Health inspection·October 26, 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, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for sanitation in that: 1. The facility failed to keep accurate temperature and chemical logs 2. The facility failed to label and date items in the nutrition rooms 3. The facility failed to discard and replace dented pans 4. The facility failed to maintain cleanliness in the ice machine 5. The facility failed to maintain cleanliness of the floor These failures could place residents at risk of foodborne illnesses. Findings include: Initial tour of the kitchen on 10/23/23 beginning at 10:20 a.m. with the DM revealed the high-temp wash log was missing documentation per DW A. DW A stated the kitchen staff sometimes did not document and he had to get on them for it. DW A stated there was no excuse other than that sometimes they (staff) just don't do it. There was a dented metal colander hanging on the pan rack. The ice machine had a black fuzzy substance on the ice chute, identified as mold and removed with a paper towel by the DM. There was a large dark-brown liquid substance on the floor behind the stove. The DM stated she did not know what it was, and that something must have spilled and never got cleaned up. The DM stated they used a cleaning sheet, but they did not always follow it. Interview with DW B on 10/23/23 at 03:42 p.m. stated his co-workers told him to fill in the shifts he worked. He stated he only filled in the shifts he had worked. DW B stated he did not fill in the log every day because he was too busy. DW B stated he did not know why accurate logs were important. DW B would not reveal the co-worker's names, only that they were a boy and a girl. Observation of the nutrition room in the 200 Hall on 10/25/23 at 2:40 p.m. revealed 1 unlabeled, open, and half-eaten dill pickle, 1, 64 oz. of honey thick-it water expired 09/24/23, and 1 unlabeled 6-pack of 5.5 oz. of green Jell-O. Observation of the nutrition room in the 100 Hall on 10/25/23 at 2:44 p.m. revealed 1 unlabeled Page 1 of 6 455455 455455 10/26/2023 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many full quart container of sherbet, 6 unlabeled 3 oz. containers of sherbet, 1 unlabeled and open pint of ice cream, and 3 unlabeled ice cream treats. An interview with the ADON on 10/25/23 at 2:42 p.m. stated that residents who got the expired honey-thickened water could be affected because the thickened water could lose its thickness and they could aspirate it and get pneumonia and depending on the severity, could end up in the hospital and be put on antibiotics. An interview with the RM on 10/25/23 at 2:47 p.m. stated items in the refrigerator and freezer should be labeled because staff needs to know who the food belongs to, so no one gets the wrong thing, like a diabetic might get someone else's sugary treat and get sick. An interview with DW C on 10/26/23 at 06:45 a.m. stated she was trained by two other dishwashers, not the DM. DW C stated she did not know if hot water was used to sanitize the dishes, but the water was super hot. DW C stated she thought the temperature of the water should be 150F. An interview with the DM on 10/26/23 at 08:55 a.m. stated she trained the staff on the dishwasher and chemical testing, and that she should stay on top of it (the logs) to make sure they do it. The DM stated she threw the dented colander away because it needed to be thrown away because bacteria or bits of food could get stuck in the dents and crevasses and come off in the food and make someone sick or break a tooth because it was metal. The DM stated she was responsible for checking and replacing dented pans. The DM stated the dented colander was an oversight and it should have been thrown away sooner. An interview with MSA (maintenance supervisor assistant) on 10/26/23 at 11:00 a.m. revealed not sure what type the washer was but thought it was a high-temperature washer. He did not know what temperature the washer should run at. Record review of the dishwasher logs dated 05/01/23-10/23/23 and interview with the DM on 10/23/23 at 3:12 p.m. revealed all blanks on the washer temperature and chemical strip log had been filled in with black marker-like ink for the following dates: 06/09/23 -06/12/23, 06/27/23-06/30/23, 07/10/23-07/15/23, 07/17/23-07/19/23, 07/26/23, 07/30/23-07/31/23, 08/30/23-08/31/23, 09/19/23, 10/03/23, 10/04/23, 10/09/23, 10/10/23 -10/16/23. Interview with the DM on 10/23/23 at 3:13 PM, she stated she did not know who would have done that. The DM stated DW B had worked some of the days where there was no documentation, and she would tell him when he came to work that day. Record review of the facility policy titled, Dishwashing Machine Use revised 03/2010 revealed Policy Statement: Food service staff required to operate the dishwashing machine will be trained in all steps of dishwashing machine use by the supervisor or a designee proficient in all aspects of proper use and sanitation. 