F 0804
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview, observation and record review, the facility failed to ensure meals served looked
appetizing and were served at palatable temperatures. This had the potential to affect all residents
receiving meals from the kitchen with the exception of Residents #1 and #10 who received no nutrition by
mouth. The facility census was 49.
Residents Affected - Many
Findings include:
Interview on 07/17/23 at 2:08 P.M. with Resident #3 revealed hot foods were served cold upon meal
service.
Interview on 07/17/23 at 2:21 P.M. with Resident #45's sister revealed while at the facility, Resident #45 did
not eat the food because Resident #45 said it did not taste good.
Interview on 07/17/23 at 2:32 P.M. with Resident #19 revealed the food was overcooked, soggy and terrible.
Observation of a test tray on 07/17/23 at 5:45 P.M. with Dietary Manager (DM) #210 revealed the meal
consisted of chicken tenders, french fries, zucchini and mandarin oranges. Temperatures were obtained
with the chicken tenders revealing a temperature of 119 degrees Fahrenheit (F) and the zucchini revealing
a temperature of 126 degrees F. The french fries were noted to be undercooked and soft.
Interview on 07/17/23 at 5:50 P.M. with DM #210 revealed DM #210 stated all hot foods should be served
above 140 degrees F.
Interview on 07/18/23 at 9:15 A.M. with Resident #46 revealed the food was often cold and tasteless.
Review of the facility policy titled Food Temperature Policy dated 08/28/19 revealed hot foods should not fall
below 135 degrees while holding after cooking and hot food should be palatable when delivered.
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 2
Event ID:
365814
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
365814
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/24/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Cortland Center
369 N High Street
Cortland, OH 44410
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and facility policy review, the facility failed to ensure proper hand hygiene
was completed during medication administration including hand washing and wearing gloves. This affected
three Residents (Residents #4, #32, and #101) out of seven residents administered medications. The
facility census was 49.
Residents Affected - Few
Findings include:
Observations made on 07/19/23 from 7:59 A.M. to 12:30 P.M. of medication administration by Licensed
Practical Nurse (LPN) #223, LPN #234, and LPN #265 of 25 administrations made for seven residents
(Residents #4, #14, #16, #32, #35, #101 and #103) revealed LPN #223 did not perform hand hygiene
before or after administering medications to Resident #4. LPN #223 was observed dispensing medication
into her bare hand then placing them into a medication cup, crushing them, placing in applesauce, and then
administered the medications to Resident #4. Additional observation of LPN #223 revealed she did not
perform hand hygiene before or after, or wear gloves while administering insulin to Resident #101.
Observation during Medication Administration of LPN #265 revealed she did not wear gloves or perform
hand hygiene before or after administering insulin to Resident #32.
Interview conducted on 07/19/23 at 8:45 A.M. with LPN #223 revealed she did not perform hand hygiene
before or after administering medications to Resident #4.
Interview conducted on 07/19/23 at 11:30 A.M. with LPN #265 confirmed she did not perform hand hygiene
before or after administering insulin to Resident #32. LPN #265 also confirmed she did not wear gloves
while administering the insulin to Resident #32.
Interview conducted on 07/19/23 at 12:00 PM with LPN #223 confirmed she did not perform hand hygiene
before or after administering insulin to Resident #101. LPN #223 also confirmed she did not wear gloves
while administering the insulin to Resident #101.
Review of facility policy titled General Dose Preparation and Medication Administration, last revised
01/01/22 revealed the facility staff failed to follow their policy for medication administration under Procedure
headline, bullet point number two Prior to preparing or administering medications, authorized and
competent facility staff should follow facility's infection control policy, including hand hygiene, and under
bullet point number 3.4 Facility staff should not touch the medication when opening the bottle or unit dose
package.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365814
If continuation sheet
Page 2 of 2
