Health inspection·September 2, 2021

F 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and staff interview, the facility failed to provide adaptive equipment as ordered. This affected one (Resident #12) of two residents reviewed for use of adaptive equipment. The facility census was 78. Residents Affected - Few Findings include: Review of the medical record for Resident #12 revealed an admission date of 11/30/01. Diagnoses included multiple sclerosis, hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had impaired cognition. The resident required extensive assistance of one staff for eating. Review of the care plan dated 03/10/21 revealed the resident required a divided plate to aid in self-feeding. Review of the nutrition services progress note dated 03/10/21 revealed the resident was able to feed herself at times and a divided plate would be provided with meals. Review of the nutrition services progress note dated 08/26/21 revealed a divided plate was provided to aid in self-feeding. During observation on 08/30/21 at 12:03 P.M., Resident #12 was seated in a wheelchair by herself at a table in the dining room. The resident was attempting to scoop mashed potatoes from a regular, non-divided plate with a spoon. The mashed potatoes were pushed off the left side of the plate as the resident attempted to place the food onto the spoon. The resident then picked up the mashed potatoes from the table with her fingers and placed them in her mouth. Review of Resident #12's meal ticket on 08/30/21 at 12:06 P.M. stated she needed a divided plate. During interview on 08/30/21 at 12:12 P.M., State Tested Nursing Assistant (STNA) #322 verified Resident #12 did not have a divided plate and was pushing her food off the plate as she was attempting to scoop the food. STNA #322 stated dietary staff are supposed to provide adaptive equipment when preparing the meal tray. During observation on 08/31/21 at 12:21 P.M., Resident #12 was laying in her bed attempting to eat Page 1 of 4 365422 365422 09/02/2021 Brookhaven Nursing & Rehabilitation Center One Country Lane Brookville, OH 45309

F 0810 Level of Harm - Minimal harm or potential for actual harm a pureed sandwich. The food was not served on a divided plate. Resident #12 picked up the pureed food from the plate with her fingers. During interview on 08/31/21 at 12:29 P.M., Registered Nurse (RN) #358 verified the resident did not have a divided plate. Residents Affected - Few 365422 Page 2 of 4 365422 09/02/2021 Brookhaven Nursing & Rehabilitation Center One Country Lane Brookville, OH 45309

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, record review and interview, the facility failed to store and serve food in accordance with professional standards for food safety. This had the potential to affect 78 residents who received meals in the facility. The facility census was 78. Findings include: Observation of the kitchen on 08/30/21 at 08:28 A.M. revealed a tray of chocolate pudding and vanilla pudding dated 08/23/21. Seven gallons of drinks marked tea, prune juice, and lemonade were not dated. The next cooler contained eight glasses of poured dinks. The drinks were not labeled or dated. Review of the facility food temperature log revealed on 08/02/21, 08/19/21, and 08/20/21 the facility did not record any food temperatures for the meals served on that day. On 08/03/21, 08/04/21, 08/05/21, 08/08/21, 08/09/21, 08/10/21, 08/11/21, 08/12/21, and 08/13/21, the facility did not record any food temperatures of the evening meal. During interview on 08/30/21 at the time of the observations, Registered Dietitian (RD) #500 during the initial tour of the kitchen confirmed the pudding were labeled and dated 08/23/21 and the drinks were not dated. RD #500 also verified the food temperate logs were incomplete. During observation on 09/01/01 at 11:20 A.M. of kitchen of food prep and tray line, Dietary Manger (DM) #355 check the temperature of a piece of cooked chicken without cleaning the thermometer. DM #355 used the same food thermometer to check the temperature of a cooked hamburger without sanitizing the food thermometer. DM #355 donned plastic gloves and attempted to separate raw frozen beef patties. Without removing the gloves, DM #355 opened a drawer and pulled out a utensil to separate the frozen raw beef patties. DM #355 went back to the raw beef patties and attempt to separate without washing her hands or changing her gloves. During interview on 09/01/21 at 11:20 A.M., DM #355 stated she did not sanitize the thermometer in between food items and did not change her gloves while working with the raw beef patties. She stated thought it was okay not to remove her gloves, because cooking the hamburger would kill the germs. She said she would go back later and clean the drawer she touched with the gloves on. During observation on 09/01/21 at 12:00 P.M. the top of the trash can was soiled with splashes of dried stains and food debris. There was a dried grease like substance on the bottom of a food prep table with stacked clean dishes. The top of the food tray line shelf contained bottles of spices that was dirty with food particles and droppings. Review of the facility cleaning log notebook revealed a cleaning schedule for each day of the week. The kitchen was last documented as cleaned on 08/12/21. This was verified by RD #500. During interview 09/01/21 at 12:00 P.M. RD #500 verified the above findings and verified the kitchen was last documented as being clean on 08/12/21. During interview on 09/02/21 at 1:31 P.M., RD #500 stated she was unable to provide a policy 365422 Page 3 of 4 365422 09/02/2021 Brookhaven Nursing & Rehabilitation Center One Country Lane Brookville, OH 45309

F 0812 regarding labeling and discarding food or the kitchen cleaning schedule. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 365422 Page 4 of 4