Health inspection·April 7, 2022

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, facility policy and procedure review and interview the facility failed to ensure altered textured food items were prepared in accordance with professional standards for food service safety to prevent contamination and/or food borne illness. This affected 16 residents (#2, #4, #5, #9, #21, #23, #28, #30, #31, #32, #36, #40, #44, #51, #115 and #210) of 16 residents identified to receive altered textured diets in the facility. The facility census was 56. Findings include: On 04/06/22 from 10:00 A.M. to 10:10 A.M. [NAME] #142 was observed during preparation of the lunch meal. [NAME] #142 was observed preparing altered texture food items. The cook was wearing gloves and placed turkey ala king into the blender. After blending one pan to a puree texture and three pans to a ground texture, [NAME] #142 gave the blender container to Dining Services Director #263 to be washed. [NAME] #142 then grabbed the sanitizing bucket, put her hand in the sanitizer to grab a wash cloth, wiped the blender base with the sanitizing cloth, threw a piece of turkey from the counter into the trash can, and changed the page on the food preparation manual. This was all done wearing the same gloves. [NAME] #142 did not change gloves or perform any hand hygiene during this process. Dining Services Director #263 then brought the blender container back to [NAME] #142 to prepare pureed texture minestrone soup. Wearing the same gloves as above, [NAME] #142 placed the soup in the blender, prepared it to the proper texture and poured it into a clean pan. While pouring the pureed soup into the clean plan, she placed a gloved hand on the top of the blending blade. After pouring all the soup into the clean pan, she cleaned the blender base with the sanitizing cloth. After doing this, [NAME] #142 then removed her gloves. On 04/06/22 at 10:13 A.M. interview with [NAME] #142 confirmed she did not change her gloves between preparing the altered food texture of the turkey ala king and minestrone soup. [NAME] #142 revealed staff typically do not change their gloves when preparing food textures until they change food types; so she did not change her gloves (perform hand hygiene) between the turkey ala king and minestrone soup because both foods contained turkey in them even though they were completely different food items. [NAME] #142 confirmed she did use the sanitizing cloth, threw a piece of turkey in the trash, touched the top of the blending blade, and changed pages in the food preparation manual prior to starting the process of blending the minestrone soup wearing the same gloves. The facility identified 16 residents, Resident #2, #4, #5, #9, #21, #23, #28, #30, #31, #32, #36, #40, #44, #51, #115 and #210 who received altered textured diets in the facility. Review of the undated facility Kitchen Hand Hygiene Policy revealed dietary employees shall clean (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: 365399 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/07/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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)