7. The operator will check the temperature using the machine gauge with each dishwashing machine cycle and will record the results in a facility-approved log. The operator will monitor the gauge frequently during the dishwashing machine cycle. Inadequate temperatures will be reported to the supervisor and corrected immediately. A record review of in-services and training for the kitchen staff revealed all had completed a computerized Texas Food Handler Safety; one had expired on 04/01/23. 05/22/23-Diets, snacks, drinks, green sticker program, diet roster. 07/07/23-Food high MSG. 07/14/23-All diets will be liberalized on 455455 Page 2 of 6 455455 10/26/2023 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0812 Level of Harm - Minimal harm or potential for actual harm all diets upon admission, and all NAS (No Added Salt) and NCS (No Concentrated Sweets) will be discontinued. Textures will stay the same. Exceptions will be renal diets. 08/01/23-Renal Diets. 08/24/23 Handwashing; must wash hands for 20 seconds, explained when handwashing is needed, must wash hands when you change your gloves, after bathroom, entering or leaving a room, after eating food, etc. 10/24/23-Temperature logs, Temperatures must be logged in real-time with exact temperature. Residents Affected - Many Review of References: TAC 228.111 (p) Warewashing equipment (three-compartment-sink) determining chemical sanitizer concentration: concentration of the sanitizing solution shall be accurately determined by using a test kit or other device. Figure: 25 TAC 228.111(n)(1) Sanitizer Concentration range: 25-49 ppm, when the minimum temperature is 150 degrees Fahrenheit. 455455 Page 3 of 6 455455 10/26/2023 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on Observation, interviews, and record reviews, the facility failed to maintain essential equipment in safe operating condition for 1 of 1 kitchen reviewed for safe operating equipment: Residents Affected - Some 1. The meat freezer was not sealing properly 2. The ice machine had jagged edges These failures could place residents at risk of foodborne illnesses and injury. Findings included: An initial tour of the kitchen on 10/23/23 beginning at 10:20 a.m. and interview with the DM revealed the outsides of the ice machine were heavily rusted and becoming detached from the machine creating a hazard of sharp rusted metal. The seals on the meat freezer doors had ice on them, breaking the seals away from the freezer and melting. The doors to the meat freezer were not closing properly because of the bad seals. The DM stated it had been that way for a couple of weeks, and she had told maintenance. The DM stated kitchen staff checked the meat freezer often to make sure it was still running and not thawing the items inside. There was no documentation for the extra checks of the meat freezer. The items inside were cold and hard to the touch. An interview with the MSA on 10/26/23 at 11:00 a.m. revealed he did not know about the meat freezer or the ice machine in the kitchen. The MSA stated the kitchen staff or the MS did not inform him of everything that goes on in the kitchen. The MSA stated he did not make regular rounds in the kitchen and only went in there if the MS needed help. A phone interview with the MS on 10/26/23 at 2:00 p.m. stated he had straightened out the seal on the meat freezer yesterday. The MS stated he had the meat freezer repaired not too long ago, that a wire was loose and kept tripping the breaker, and the meat freezer was holding temperature, so we (the repairmen) did not look at it. The MS stated he did not know how long the meat freezer had been that way until this surveyor pointed it out. The MS stated he saw the rusted sides on the ice maker bin but could not give an estimated time for how long it was like that-for a while I guess. The MS stated he was about to get bids for the freezer part(s). The MS stated it was important to maintain kitchen equipment to avoid catastrophes, such as it was not possible to know when the freezer could go out, and all that food would be ruined. The MS stated if the seal in the meat freezer should shift because of melting ice, it would make a big mess and the residents would not get the meats and nutrition they should. The MS stated he did not make regular rounds in the kitchen and only went in there to fix things as needed and when they (the kitchen staff) told him about it. The MS stated the kitchen staff was responsible for overseeing the kitchen. A record review of the only Maintenance logs provided revealed several pages from 2016. 