Inspection·September 5, 2019

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and 7:00 A.M. when she worked. STNA #120 reported Resident #2 will let them know when she wants to get up and they will get her up and dressed when she chooses. Review of the undated facility orientation training titled Resident [NAME] of Rights, revealed residents have the right to get up and go to bed as the resident wished as long as it did not disturb others or posted meal schedules. Event ID: Facility ID: 366148 If continuation sheet Page 2 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on record review, staff interview, and review of facility policy, the facility failed to issue timely notifications of the ending of skilled Medicare Part A services for two (#168 and #169) of three reviewed for liability notices. The facility identified four residents with Medicare as their primary payor source. The facility census was 18. Residents Affected - Few Findings include: 1. Review of Resident #168 cut letter from Medicare part A services revealed the last day of covered services would end on 06/05/19. Resident #168's responsible party was informed on 06/04/19 of the resident's notice of Medicare non-coverage and their right to appeal. Interview on 09/05/19 at 10:24 A.M. with the Administrator verified Resident #168's last covered day for skilled services was on 06/05/19. The responsible party was notified on 06/04/19. 2. Review of Resident #169 cut letter from Medicare A skilled services for physical therapy and speech therapy (PT/ST) revealed the last covered day was 05/16/19. The resident's responsible party was informed via telephone on of the resident's last covered day and their right to appeal on 05/17/19. During the same telephone notification on 05/17/19 the residents responsible party was informed occupational therapy (OT) skilled services would end on 05/18/19 and that would be the last covered day. Interview on 09/05/19 at 10:32 A.M., the Administrator verified Resident #169's last covered date for PT/ST was on 05/16/19. Resident #169's responsible party was notified on 05/17/19 via telephone. Administrator further verified OT skilled serviced last day of coverage was on 05/18/19 and notification was on 05/17/19. Resident #169's responsible party signed the notification form on 5/20/19. Review of facility policy and procedure titled Medicare Non-Coverage CMS-12123, dated 04/01/2009 and updated 05/07/18, revealed the facility was to notify the guardian or responsible party no later than two days prior to the termination of services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 3 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and medical record review, the facility failed to ensure individualized activity involvement was provided for one (#1) of twelve residents reviewed for the provision of ongoing activities. The facility census was 18. Residents Affected - Few Findings include; Review of the medical record revealed Resident #1 admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease, peripheral vascular disease, major depressive disorder, dementia, anxiety, osteoarthritis, pain, and age related osteoporosis. Review of the most current Minimum Data Set assessment, dated 08/13/19, identified the resident with severe cognitive impairment, the ability to understand and be understood, dependent on staff for the completion of activities of daily living including transfer and transport, and receiving hospice services. Review of activity plan of care revised, on 06/05/19, focused on the residents need for reminders and transportation to attend activities. Interventions included enjoying bingo, enjoys attending music, entertainment, exercise (sometimes), and sing-a-longs, remind daily of scheduled programs, and provide an activity calendar monthly. Observations on 09/03/19 at 3:10 P.M. noted the resident in bed with eyes closed. A game show was playing on the television (TV) placed at the foot of the bed. At 4:37 P.M. the resident was placed to a reclining chair in her room sitting in front of the TV with daytime programming. On 09/04/19 at 11:38 A.M. the resident was reclined in a specialized chair (broda) in the room sitting in front of the TV with a western program. Interview on 09/04/19 11:55 A.M., Activity Assistant #202 revealed the resident floor staff are also responsible for engaging residents in activities. Additional observation on 09/04/19 at 1:30 P.M. found the resident in the room sitting in front of the TV with eyes closed and a western programing playing. At 2:30 P.M. the resident remained in the room watching TV western. Interview on 09/04/19 at 2:45 P.M., State Tested Nurse Aide (STNA) #300 revealed staff use the activity plan of care to determine the