Health inspection·February 15, 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 observation, resident interview, staff interview, food committee review, and review of the policy, the facility failed to ensure food was served at the preferred temperature. This had the potential to affect all residents residing at the facility, with the exception of two residents (#33 and #34) who received nothing by mouth. The facility census was 114. Residents Affected - Some Findings include: Review of food committee minutes dated 01/09/24 at 1:30 P.M., revealed residents expressed concerns with hot food not being hot enough at times. Kitchen staff were in-service to ensure proper food temperatures were maintained at the point of service. Interviews on 02/15/24 between 10:03 A.M. and 10:17 A.M., with Resident #83, #20, #73, and 47 revealed the food the facility served was not always warm enough. Observation on 02/15/24 at 12:12 P.M., of the tray line revealed chicken sandwiches, potato salad, and vegetable soup was being served. Oreo pie was also being served for dessert. Further observation continued as dietary staff plated the lunch meal from a steam table in the kitchen. As the tray line neared an end, the surveyor requested a test tray be prepared and placed on the last food cart. Observation was made as the test tray was prepared, placed on the cart at 1:00 P.M., and transported to the unit where it arrived at 1:02 P.M. The test tray remained on the cart in view of the surveyor, until all other trays were distributed to residents. The test tray was removed from the cart at 1:15 P.M. by Dietary Manager #246 who used a facility thermometer that confirmed the temperatures of the chicken was 124 degrees, the vegetable soup was 125 degrees, the potato salad was 55 degrees, and the Oreo pie (similar to a cheesecake) was 64 degrees. Dietary Manager #246 verified all temperatures. The chicken sandwich tasted somewhat warm, the soup broth was only slightly warm to the palate and was not palatable, the potato salad was only slightly cool which was not appealing, and the pie tasted room temperature which was not palatable. Interview with Dietary Manager #246 confirmed the pie was similar to a cheesecake and should be below 40 degrees along with the potato salad. Interview on 02/15/24 at 1:54 P.M., with Resident #47 revealed the temperature of the soup and chicken was warmer than usual, usually the foods were barely room temperature, the pie was rich and not cold enough, so she did not eat it. Review of the undated policy titled, Food Temperatures, revealed all hot foods must be held at a temperature of at least 140 degrees F, and served at a temperature that is palatable to the resident. All cold food items must be held at a temperature of 40 degrees F or below and served at a temperature that is palatable to the resident. (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: 365264 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 365264 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE O'Neill Healthcare Bay Village 605 Bradley Rd Bay Village, OH 44140 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)