Inspection·July 5, 2023

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, interview, record review and facility policy review the facility failed to have staff wear proper hair restraint, record food temperatures to conform safe serving temperatures, keep equipment clean, and keep prepared food covered and dated. This had the potential to all affect all 45 residents residing in the facility who were receiving food from the kitchen. Findings included: 1. a. Observation on 07/03/23 at 8:30 A.M. of Dining Services Assistant Director (DSAD) #159 walking through the kitchen past the yellow line on the floor requiring hair covering wearing a ball cap. His hair was extruding from the bottom of the ball cap approximately 3 inches over the collar of his shirt. He did not have a hair net covering or retaining the hair extruding from the bottom of the ball cap while reviewing the meal temperature log in the food preparation area. Observation on 07/03/23 at 9:30 A.M. of the DSAD #159 with the Licensed Nursing Home Administrator (LNHA) #159 wearing a hair net under his ball cap to retain the hair extruding from the bottom of the ball cap. An interview at the time with DSAD #159 revealed he was not wearing the hair net covering earlier and after reviewing the policy realized he should be. DSAD #159 removed his ball cap and hair net and replaced his ball cap. LNHA #159 verified DSAD #159's hair extruded from the bottom of the ball cap and down over the collar of his shirt. 1. b. Observation on 07/03/23 at 12:07 P.M. of State Testing Nursing Assistant (STNA) #131 walking into the kitchen past the yellow line on the floor requiring hair covering while lunch was being served. STNA #131 was directed to put on a hair net by another staff member. STNA #131 put on a hair net that only covered the top half of her head. Her hair was hanging out of the hair net on the back of her head from her ear level down. She entered the walk-in refrigerator where there was food on trays uncovered. An interview at the time with DSAD #159 verified she entered the kitchen without any covering and entered the walk-in refrigerator without her hair fully covered. Review of the facility policy titled, Hair Restraint, effective date 05/31/16, revealed the facility has chosen a baseball or beanie style cap for the restraint policy to meet the designed uniform code. This had will be worn to effectively keep hair from contacting exposed food. Those employees that have hair that extrudes out of the cap will be required to have hair wrapped into a bun style or tucked under the hat. Food Service employees will wear hair restraints while in all food preparation areas. 2. Review of food temperature logs for June 2023 revealed temperatures were not logged on 06/02/23 for dinner, 06/03/23 for dinner, and 06/26/23 for lunch to confirm food items were cooked to safe (continued on next page) 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 3 Event ID: 366413 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 366413 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oaks at Bethesda The 2971 Maple Avenue Zanesville, OH 43701 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)