Health inspection·October 16, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen reviewed for food service safety. Residents Affected - Few The facility failed to recognize and dispose of food which had pests, including maggots on the food items. This failure could place residents who receive food and/or snacks from the kitchen at risk for food borne illness. The findings included: Observation by a Life Safety Code inspector on 10/16/2024 at approximately 2:30 PM revealed an opened box of vanilla pudding cups in the dry storage area of the kitchen. Upon further inspection, the box was revealed to have a foul odor and bugs flew out of the box. Observation on 10/16/2024 at 3:55 PM revealed an opened box of vanilla pudding cups with an opened pudding container inside of the box. Inside the box and on the open pudding container were maggots and what appeared to be insect eggs on and around the pudding cups. Interview and observation on 10/16/2024 at 3:58 PM, [NAME] A stated she was not the person who put away the food delivery after it was completed yesterday, and that neither of the staff who did were at the facility or available that day. [NAME] A stated that no pudding from the box was served or put away onto the shelves. Observation of the dry storage shelves revealed one (1) vanilla pudding cup with an insect egg on the outside of the pudding container. [NAME] A stated that she believed it was appropriate to serve this vanilla pudding cup to residents and would likely move it from this container into a bowl so it would be easier for the residents to consume. [NAME] A stated the item on the outside of the pudding container appeared to be dirt. [NAME] A did not state why she believed it was appropriate to give to residents or what could happen if spoiled food was served. Interview on 10/16/2024 at 5:00 PM, the DM stated she would not serve the pudding to residents and would expect her staff to not serve it to residents as well. The DM stated that her expectation would be for staff to take photos of the damaged food and to immediately throw the damaged food away. The DM stated that what [NAME] A said was not acceptable and is not how kitchen staff are trained. The DM stated she is responsible for training staff and that food is inspected at delivery and before and during preparation of the food. (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: 455278 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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)