Health inspection·March 26, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and review of facility documents, the facility failed to ensure they had a three-day emergency supply of food as required. This had the potential to affect all 54 residents. The facility identified no residents as receiving nothing by mouth. The census was 54. Findings include: Observation during initial tour of the kitchen on 03/25/24 from 8:03 A.M. to 8:25 A.M. with Dietary [NAME] (DC) #355 and Dietary Aide (DA) #356 revealed a minimal supply of foods in dry and cold storage areas of the kitchen. The walk-in cooler and freezer revealed the shelves held minimal foods available to cook for the meals. The bread rack had multiple empty shelves with a few packages of bread products. There was no instant powdered milk or canned meat items available for an emergency food supply. Dietary Aide #356 at the time of observation confirmed the facility did not have a three-day emergency supply of food. Interview on 03/25/24 at 8:39 A.M. with Dietary Manager (DM) #350 confirmed the facility did not have a three-day supply of food on hand in the facility. She stated there had never been a three-day supply of food since she started at the facility six months ago. DM #350 stated she had gotten a quote from the food vendor on everything she needed for a three-day supply of food and had presented it to the Administrator. DM #350 stated the Administrator would get back to her. Review of the facility document Three Day Emergency Menu, dated 12/06/22, revealed for all three days for breakfast corn beef hash, assorted cereals, orange juice, instant powdered milk and spring water would be served. For day one lunch, chili beef with beans, saltines, wheat bread, mandarin oranges, instant powdered milk, and spring water and for dinner peanut butter and jelly sandwiches, carrots, potato chips, apple sauce and [NAME] cookies, powdered milk, and spring water would be served. For day two lunch, chicken and dumplings, carrots, wheat bread, fruit cocktail, instant milk, and spring water and for dinner sloppy joe sandwich, green peas canned, pretzels, chilled peaches, [NAME] cookies, instant powdered milk, and spring water would be served. For day three lunch, beef stew, green beans, graham crackers, wheat bread, pineapple chunks, instant powdered milk and spring water and for dinner, tuna salad sandwich, beets, potato chips, fruit cocktail, [NAME] cookies, instant powdered milk and spring water would be served. Review of the Three Day Emergency Menu and interview on 03/25/24 at 4:33 P.M. with DM #350 confirmed the facility couldn't provide the emergency menu since the facility did not have powdered milk, canned meats, potato chips, pretzels, and Loorna [NAME] cookies in stock. Page 1 of 5 366270 366270 03/26/2024 Eagle Pointe Skilled Nursing & Rehab 87 Staley Road Orwell, OH 44076

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of the Emergency Menu Quote List revealed on 02/21/24 the food vendor had given a price for everything needed for the emergency menu. Review of email to Regional Director #353 and District Director #354 from DM #350, dated 03/21/24 and timed at 1:31 P.M., indicated there was zero emergency food in the facility, and DM #350 had given the administrator a quote for the food vendor and was waiting on authorization from him to allow her to purchase the items needed for the emergency menu. DM #350 stated she had been following up almost weekly to see if he has heard anything back from his boss. This deficiency represents noncompliance investigated under Complaint Number OH00151786. 366270 Page 2 of 5 366270 03/26/2024 Eagle Pointe Skilled Nursing & Rehab 87 Staley Road Orwell, OH 44076

