Health inspection·October 20, 2022

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, observation, and review of facility recipes, the facility failed to make pureed food to the correct texture and failed to follow a recipe to make the pureed food. This had the potential to affect six (#5, #15, #20, #24, #38, and #53) residents who have orders for pureed food. Facility census was 75. Finding include: Observation and interview on 10/18/22 at 11:00 A.M. revealed Dietary Staff #73 placed an unmeasured amount of grilled chicken in a blender to make pureed chicken, then seven,four ounce scoops of gravy were added. The food was blended and the remainder of the pot of gravy was poured into the mixture (unmeasured). Dietary staff revealed they put in typically seven to eight chicken breasts to make the required seven pureed meals. The mixture appeared to be thin and smoothie like consistency. Observation and interview on 10/18/22 at 11:07 A.M. revealed Dietary Staff #73 placed four, four ounce scoops of mixed vegetables in the blender, blended the vegetables and placed the mixture on the warming table. No butter or thickener was added during the observation. Observation and interview on 10/18/22 at 11:15 A.M. with Dietary Staff #73 placed seven servings of ice cream, canned peaches and a fruit syrup into the blender. When mixed the consistency was about a thin milkshake consistency. When asked if the consistency was accurate for pureed texture dietary staff did not comment, but then pumped about three pumps of liquid thickener into the pan and mixed with a spoon. Interview on 10/18/22 at 11:18 with Dietary Staff #73 and Kitchen Manager #42 revealed the facility had recipes for the pureed food in binders in the back of the kitchen. Kitchen Manager #42 revealed they were waiting to get a final copy of recipes from the menu on 10/18/22 but revealed it was on her computer just not in the binder. Dietary Staff #73 confirmed recipe was not used in making pureed foods on 10/18/22. Interview on 10/20/22 at 5:51 P.M. with Dietician #99 revealed staff from her company review the menus and recipes. Dietician #99 confirmed staff should follow the recipes provided to ensure nutritive value and proper texture. The facility confirmed the identified concern had the potential to affect six (#5, #15, #20, #24, #38, and #53) residents who have orders for pureed food. The recipe for chicken breast ranch crunchy baked called for the baked crunchy ranch chicken breast to be made according to recipe then pureed along with a chicken stock base and hot water mixture as Page 1 of 5 366235 366235 10/20/2022 Fair Haven Shelby County 2901 Fair Road Sidney, OH 45365

F 0805 well as thicker for texture. Level of Harm - Minimal harm or potential for actual harm The recipe for vegetable blend prince charles called for four ounces per serving to be blended with butter and thickener for consistency. Residents Affected - Some The recipe for peach [NAME] (ice cream, peaches, and fruit syrup) called to remove portions to be pureed and puree separately then add to the dish. Apple juice was to be added as a thinning agent. Menu spreadsheet for lunch meal on 10/18/22 revealed resident's with orders for pureed foods should have received a four ounce servings for vegetables. Facility had no policy regarding the making of therapeutic texture meals. 366235 Page 2 of 5 366235 10/20/2022 Fair Haven Shelby County 2901 Fair Road Sidney, OH 45365

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 policy review, the facility failed to safety store food items in the refrigerator, freezer, and dry storage areas. This had the potential to affect 74 out of 75 residents residing in the facility, the facility identified one (#52) resident who receives no food from the kitchen. Facility census was 75. Findings include: Observation on 10/17/22 at 11:20 A.M. to 11:40 A.M. revealed the following concerns in the walk in refrigerator: - shredded lettuce left open to air with no date - shredded white cheese left open to air with no date - both containers of cranberry juice were had expired 10/13/22 - unknown pureed food in a styrofoam bowl with no label and no date - butter sticks were left open to air and undated - lunch meat turkey was open to air and undated - hotdog's were left open to air and undated - chunk of meat (appeared like ham) was not labeled or dated Observations in the walk in freezer revealed the following concerns: - pie missing slice and two whole pies were undated - breadsticks undated - slices of bread and rolls undated - chicken nuggets open to air and undated - unknown meat was not labeled and was undated Observations in the dry storage area revealed the following concerns: - salsa had been opened and placed back in dry storage (bottle had instructions to refrigerate after opening). The salsa had gone bad and expanded the bottle so much it would not sit straight on the shelf. - nine bottles of lemon juice expired on 08/27/22 366235 Page 3 of 5 366235 10/20/2022 Fair Haven Shelby County 2901 Fair Road Sidney, OH 45365

F 0812 - three dented cans of sliced apples, mandarin oranges, and sweet potatoes Level of Harm - Minimal harm or potential for actual harm Interview on 10/17/22 at 11:45 A.M. with Kitchen Manager #42 confirmed all food storage findings in the refrigerator, freezer, and dry storage areas. The facility confirmed this had the potential to affect 74 out of 75 residents residing in the facility, there was one (#52) resident who receives no food from the kitchen. Residents Affected - Some Follow up observation on 10/18/22 at 11:20 A.M. revealed many of the findings were still in place. Observations in the walk in refrigerator revealed the following concerns: - chunk of meat (appeared like ham) was not labeled or dated Observations in the walk in freezer revealed the following concerns: - pie missing slice and two whole pies were undated - breadsticks undated - slices of bread and rolls undated - chicken nuggets open to air and undated - unknown meat was not labeled and was undated Review of facility policy titled Food Storage, undated, revealed the facility failed to implement the policy in regards to the allegation. The policy revealed food storage areas should be maintained in a clean, safe, and sanitary manner. An amendment was added 08/03/15 stating the dietary manager or designee would check refrigerators weekly for expired food or food close to expiration date and would be done for six months. The policy does not give guidance on dating, labeling, and sealing food after opening, or on the handling of expired food after 02/2016. 366235 Page 4 of 5 366235 10/20/2022 Fair Haven Shelby County 2901 Fair Road Sidney, OH 45365

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations and staff interview, the facility failed to maintain covered and clean trash receptacles in the kitchen. This had the potential to affect 74 out of 75 residents residing in the facility, the facility identified one (#52) resident who receives no food from the kitchen. Facility census was 75. Residents Affected - Some Findings include Observation on 10/17/22 at 11:20 A.M. to 11:40 A.M. revealed the kitchen had one blue recycling bin that was overflowing with items piled on top of the lid. Their was a large gray round trash bin with a trash bag that had fallen off the rim down into the trash can with no lid or covering. Four black kitchen trash cans were observed to have no lids or coverings. Interview on 10/17/22 at 11:45 A.M. with Kitchen Manager #42 confirmed trash cans did not have lids. Kitchen manager #42 revealed the lids were thrown out before she started and she was told they were unsanitary. The facility confirmed this had the potential to affect 74 out of 75 residents residing in the facility, the facility identified one (#52) resident who receives no food from the kitchen. 366235 Page 5 of 5