Health inspection·December 13, 2023

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, review of the facility menu spread sheets, review of the printed tray cards, and medical record review, the facility failed to ensure proper food portions were served to meet the individual needs of Resident #143 who was ordered double portions, and failed to ensure proper food portions were served to all residents receiving meals from the kitchen. This had the potential to affect all residents receiving meals from the kitchen except Resident #37 who the facility identified as receiving nothing by mouth. The facility census was 147. Findings include: 1. Observation of the lunch meal trayline on 12/12/23 from 11:18 A.M. to 12:55 P.M. with Dietary Cook/Supervisor (DC/S) #413 revealed [NAME] #419 used one number-eight, gray handled ( four ounce) scoop to dish out the regular and mechanical soft turkey [NAME] and one number-12, green handled (two and two-third ounce) scoop to dish the puree turkey [NAME] and the puree mashed sweet potatoes. Review of facility Fall and Winter 2023 to 2024 spread sheet for Tuesday, week three revealed the correct portion size for the regular and mechanical soft turkey [NAME] was one eight-ounce spoodle (portion controlled serving spoon) and the puree turkey [NAME] was one number-six, white handled (five and one-third ounce) scoop. The puree mashed sweet potato was one number-eight (four ounce) gray handled scoop. Review of the of facility Fall and Winter 2023 to 2024 spread sheet for Tuesday, week three and interview on 12/12/23 at 2:50 P.M. with DC/S #413 revealed she was unaware of what the color of the handle of the scoop represented. She confirmed the residents who received the regular, mechanical soft and puree turkey [NAME] and the puree mashed sweet potatoes did not receive the full portion sizes since the residents who received regular and mechanical soft turkey [NAME] received four ounces instead of eight ounces, the residents who received the puree turkey [NAME] received two and two-third ounces instead of five and one third ounces, and the residents who received puree mashed sweet potatoes received two and two-third ounces instead of four ounces. DC/S #413 stated she had never seen a spread sheet. She indicated the facility had been printing out production sheets which listed the portion sizes, but since the employee who printed them out had been on leave of absence, there had not been any production sheets printed for about a month. 2. Review of medical record for Resident #143 revealed an admission date of 05/25/23. Diagnoses included fatty liver, hypo-osmolality (low levels of electrolytes in blood) and hyponatremia (low sodium levels in the blood), atherosclerotic heart disease, and essential hypertension (high blood pressure). Page 1 of 3 365655 365655 12/13/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of physician orders for Resident #143 revealed an order dated 05/26/23 for mechanical soft, double portions diet. Observation of Resident #143's breakfast tray and review of the resident's breakfast tray card on 12/13/23 at 9:21 A.M. with State Tested Nursing Assistance (STNA) #347 revealed Resident #143 received a single portion of eggs, one piece of toast, one bowl of hot cereal, and one bowl of sliced bananas. Resident #143's tray card placed on his breakfast tray did not indicate he was to receive double portions. At the time of observation, STNA #347 confirmed Resident #143 received a single portion for breakfast and his tray card had not indicated he should be receiving double portions. Interview on 12/13/23 at 9:34 A.M. with Dietary Manager (DM) #505 confirmed Resident #143's breakfast tray card should have specified the resident was on double portions. DM #505 stated he did audits to compare tray card and physician orders, and he had no idea how that got missed. This deficiency represents non-compliance investigated under Complaint Number OH00148558. 365655 Page 2 of 3 365655 12/13/2023 McKinley Nursing 800 Market Avenue North Suite 1560 Canton, OH 44702

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, staff interview, and review of facility policy, the facility failed to ensure food was served in a sanitary manner when a dietary staff member with artificial nails was observed not wearing gloves during tray line. This had the potential to affect 146 residents who received food from the kitchen. The facility identified one resident (#37) as not receiving anything by mouth. The facility census was 147. Findings include: Observation of the tray line on 12/12/23 from 11:18 A.M. to 12:55 P.M. with Dietary Cook/Supervisor (DC/S) #413 revealed Dietary Aide (DA) #432 had long, artificial nails with a three dimensional nail charm attached to the right fourth finger. DA #432 was not wearing gloves to cover the artificial nails and was setting up the trays on trayline for the lunch meal service. Interview with the Administrator on 12/12/23 at 3:38 P.M. revealed gloves should be worn by any dietary employee who has artificial nails, and DA #432 should have been wearing gloves to cover the artificial nails while on tray line. Review of undated facility policy Personal Hygiene revealed the food handler must wear gloves if artificial nails are worn to work in order to reduce the risk of food borne illness and food handler hazards. This deficiency represents non-compliance as an incidental finding during the investigation of Complaint Number OH00148558. 365655 Page 3 of 3