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, interviews, review of facility records and review of facility policy, the facility failed to ensure the low temperature dish machine was being appropriately monitored for levels of chemical sanitizer, and the kitchen was clean and sanitary. This had the potential to affect all 54 residents. The facility identified no residents as receiving nothing by mouth. The census was 54. Findings include: 1. Observation of the low temperature dish machine on 03/25/24 from 9:05 A.M. to 9:13 A.M. with Regional Director (RD) #353 revealed the dish machine had not met the recommended sanitation level of 50 parts per million (ppm) when RD #353 tested the dish machine's rinse water with a QAC QR Code 2951 sanitation test strip. The strip turned a pale green color which indicated the sanitizer level did not meet the sanitation level of 50 ppm. Further observation of the low temperature dish machine and interview on 03/25/24 at 2:15 P.M. with RD #353 revealed when RD #353 used a QAC QR Code 2951 test strip to test the sanitation level of the dish machine, the test strip turned a pale green color which indicated the sanitation level did not meet the level of 50 ppm. RD #353 at the time of observation confirmed the dish machine was not meeting the recommended sanitation levels; however, the test strips were past their expiration date, and he was going to get new test strips. Further observation of the low temperature dish machine and interview on 03/25/24 at 2:26 P.M. with Dietary Manager (DM) #350 revealed she had found a different brand of test strips to check the sanitation level of the dish machine. When DM #350 tested the dish machine's rinse water with hydrion chlorine sanitizer test strips, the test strip turned an indigo blue which indicated 200 ppm. DM #350 repeated the same process, and the test strip turned a color between dark purple and indigo blue which indicated the sanitation level was between 150 and 200 ppm. DM #350 confirmed the dish machine's sanitation level was now reading too high and should be reading at 50 ppm. Observation of the test strips containers with DM #350 on 03/25/24 at 2:36 P.M. revealed the QAC QR Code 2951 test strips RD #353 used had an expiration date of 2017, and the hydrion chlorine sanitizer test strips DM #350 used had an expiration date of July 2022. At the time of observation, DM #350 confirmed both test strips were outdated. Further observation of the low temperature machine and interview on 03/26/24 between 8:30 A.M. and 8:35 A.M., with RD #353 revealed when he put a hydrion chlorine sanitizer test strip into the dish machine rinse water, the test strip turned an indigo blue color indicating a sanitation level of 200 ppm. When RD #353 repeated the process, the test strip turned a color between dark purple and indigo blue which indicated a sanitation level between 150 ppm and 200 ppm. Interview with RD #353 at the time of observation revealed he was able to obtain test strips with an expiration date of August 2025, and he confirmed the dish machine was providing too much sanitizer. Interview and observation with Service Tech (ST) #360 from the dish machine chemical supply company on 03/26/24 at 10:42 A.M. revealed ST #360 tested the chemical sanitizer and the level of chemical sanitizer was reading between 150 and 200 ppm. ST #360 stated the dish machine sanitizer levels needed to be titrated, he titrated the chemical levels, and the dish machine was now meeting the 366270 Page 3 of 5 366270 03/26/2024 Eagle Pointe Skilled Nursing & Rehab 87 Staley Road Orwell, OH 44076

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many recommended sanitation level of 50 ppm. ST #360 voiced using outdated testing strips could affect the reliability of the test results. Observation of ST #360 testing the sanitation level of the dish machine with a hydrion chlorine sanitizer test strip revealed the test strip turned purple, indicating the sanitation level was 50 ppm and was meeting the recommended level for sanitation. Review of facility policy Sanitization, revised November 2022, revealed low temperature dish machine's final rinse should read 50 ppm and the chemical was to be maintained at the correct concentration, based on periodic testing, at least once per shift and for the corrective contact time according to manufacturer's guidelines. 2. Observation during initial kitchen tour on 03/25/24 from 8:03 A.M. to 8:25 A.M. with Dietary [NAME] #355 and Dietary Aide #356 revealed the following concerns: • In the walk-in cooler on the right-hand side, there were two cases of liquid eggs sitting on the open wired shelf above an open case of apples and an open case of oranges sitting on the bottom shelf. • The floor of the walk-in freezer had a buildup of debris around the perimeter of the floor with four dried up green bean pieces in the middle of the floor • The two-door reach in freezer revealed a buildup of debris on the base of the unit. • A large white plastic circular container of sugar, located on a metal shelf between the three compartment sink and the oven, had a white Styrofoam cup stored in the container. • The plugged-in black metal circular fan, located on the floor near the kitchen doors and pointing towards the tray line, revealed a buildup of black dust on the blades and cage of the unit. At the time of observation, Dietary Aide #356 confirmed the liquid egg should not have been stored above the oranges and apples, the floor of the walk-in freezer and two door reach in cooler needed cleaned, and there was a Styrofoam cup being stored in the bulk sugar. Dietary [NAME] #355 confirmed the fan was dirty and needed to be cleaned. Interview with Dietary Manager #350 on 03/25/24 at 8:39 A.M. revealed nothing should be stored in bulk containers and confirmed the Styrofoam cup should not have been stored in the sugar. Review of facility policy Food Receiving and Storage, revised November 2022, revealed uncooked and raw animal products would be stored in drip proof container and below fruits to prevent juices from dripping onto those foods. 366270 Page 4 of 5 366270 03/26/2024 Eagle Pointe Skilled Nursing & Rehab 87 Staley Road Orwell, OH 44076

F 0812 Level of Harm - Minimal harm or potential for actual harm Review of facility policy Sanitization, revised November 2022, revealed all kitchen areas were to be kept clean and free from debris. This deficiency represents noncompliance investigated under Complaint Number OH00151786. Residents Affected - Many 366270 Page 5 of 5