residents' interest. STNA #300 stated Resident #1 was known for watching, cowboy shows. On 09/04/19 at 3:20 P.M. additional interview with STNA #300 during review of the activity plan of care verified no current interest are listed on the plan. Observation on 09/04/19 at 4:13 P.M. revealed the resident remained in room watching western programs and sitting reclined in a broda chair. Review of the most current activity progress note contained in the medical record documented on 12/20/18 at 8:44 A.M. Resident #1 comes to activities of her choice. Some days she will come to all activities and other days she refuses everything. The resident has become more verbal and can sometimes say inappropriate things. No revision or additional activity provision is documented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 4 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of Resident #1's monthly resident activity participation records noted attendance to decrease between February 2019 and June 2019. Monthly documentation was as follows; February 2019 attended four activities, March attended four activities, April two activities, May one activity, and June two activities. No documentation was provided for July 2019 activity attendance. Interview on 09/05/19 at 4:10 P.M., with Activity Director #1, during a review of the activity plan of care, verified no specific individualized activities were listed. Further interview verified Resident #1's activity attendance had decreased during the past six months and no revision or attempts to promote activity participation were documented. Event ID: Facility ID: 366148 If continuation sheet Page 5 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, medical record review and manufacturer recommendations for use instructions, the facility failed to ensure the administration of insulin included the proper dosage which resulted in a medication error rate of 6.25%. This affected two (#14, #5) of three residents reviewed for medication administration. The facility census was 18. Residents Affected - Few Findings include;: 1. Observation on 09/04/19 at 7:22 A.M. noted Registered Nurse (RN) #101 to obtain a Toujeo SoloStar Solution Pen-injector 300 units (Insulin Glargine) per milliliter(ml) for administration to Resident #14. After entering the room and administering the resident's oral medications, RN#101 dialed the pen insulin indicator to 60 units, placed the injector tip to the pen, cleansed Resident #14's abdomen with a alcohol wipe and injected the 60 units of insulin. No prime of the pen was observed. RN#101 then discarded the soiled injector cap and placed a new injector cap on the pen followed by dialing a second dose of 60 units on the pen insulin indicator. Once RN#101 cleansed the abdomen the 60 units were then injected without priming the pen. Interview on 09/04/19 at 7:25 A.M. RN #101 revealed when insulin pens are used for the first time the nurse will prime the pen. Otherwise, after the first use the pen does not require priming. Review of Resident #14's medical record identified a physician order, initiated on 01/03/19, for Toujeo SoloStar Solution Inject 120 units subcutaneously one time a day for diabetes. Review of the Toujeo SoloStar Solution Pen-injector manufacturer instructions, dated 2002-2015, indicated a safety test should be performed before each injection. The procedure included selecting 3 units by turning the dose selector until the dose pointer is at the mark between 2 and 4. Then press the the injection button all the way in. When insulin comes out of the needle tip, the pen is working correctly. If no insulin appears repeat up to three times. 2. Observation during medication administration to Resident #5 on 09/04/19 at 8:49 A.M. noted RN #101 to obtain Tresiba FlexTouch Solution Pen-injector 100 UNIT/ML (Insulin Degludec). RN#101 dialed the pen insulin indicator to 12 units, placed the injector tip to the pen, cleansed Resident #5's right posterior arm with an alcohol wipe. No prime of the pen was observed. Review of the medical record for Resident #5 noted a physician order dated 12/02/18 for Tresiba FlexTouch Solution Pen-injector 100 UNIT/ML (Insulin Degludec) Inject 12 units subcutaneously one time a day. Interview on 09/04/19 at 8:53 A.M., RN #101 revealed when insulin pens are used for the first time the nurse will prime the pen. Otherwise, after the first use the pen does not require priming. Review of the Tresiba FlexTouch Solution Pen-injector 100 units per milliliter (Insulin Degludec) manufacturer instructions, dated December 2018, revealed priming the pen includes turning the dose selector to 2 units. Hold the Pen with the needle pointing up. Tap the top of the Pen gently a few times to let any air bubbles rise to the top. Hold the Pen with the needle pointing up. Press and hold in the dose button until the dose counter shows 0. The 0 must line up with the dose pointer. A drop of insulin should be seen at the needle tip. