Health inspection·April 2, 2025

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, medical record review and staff interview, the facility failed to ensure residents received meal textures as physician ordered. This affected two (#37 and #38) of three residents reviewed for altered food textures. The facility census was 56. Findings include: 1. Review of the medical record for Resident #37 revealed an admission date of 07/11/24 with a diagnosis of dementia. Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/14/25, revealed Resident #37 had impaired cognition and required set-up or clean-up assistance for eating. Review of a physician order, dated 10/31/24, revealed Resident #37 received a regular diet with mechanical soft textures and ground meats, with regular texture liquids. Also noted in the physician's order was Resident #37 should receive gravy or sauce on all foods, and should receive no skins, seeds, or nuts. Observation on 04/02/25 at 12:10 P.M. revealed Resident #37 seated in the dining room during the noon meal. Resident #37 received ground Salisbury steak, mashed potatoes, and whole peas with diced carrots on his plate. Resident #37 ate his meal without assistance. Observation and interview on 04/02/25 at 12:12 P.M. with Certified Nursing Assistant (CNA) #101 confirmed Resident #37 received peas and was eating them. 2. Review of the medical record for Resident #38 revealed an admission date of 9/19/24 with diagnoses of dementia and dysphagia (difficulty swallowing). Review of the quarterly MDS assessment, dated 02/13/25, revealed Resident #38 was rarely/never understood and required set-up or clean-up assistance for eating. Review of a physician order, dated 11/11/24, revealed Resident #38 received a regular diet with mechanical soft textures and ground meats, with regular texture liquids. Also noted in the physician's order was Resident #38 should receive gravy or sauce on all foods, and should receive no skins, seeds, or nuts. Observation on 04/02/25 at 12:18 P.M., in the dining room, revealed Resident #38 was served a plate Page 1 of 2 365680 365680 04/02/2025 Vancrest of Hicksville 601 Defiance Avenue Hicksville, OH 43526

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with ground Salisbury steak, mashed potatoes, and whole peas and carrots. Concurrent interview with Dietary Aide (DA) #301 confirmed Resident #38 received peas on her tray and confirmed Resident #38's diet ticket stated she should not receive skins, seeds, or nuts. DA #301 stated items with skins would include foods such as grapes or other fruit with skins. Interview on 04/02/25 at 12:37 P.M. with Dietary Manager (DM) #300 revealed food items with skins included corn and dried beans. DM #300 further stated she had no defined list of items to be excluded for residents who should not receive skins, seeds, or nuts with their meals. A telephone interview on 04/02/25 at 12:47 P.M. with Speech Therapist (ST) #200 verified peas would be included as a food item with skin. Further, ST #200 confirmed Resident #37 and Resident #38 should not receive peas. This deficiency represents non-compliance investigated under Complaint Number OH00161460. 365680 Page 2 of 2