455455 Page 4 of 6 455455 10/26/2023 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on record review, observation, and interviews, the facility failed to provide a safe, functional, and comfortable environment to include fire extinguishers throughout the buildings were regularly inspected and maintained for 1 of 4 portable fire extinguishers inspected throughout the facility. One of four portable fire extinguishers that were observed for monthly quick checks were not inspected monthly. This failure could result in undetected impairments of the portable fire extinguishers delaying suppression of fires exposing residents and staff to smoke inhalation and other fire related injuries resulting in more than minimal harm. Findings included: Record review of portable fire extinguisher quick check tags revealed 1 of 4 fire extinguishers were not inspected monthly. Observations on 10/26/2023 at 12:00 PM revealed 1 portable fire extinguisher in the laundry area did not have any indication that monthly quick checks were performed since June 15th, 2023. In an interview on 10/26/2023 at 12:00 PM Housekeeper A said she worked in the laundry and did not know when the fire extinguishers should be inspected. In an interview on 10/26/2023 at 12:25 PM with the Administrator and maintenance worker B they said the fire extinguishers should be checked monthly to ensure proper operation. The Administrator and maintenance worker B observed the fire extinguisher was last inspected June 15th, 2023. No explanation was given why the fire extinguisher had not been inspected since then. Maintenance worker B said the fire extinguishers are inspected by the maintenance department. The Administrator said not having a working fire extinguisher could endanger the lives of the staff and residents. Record review of facility Fire Extinguishers policy dated 2001 and revised April 2008 indicate The facility has placed fire extinguishers strategically throughout the facility and shall keep them operable at all times. 455455 Page 5 of 6 455455 10/26/2023 Meridian Care of Alice 218 219 N King St Alice, TX 78332

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain an effective pest control program to keep the facility free of pests for 1 of 1 kitchen reviewed for pests. Residents Affected - Few The facility failed to treat gnats in the kitchen This failure could affect all residents by placing them at risk for the potential spread of infection, cross-contamination, food-borne illness, and decreased quality of life. Findings were: An initial tour of the kitchen on 10/23/23 at 10:20 a.m. with the DM revealed gnats in all of the general kitchen areas. Observation of the kitchen on 10/26/23 at 6:40 a.m. revealed a swarm of gnats in the kitchen near the dishwasher machine area, and in all of the general kitchen areas. Interview with DW B on 10/23/23 at 03:42 p.m. stated he had seen gnats in the kitchen, but they came and went-they were not constantly there. An interview with DW C on 10/26/23 at 06:45 a.m. stated she had seen gnats everywhere in the kitchen. She stated she had not told anyone about the gnats because everyone knew about them. An interview with the DM on 10/26/23 at 06:50 a.m. stated she got a shipment of a solution about 3 days ago that took care of the gnats. The DM stated kitchen staff poured the solution into the kitchen drains at night so it could sit, and it did a good job of killing the gnats. The DM stated kitchen staff used the solution for the first time last night since they received the shipment of the solution. The DM did not answer why the kitchen did not use the solution right away or on a regular basis. An interview with the MSA on 10/26/23 at 11:00 a.m. revealed he knew about the gnats in the kitchen. The MSA stated the kitchen staff treated it at night when there was no food around and the water was settled because it goes in the drain. The MSA stated he did not know if the kitchen staff was using the solution to rid the gnats on a regular basis. A phone interview with the MS on 10/26/23 at 2:00 p.m. revealed he had worked at the facility for 6 years and no one ever told him about any gnats. The MS stated the facility had regular pest control. An interview with the ADM on 10/26/23 at 4:00 p.m. revealed she was aware of the gnats in the kitchen and knew the kitchen staff was treating the gnats on an as-needed basis. The ADM was unaware of the potential for gnats to cause cross-contamination and illness. A record review of the only Maintenance logs provided revealed several months from 2016. A record review of the facility pest control logs dated 2023 revealed regular montly pest control, but not for gnats. 455455 Page 6 of 6