Health inspection·April 2, 2024

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff and resident interviews, and review of the facility policy, the facility failed to ensure food was served at an appetizing temperature. This had the potential to affect 40 residents who received meals in the facility. The facility identified Residents #30 and #32 as receiving no food from the kitchen. The facility census was 42. Residents Affected - Many Findings include: Observation on 03/28/24 at 11:39 A.M. of Dietary [NAME] #308 taking the temperatures of the lunch meal items prior to food service revealed the chicken tenders were 173 degrees Fahrenheit (F), the [NAME] fries were 165 degrees F, the carrots were 162.1 degrees F, the white slice of bread was room temperature, and the chocolate cake was room temperature. Tray service for hall trays began on 03/28/24 at 11:50 A.M. As the kitchen staff started to load the last tray cart for the third floor at 12:03 P.M., the surveyor asked for a test tray at 12:08 P.M. as the last tray cart for the third floor was three fourths of the way full. A test try was plated at 12:17 P.M. and was placed on top of the steam table wells without a lid while four other uncovered resident trays were plated and sitting on the table next to the steam table while staff waited for Dietary Manager (DM) #307 to bring up a new box of dome lids, which were stored in the basement, and for the new lids to be washed. A dome lid was placed on the test tray and the four other residents' plates and placed into the covered cart at 12:20 P.M. The food cart was taken up to the third floor by DM #307 and arrived at 12:23 P.M. After the last tray was passed at 12:34 P.M., the test tray was removed from the food cart and was taken to the nurse's station counter with the surveyor and DM #307. DM #307 checked the temperatures of the food as the surveyor tasted the food for temperature and palatability. The chicken tenders had a temperature of 116.8 degrees F, had a good flavor, were moist, but tasted lukewarm. The [NAME] fries had a temperature of 115 degrees F, had a good flavor, were moist, but tasted lukewarm. The carrots had a temperature of 117 degrees F, had a good flavor, but tasted lukewarm at 116.8 degrees F. Milk was 51.4 degrees F and tasted warm. Chocolate cake was room temperature, had a good temperature, and was moist. [NAME] bread was room temperature and was palatable without signs of dryness or mold. DM #307 tasted the food and drank the milk and confirmed the food had a good taste but could have been warmer and the milk should have been colder. She stated waiting for the dome lids to be brought up and washed negatively affected the temperature of the food items since the food had already been plated, and the milk was iced but the ice bath should have had salt added to it to help bring down the temperature. Page 1 of 4 366110 366110 04/02/2024 Crawford Manor Healthcare Center 1802 Crawford Rd Cleveland, OH 44106

F 0804 Level of Harm - Minimal harm or potential for actual harm An interview conducted on 03/28/24 at 3:30 P.M. with Resident #16 revealed the food was cold when it was delivered to the room. An interview was conducted 03/28/24 at 3:36 P.M. with Resident #39 revealed the food was not hot when it was delivered to the room. Residents Affected - Many An interview conducted on 03/28/24 at 3:45 P.M. with Resident #38 revealed the food was tepid when it was delivered to the room. Review of facility policy Food and Nutrition Services: Meal Service, revised 09/21/20, revealed food would be served at preferable temperatures with hot foods hot and cold foods cold. This deficiency represents non-compliance investigated under Complaint Number OH00151013. 366110 Page 2 of 4 366110 04/02/2024 Crawford Manor Healthcare Center 1802 Crawford Rd Cleveland, OH 44106

