Health inspection·December 27, 2018

F 0584 Level of Harm - Potential for minimal harm Residents Affected - Many Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, staff interview, review of the coded announcement sheet and review of facility policy and procedures, it was determined the facility failed to ensure overhead paging was utilized for emergency situations only to maintain a homelike environment for the residents. This affected two (#107 and #108) of two residents who reside in the facility Findings include: On 12/26/18 at 8:23 A.M., during entrance/initial tour to the facility, a coded announcement was heard over the intercom system throughout the facility/unit where residents were residing. The code was announced as follows: Attention code agency is now in affect at the facility. We would like to welcome the Ohio Department of Health. This code was repeated five times over the intercom system. On 12/26/17 at 9:12 A.M., interview with the Administrator verified the intercom system was only to be used for emergency situations. She verified the operator at the front was the person who made the announcement. On 12/27/18 at 11:56 A.M., interview with Operator #35 verified she made the coded agency announcement as described above on 12/26/18. She verified it was repeated five times throughout the facility utilizing the intercom system. She further verified paging announcements were usually for emergency situations only. Review of the code announcement instruction sheet revised 03/21/18, documented a Code Agency was among other codes for various emergency situations. Further review documented instructions to have surveyor have a seat in the lobby, contact the Administrator and other facility staff at an extension provided, and then to announce Attention. code agency is now in affect at facility. We would like to welcome the (agency name) to our facility. Further instruction documented to repeat twice at 10 second intervals three times. Review of the policy and procedures with a subject matter of unnecessary noise reduction dated July 2015, documented the facility will reduce noise levels by limiting overhead paging for matters of urgent public safety or urgent clinical operations. The overhead paging will not be used as a convenience or unnecessarily. Page 1 of 3 365807 365807 12/27/2018 Transitional Care Unit 200 St Clair Street Saint Marys, OH 45885

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 observations, staff interview, and review of the manufacturer's recommendations/facility policy, the facility failed to ensure food was properly labeled and stored, and dishes were sanitized in a manner to prevent contamination. This had the potential to affect two (#107 and #108) of two residents who reside in the facility. Findings include: Observations on 12/26/18 at 8:52 A.M. with Food Service Director (FSD) #300, revealed the walk-in freezer contained multiple food items that were expired. The food were as follows: diced chicken (two packs) opened and repackaged in gallon size zip lock bags dated 08/12/18; corn beef wrapped in aluminum foil dated 05/08/18; pastrami (two packs) wrapped in aluminum foil dated 06/07/18; one unidentified food item wrapped in aluminum foil, unlabeled and undated; apple corn bread stuffing opened and repackaged in gallon size zip lock bags dated 01/24/18, ham wrapped in aluminum foil and undated; and one bag of frozen peas, opened and undated. In the reach in freezer there was an opened and undated package of English muffins, and toast was repacked in a zip lock bag dated 12/10/18. In the walk-in refrigerator there were multiple opened and repackaged containers including: chili sauce dated 12/11/18; two opened and repackaged containers of tomato paste dated 12/16/18; pesto sauce opened, repackaged and undated; ketchup opened and repackaged dated 12/15/18; and oyster sauce opened and repackaged dated 12/11/18. In the service area reach-in refrigerators there were three opened and undated packages of cheese. Interview with FSD #300 during the time of the observations, verified all the items noted above were opened and expired or undated. FSD #300 stated he needs to work on dating food. FSD #300 stated the facility practice was to discard opened food after seven days in the refrigerator. Regarding foods in the freezer, FSD #300 stated he discards foods after three or four months but was unsure of the facility policy for the length of time things can be stored in the freezer. FSD #300 further verified the frozen foods noted above should have been discarded. FSD #300 stated the items in the walk-in refrigerator should have been labeled with the manufacturer's expiration date. He also verified both Resident #107 and Resident #108, were served meals from the kitchen. Continued observations revealed the kitchen three-sink dishwashing system was in use. FSD #300 obtained a test strip to check the sanitizer. He dipped the strip in the third sink and held it in the water for the manufacturer's recommended ten seconds. He removed the strip from the water and compared the strip to the package. The strip did not change color. The sanitizer was not at the recommended 200 parts per million (ppm) for effective sanitizing. Interview at the time of the observation revealed FSD #300 verified the dietary staff were currently washing dishes in the three sinks dish system. FSD #300 stated the three sink dish system used Quaternary solution for dish sanitizing. FSD #300 verified the Quaternary solution did not meet the minimum of 200 ppm for effective dish sanitation. Further interview with FSD #300 on 12/26/18 at 10:02 A.M., stated the facility policy does not 365807 Page 2 of 3 365807 12/27/2018 Transitional Care Unit 200 St Clair Street Saint Marys, OH 45885

F 0812 address dating opened food. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Food Storage, revised 07/16, revealed foods must be protected from contamination, spoilage and other damage during storage. Foods stored in refrigerators should be covered, labeled and dated. All frozen foods should be labeled and dated. Residents Affected - Many Review of the manufacturer's instructions revealed the Quaternary solution must be 200 ppm concentration for effective dish sanitizing. Review of the Quaternary test strip instructions, revealed the proper testing method was to dip a test strip in the water and hold it for ten seconds. Remove the strip from the water and immediately compare the color. 365807 Page 3 of 3