Health inspection·February 8, 2024

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. Based on observations, interviews, review of facility food production sheets and diet type report, the facility failed to ensure Resident #18, #28, #38, #63, #85 and #94 received the pureed main entree in the proper portion size, failed to ensure Residents #19, #44, #49, #50, #60, #76, #77, #86 and #89 received the appropriate main entree for their low sodium diets as ordered, and failed to ensure Residents #13, #17, #21, #23, #25, #26, #30, #34, #41, #87, #91, #53, #54, #67, #69, #72, #73 and #79 received fortified foods as ordered. This affected a total of 33 residents of 94 residents receiving meals from the kitchen. The facility identified four residents (#2, #32, #65 and #74) as receiving nothing by mouth. The facility census was 98. Findings include: 1. Review of the facility food production sheet for lunch on 02/06/24 revealed residents on a puree diet were to receive two number eight scoops of pureed chili. Observation of the lunch tray line on 02/06/24 from 12:07 P.M. to 12:41 P.M. revealed residents who were on a puree diet received one number eight scoop of pureed chili from Dietary [NAME] (DC) #450 who was observed serving the pureed chili on the tray line. Interview on 02/06/24 at 12:34 P.M. with DC #450 confirmed he gave one number eight scoop of pureed chili to the residents on a puree diet. Review of the 02/06/24 lunch production sheet and interview with Dietary Manager on 02/06/24 at 12:57 P.M. confirmed the production sheet had not been followed and all residents on a puree consistency should have received two number eight scoops of pureed chili instead of one number eight scoop of puree chili. Review of the facility document titled Diet Type Report identified Residents #18, #28, #38, #63, #85 and #94 as having either pureed meat or pureed diet. 2. Review of facility food production sheet for lunch on 02/06/24 revealed residents on a low sodium diet were to receive one three-ounce hamburger on a bun with lettuce and onion instead of the chili. Observation of the lunch tray line on 02/06/24 from 12:07 P.M. to 12:41 P.M. revealed residents on a low sodium diet received one eight-ounce scoop of chili from DC #450. Interview on 02/06/24 at 12:34 P.M. with DC #450 confirmed he gave one eight-ounce scoop of chili Page 1 of 4 365353 365353 02/08/2024 Candlewood Healthcare and Rehabilitation 1835 Belmore Ave East Cleveland, OH 44112

F 0800 for the residents on a low sodium diet. Level of Harm - Minimal harm or potential for actual harm Review of the 02/06/24 lunch production sheet and interview with Dietary Manager on 02/06/24 at 12:57 P.M. confirmed the production sheet had not been followed and residents on a low sodium diet should have received one three-ounce hamburger on a bun with lettuce and onion instead of the one eight-ounce scoop of chili. Residents Affected - Some Review of the facility document titled Diet Type Report identified Residents #19, #44, #49, #50, #60, #76, #77, #86 and #89 as having a low sodium diet. 3. Observation of the lunch tray line on 02/06/24 from 12:07 P.M. to 12:41 P.M. revealed residents who were identified on their meal tickets as needing fortified mashed potatoes for lunch did not receive them. Observation of the items in the steam table revealed no fortified mashed potatoes had been prepared for the meal. Interview on 02/06/24 at 12:08 P.M. with DC #450 confirmed there were no fortified mashed potatoes made, and stated he only gave fortified mashed potatoes when mashed potatoes were on the menu. Interview on 02/06/24 at 12:45 P.M. with Dietary Manager #374 confirmed those residents who have fortified mashed potatoes identified on their meal ticket should receive them daily not when they are on the menu. Interview on 02/08/24 at 11:11 A.M. with Dietitian #451 confirmed residents who have fortified food identified on their meal ticket should be receiving the fortified food daily, not when they are on the menu. Dietitian #451 then stated the cooks down there know that. Review of the facility document titled Diet Type Report identified Residents #13, #17, #21, #23, #25, #26, #30, #34, #41, #87, #91, #53, #54, #67, #69, #72, #73 and #79 as having fortified foods diet. This deficiency resulted from incidental findings during the investigation of Complaint Number OH00150593. 365353 Page 2 of 4 365353 02/08/2024 Candlewood Healthcare and Rehabilitation 1835 Belmore Ave East Cleveland, OH 44112

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to ensure kitchen employees were wearing beard guards while preparing and serving food, and failed to ensure drinks on resident meal trays were covered while carrying the trays through the hallways for delivery to the residents. This had the potential to affect all 94 residents receiving meals from the kitchen. The facility identified four residents (#2, #32, #65, and #74) as receiving nothing by mouth. The facility census was 98. Findings include: 1. Observation on 02/01/24 from 12:20 P.M. to 12:25 P.M. revealed State Tested Nursing Assistant (STNA) #336 poured lemonade and fruit punch into plastic cups in an area around the nurse's station and then placed the cups of liquid back onto the meal trays in the covered food cart. STNA #336 then closed the door to the covered food cart and pushed it down the hall and placed the cart in the middle of the hall between room [ROOM NUMBER] and 111. STNA #336 then took Resident #95's meal tray out of the covered food cart and walked it down to the end of the hallway with the lemonade uncovered, and STNA #358 was observed taking Resident #89's out of the covered food cart and walked it down to the end of the hallway with the lemonade uncovered. Interview with Resident #89 on 02/01/24 at 12:26 P.M. with Resident #89 confirmed her lemonade didn't have a lid on it and stated sometimes the beverages comes with lids and sometimes they don't. Interview with Resident #95 on 02/01/24 at 12:28 P.M. confirmed his lemonade did not have a lid on it and stated, that is how it is served. Interview on 02/01/24 at 12:31 P.M. with STNAs #336 and #358 confirmed they walked down the hall with the beverages uncovered. Interview with Dietitian #45 on 02/01/24 at 3:12 P.M. confirmed the beverages should have been covered if the meal trays were being walked down the hallway. 2. Observations of the kitchen on 02/06/24 from 11:40 A.M. to 12:41 P.M. revealed from 11:40 A.M. to 11:47 A.M., Dietary [NAME] (DC) #401, who had a beard, was not wearing a beard guard while he prepared the puree chili, puree wax beans, and took the temperatures of the food items on the steam table. Observation at 12:00 P.M. revealed Regional Culinary #450 asked DC #401 to put on a beard guard. Observation of tray line from 12:07 P.M. to 12:41 P.M. revealed Dietary Aide (DA) #322, who had a beard, was not wearing a beard guard as he placed a domed lids on the plates of food then placed the food items in food carts. Observation of kitchen area on 02/06/24 from 11:40 A.M. to 12:41 P.M. revealed DA #330 who had a beard, was wearing a paper blue surgical mask under chin with parts of the beard on the side of the face sticking out between the ear loops of the surgical mask and was walking in and out of the kitchen and putting stock away. 365353 Page 3 of 4 365353 02/08/2024 Candlewood Healthcare and Rehabilitation 1835 Belmore Ave East Cleveland, OH 44112

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview on 02/06/24 at 12:41 P.M. with Regional Culinary #450 confirmed DC #450 had not been wearing a beard guard as he should have been until she asked him to put a beard guard on. Interview on 02/06/24 at 12:45 P.M. with Dietary Manager #374 confirmed DA #330 had a beard and a surgical mask under the chin was not an appropriate beard guard and DA #322 had a beard and was not wearing a beard guard. Dietary Manager #374 stated anyone working in the kitchen with a beard should wear a beard guard. This deficiency represents non-compliance investigated under Complaint Number OH00150593. 365353 Page 4 of 4