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and review of facility policy, the facility failed to ensure the kitchen was clean and sanitary, food items were appropriately dated, and coffee was covered as required when walking down the third-floor hallways. This had the potential to affect 40 residents who received food from the kitchen. The facility identified two residents (#30 and #32) as receiving no food from the kitchen. The facility census was 42. Findings include: 1. Observation and interview during initial kitchen tour on 03/28/24 from 11:15 A.M. to 11:39 A.M. with Dietary Manager (DM) # 307 revealed the following concerns: • On the bread rack was a one gallon unlabeled and undated storage bag full of Danishes. DM #307 stated the Danishes were most likely from yesterday but confirmed the bag was not labeled or dated. • In the two-door reach in cooler on the right-hand side was an undated metal pan of a raw pork loin sitting on the second shelf above three crates of individual milk cartons. DM #307 at the time of observation confirmed the pan was undated and shouldn't have been sitting on the shelf above the milk cartons. • In the two-door reach in cooler on the left-hand top shelf was an unlabeled clear plastic square container with a green lid three fourth full of an unidentified jelly like purple substance. On top of the lid was a sticker with a date of 02/24/24. DM #307 at the time of observation confirmed the item was grape jelly and the item was not labeled, and the dated sticker was old but could not state when the jelly had been dished into the container. DM #307 stated normal policy was to throw out items after three to seven days. • In the two-door reach in cooler on the left-hand side second shelf, there was a white eight-pound round plastic lidded container of fruit salad with a hand written open date of 03/05/24 and a printed manufacturer best before date of 03/14/24. When the lid was opened, there was a fermented smell coming from the fruit. DM #307 at the time of observation confirmed the fermented smell and stated the fruit should have been thrown out. • In the dry storage area under a metal shelving unit, there was a white powdered substance on the floor along with two pink sugar substitute packets and two yellow sugar substitute packets. Around the perimeter of the floor of the dry storage unit there was a build up of dirt and debris. There was 366110 Page 3 of 4 366110 04/02/2024 Crawford Manor Healthcare Center 1802 Crawford Rd Cleveland, OH 44106

F 0812 Level of Harm - Minimal harm or potential for actual harm an open to air bag of basmati rice sitting on the second shelf of the metal shelving unit. DM #307 at the time of observation confirmed the floor of the dry storage area needed cleaning and the open bag of basmati rice should have been sealed when opened. • Residents Affected - Many The four hinged lids covering the food on the tray line revealed a build of dried food and debris. DM #307 at the time of observation confirmed the lids did not appear to be clean. Review of facility policy Frozen and Nutrition: Food Production and Food Safety, revised 03/09/24, frozen meat would have a date when pulled from the freezer and placed in the refrigerator to be thawed. Review of facility policy Food and Nutrition Services: Food Production and Food Safety, revised 03/09/24, revealed the ready to eat food would be stored above raw pork, all bulk items would be dated when opened. 2. Observation on 03/28/24 from 12:25 P.M. to 12:24 P.M. revealed at 12:25 P.M. State Tested Nursing Aide (STNA) #306 filled a cup of coffee from a hot beverage carafe sitting on a cart in the middle of the hallway and placed the uncovered cup of coffee on a resident's tray and walked it down the hallway to room [ROOM NUMBER]. At 12:30 P.M. License Practical Nurse (LPN) #305 filled a cup of coffee from the same beverage cart and placed the uncovered cup of coffee on a resident's tray and walked it down the hallway to room [ROOM NUMBER]. At 12:34 P.M. STNA #306 filled a cup of coffee from the same beverage cart and placed the uncovered cup of coffee on a resident's tray and walked it down the hallway to room [ROOM NUMBER]. Observation of the drink cart and Interview on 03/28/24 with Dietary Manager (DM) #307 at 12:44 P.M. revealed there were no lids on the drink cart. DM #307 at time of observation confirmed if coffee was being walked down the hallway the coffee should have lids and confirmed there were no lids on the beverage cart. DM #307 stated when she passed food trays, she would take the food cart and beverage cart closer to the residents rooms. Interview on 03/28/24 at 12:55 P.M. with STNA #306 confirmed she had walked the coffee uncovered halfway down the hallway and stated the kitchen didn't normally send lids. This deficiency represents non-compliance investigated under Complaint Number OH00151013. 366110 Page 4 of 4