thickener, for a total of seven tablespoons for thickener. Continuous observation of the turkey burger puree revealed it lacked turkey flavor and tasted like paste/starch. Interview 11/12/24 at 5:42 P.M. with Resident #46 revealed she received the puree turkey burger. Resident #46 stated the turkey burger did not taste like turkey and the pureed food tasted awful. Interview on 11/13/24 at 11:00 A.M. with Dietician #59 revealed puree foods should be thickened to the right consistency by blending the food first then adding either liquid or thickener to reach the desired consistency. (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 4 Event ID: 365222 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 365222 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Norworth The 6830 North High Street Worthington, OH 43085 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)