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 6 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 09/04/19 at 2:15 P.M. the Director of Nursing revealed the facility did not possess a policy or procedure for the administration of insulin pens. The facility utilizes the manufacturer information. The Director of Nursing confirmed the insulin pens are required to be primed prior to administration each time to ensure the ordered amount of insulin is injected. During the medication observation a total of 32 opportunities were observed with two medication errors for a 6.25% error rate. Event ID: Facility ID: 366148 If continuation sheet Page 7 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, medical record review and manufacturer recommendations for use instructions, the facility failed to ensure the administration of insulin included the proper dosage which resulted in a significant medication error for two (#14, #5) of three residents reviewed for medication administration. The facility census was 18. Residents Affected - Few Findings include;: 1. Observation on 09/04/19 at 7:22 A.M. noted Registered Nurse (RN) #101 to obtain a Toujeo SoloStar Solution Pen-injector 300 units (Insulin Glargine) per milliliter(ml) for administration to Resident #14. After entering the room and administering the resident's oral medications, RN#101 dialed the pen insulin indicator to 60 units, placed the injector tip to the pen, cleansed Resident #14's abdomen with a alcohol wipe and injected the 60 units of insulin. No prime of the pen was observed. RN#101 then discarded the soiled injector cap and placed a new injector cap on the pen followed by dialing a second dose of 60 units on the pen insulin indicator. Once RN#101 cleansed the abdomen the 60 units were then injected without priming the pen. Interview on 09/04/19 at 7:25 A.M. RN #101 revealed when insulin pens are used for the first time the nurse will prime the pen. Otherwise, after the first use the pen does not require priming. Review of Resident #14's medical record identified a physician order, initiated on 01/03/19, for Toujeo SoloStar Solution Inject 120 units subcutaneously one time a day for diabetes. Review of the Toujeo SoloStar Solution Pen-injector manufacturer instructions, dated 2002-2015, indicated a safety test should be performed before each injection. The procedure included selecting 3 units by turning the dose selector until the dose pointer is at the mark between 2 and 4. Then press the the injection button all the way in. When insulin comes out of the needle tip, the pen is working correctly. If no insulin appears repeat up to three times. 2. Observation during medication administration to Resident #5 on 09/04/19 at 8:49 A.M. noted RN #101 to obtain Tresiba FlexTouch Solution Pen-injector 100 UNIT/ML (Insulin Degludec). RN#101 dialed the pen insulin indicator to 12 units, placed the injector tip to the pen, cleansed Resident #5's right posterior arm with an alcohol wipe. No prime of the pen was observed. Review of the medical record for Resident #5 noted a physician order dated 12/02/18 for Tresiba FlexTouch Solution Pen-injector 100 UNIT/ML (Insulin Degludec) Inject 12 units subcutaneously one time a day. Interview on 09/04/19 at 8:53 A.M., RN #101 revealed when insulin pens are used for the first time the nurse will prime the pen. Otherwise, after the first use the pen does not require priming. Review of the Tresiba FlexTouch Solution Pen-injector 100 units per milliliter (Insulin Degludec) manufacturer instructions, dated December 2018, revealed priming the pen includes turning the dose selector to 2 units. Hold the Pen with the needle pointing up. Tap the top of the Pen gently a few times to let any air bubbles rise to the top. Hold the Pen with the needle pointing up. Press and hold in the dose button until the dose counter shows 0. The 0 must line up with the dose pointer. A drop of insulin should be seen at the needle tip. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 8 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 0760 Level of Harm - Minimal harm or potential for actual harm Interview on 09/04/19 at 2:15 P.M. the Director of Nursing revealed the facility did not possess a policy or procedure for the administration of insulin pens. The facility utilizes the manufacturer information. The Director of Nursing confirmed the insulin pens are required to be primed prior to administration each time to ensure the ordered amount of insulin is injected. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 9 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 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. Based on observation, staff interview, and review of facility guidelines, the facility failed to ensure residents were provided the proper portion sizes for meals. This affected all 18 residents who received food from the kitchen. The facility census was 18. Findings Include: Observation 09/03/19 at 11:30 A.M. of tray line from the serving kitchen found Dietary Staff (DS) #205 using a #16 (two ounce) scoop for the scalloped potatoes and the pureed fish sticks. DS #205 was observed placing a single scoop of scalloped potatoes and a single scoop of pureed fish sticks on resident plates. DS #205 was observed placing varying amounts of French fries, soup, fish sticks, chicken salad, and mashed potatoes on residents' plates. Review of the spreadsheet being used by DS #205 revealed no portion sizes were present. Review of the resident meal tickets revealed the residents' order preferences were noted on the menu but no variation in amounts were noted. Interview on 09/03/19 at 11:38 A.M. with DS #205 revealed she chose the scoops and portion sizes for the meal items. DS #205 reported she had not been trained on scoop sizes. DS #205 reported the portion sizes were not indicated on the planned menu sheets so she would just fill the bowls and plates with what looked right. DS #205 verified she used the two ounce scoop for the scalloped potatoes and the pureed fish. Interview on 09/03/19 at 12:51 P.M. with Dietary Manager (DM) #200 verified there were no scoop or portion sizes listed on the serving kitchen menu. Interview on 09/03/19 at 1:12 P.M. with DM #200 revealed scoops sizes were found for the lunch food items. Residents were to receive four ounces (#8 scoop) of scalloped potatoes, four fish sticks or #10 scoop (three ounces) of pureed fish, three ounces (#10 scoop) of chicken salad on bread, and four ounces (#8 scoop) of mashed potatoes. DM #200 verified DS #205 did not provide the correct portion sizes for the lunch meal. Interview on 09/04/19 at 11:46 A.M. with Dietician #280 verified a #16 scoop (two ounces) was not the appropriate portion size for scalloped potatoes or the fish. Dietician #280 stated education would be provided to the dietary staff so they are aware of proper serving sizes. Review of the facility document titled Dining Services Kitchen Guidelines, revised 08/29/16 revealed four ounces (#8 scoop) was to be used for mashed potatoes, noodles, and casseroles. A three ounces (#10 scoop) was to be used for egg, chicken, tuna and ham salad. A #16 scoop (2 ounces) was to be used for pancakes or waffles. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 10 of 11 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 366148 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Otterbein Sunset House 4020 Indian Rd Toledo, OH 43606 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 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 guidelines, the facility failed to ensure opened food items were stored properly and food thermometers were cleaned between use. This had the potential to affect all 18 residents who received food from the kitchen. The facility census was 18. Findings include: Observation on 09/03/19 at 8:45 A.M. of the dry storage area of the kitchen found an opened, partially used, one gallon bottle of syrup on the dry storage shelf. The manufacturers label indicated, Refrigerate after opening. In addition, a dented can of navy beans was found in the dry storage room in line for use. Interview on 09/03/19 at 8:47 A.M. with Dietary Manager (DM) #200 verified the syrup was opened, partially used, and should have been stored in the refrigerator. DM #200 also verified the dented can of navy beans were in line for use. DM #200 removed and disposed of the syrup and beans. Observation on 09/03/19 at 11:30 A.M. of food temperatures being taken with Dietary Staff (DS) #205 found DS #205 used a regular white paper towel from the dispenser and wiped off the thermometer between each food temperature. No sanitizer was used. Interview on 09/03/19 at 11:33 A.M. with DS #205 verified she did not properly sanitize the thermometer between food temperatures. DS #205 reported she knows they had wipes she could use but had none currently available in the serving area. Review of the facility document titled Dining Services Kitchen Guidelines, revised 08/29/19, revealed refrigerated food must be kept at 41 degrees or below. Food thermometers were to be wiped off with the sanitizer wipe prior to taking the temperature of the next food item. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366148 If continuation sheet Page 11 of 11