Health inspection·November 22, 2022

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to assure Labeling of Drugs and Biologicals Drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and expiration date -In primary medication room, one Novolog insulin pen was with expiration date 11/19/22, one albuterol nebulizer solution 0/083% was with expiration date 11/17/22, and one Novolog insulin pen without prescription label was with expiration date 5/22. -In the memory care nurse cart one Triamcinolone 0.1% ointment was with expiration date 1/28/20, one ondansetron 4mg was with expiration date 9/23/22, one ipratropium/albuterol nebulizer solution was with expiration date of 10/26/22, and one packet containing 32 povidone iodine swab sticks was with expiration date of 8/10/21. -In the memory care medication aide cart was one Lantus Solostar pen without a prescription label. This deficient practice could place, 69 residents who receive medications from the medication room and medication carts at risk for not receiving the intended therapeutic benefit of their medications. The findings were: In an observation on 11/20/22 at 9:00AM in the primary medication room inside the refrigerator there was one Novolog insulin pen with a prescription label that showed an expiration date of 11/19/22 belonging to Resident #and one Novolog insulin pen without a prescription label and the manufacturer label stated the expiration date 5/22. There was one albuterol nebulizer solution 0.083% with a prescription label that showed an expiration date 11/17/22 belonging to Resident #64 sitting on the counter with other nebulizer solutions. In an observation on 11/20/22 at 9:15AM in the memory care nurse's medication cart there was one Triamcinolone 0.1% ointment with a prescription label that showed an expiration date 1/28/20. There was one ondansetron 4mg with a prescription label that showed an expiration date 9/23/22 that belonged to Resident #59. There was one ipratropium/albuterol nebulizer solution with a prescription label that showed an expiration date of 10/26/22 that belonged to Resident #59. There was one box that contained 32 povidone iodine swab sticks that the manufacturer's label showed an expiration date of 8/10/21. Page 1 of 5 455486 455486 11/22/2022 Ennis Care Center 1200 S Hall St Ennis, TX 75119

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an observation on 11/20/22 at 9:25AM in the medication aide's medication cart there was a Lantus Solostar pen without a prescription label. During an interview with MA-A on 11/20/22 at 9:00AM she stated once medications are expired, they should be taken out of regular stock and placed in the locked cabinet in medication room for all expired medications. She said she had not checked carts for expired medications only medications she had personally given. She said she was new and did not know who was responsible for auditing carts for expired or discontinued medications. During an interview with MA-B on 11/21/22 at 8:52AM she stated the locked cabinet in medication room is where all expired or discontinued medications should be placed by anyone passing medications. She said she had not checked carts for expired medications only medications she had personally given. She said she did not know who was responsible for auditing carts for expired or discontinued medications. During an interview with the DON and ADM on 11/22/22 at 11:05AM, they said expired medications and medications without a pharmacy label should be removed from active medication stock and placed inside locked cabinet in either medication room. They stated giving an expired medication despite route could cause harm or have less than therapeutic effects on a resident. They stated there was not a policy in place for medication carts or rooms to be audited routinely for expired or improper labeling. They said there was a policy that stated whoever was passing medications should check the expiration prior to administration but said if someone was in a hurry or distracted than an expiration date could be overlooked. In record review of Administering Medications Policy Statement stated insulin pens should be properly labeled with resident name and whoever was passing medications should check expiration date on label prior to passing medication. There was no policy in place that stated medication carts should be checked for expired medications on a regular basis. 455486 Page 2 of 5 455486 11/22/2022 Ennis Care Center 1200 S Hall St Ennis, TX 75119

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 food service safety in the facility's only kitchen. Residents Affected - Many 1) The facility failed to ensure food and beverage items were properly labeled with product's name and expiration dates. 2) The facility failed to ensure food and beverage items were properly sealed when not in use. 3) The facility failed to keep staff's personal food and beverage items separate from the residents. These failures could place the residents at risk for food-borne illness and food contamination. Findings included: An observation on 11/20/2022 at 8:47 AM upon entering the kitchen, revealed an uncovered ice scooper placed on a tray on top of the ice machine. An observation on 11/20/2022 at 8:51 AM revealed in the upright refrigerator, pre-poured cups of various colored beverages and milk on one tray that was not labeled with the product type or dated. There were individual containers of Ready Care Vanilla Shakes that did not have a manufacturer's expiration or use by date. There was a salad in a small plastic container with what appeared to be a breaded pork chop placed inside of a plastic grocery store bag. There were small cubes of orange cheese that was not labeled or dated. There was a plastic cup containing Nectar Chocolate Milk that was not labeled or dated. An observation on 11/20/2022 at 9:00 AM inside of the dry pantry revealed a box of baking soda and iodized salt where the openings were not properly covered. An observation on 11/20/2022 at 9:05 AM revealed on the top shelf a plastic container containing individual condiment packets of apple and grape jelly and syrup without an expiration date. An observation on 11/20/2022 at 9:10 AM revealed in the small refrigerator, two cooked eggs on a small plate covered with plastic, and a metal container containing cooked beans and sausages not labeled or dated. There was also a box of smoked sausage links inside of the manufacturer's box not properly stored or dated. An observation on 11/20/2022 at 9:15 AM revealed in the large refrigerator, a large stock pot containing a condensed mixture not labeled or dated. An observation on 11/20/2022 at 9:25 AM revealed in the small freezer, a bag of individual pieces of bread not labeled or dated. An observation on 11/20/2022 at 9:30 AM revealed in the large freezer, two bags of breaded meat not properly stored, labeled or dated. 455486 Page 3 of 5 455486 11/22/2022 Ennis Care Center 1200 S Hall St Ennis, TX 75119

F 0812 Level of Harm - Minimal harm or potential for actual harm In an interview on 11/20/2022 at 9:40 AM, DA A stated she had just placed the drinks in the upright refrigerator this morning. She stated the Nectar Chocolate Milk was opened this morning to be used that day. She stated if the residents were given the wrong beverage, it could make them sick. She stated if she had an emergency and had to leave work, the next worker would not know when the items had been placed there. Residents Affected - Many In an interview on 11/20/2022 at 9:45 AM, [NAME] A stated the entire staff was responsible for labeling and dating opened containers and packages. [NAME] A stated the boss is in charge of overseeing the kitchen and she told them to label everything. In an interview on 11/21/2022 at 9:05 AM, the DMGR stated she orders the Vanilla Shakes once a week due to them being consumed quickly. She said the expiration date was on the manufacturer's box. She stated if they did not get used, and got mixed up with the new ones, the residents could possibly become ill. She stated all staff members were responsible for labeling and dating. She stated she told them every day not to store their personal food and drinks in the refrigerator or freezer with the food for the residents. She stated she believed the large stock pot with a condensed consistency was Broccoli Cheddar Soup. Regarding the high temperature of the foods, she stated it could make the food dry, not be edible and kill the nutrients. If the vegetables remain at a high temperature, they will become mushy. In an interview on 11/22/2022 at 12:05 PM, the DON stated serving residents expired food could cause the residents to have food poisoning, diarrhea, GI-upsets, and electrolytes imbalances. If they cannot manage the residents' symptoms, the residents could possibly have to be sent out to the hospital. She stated she was not familiar with the policy, but everywhere she has previously worked, you must label and date everything so that you were up to date with the items being used and served. In an interview on 11/22/2022 at 12:20 PM, the ADM stated they were supposed to label and date everything in storage, opened or unopened. He stated this was their policy and procedure. He said not doing so, can cause illnesses. He said it was not a sanitary kitchen practice in his opinion. They should know when food was made and what it was being used for at the time. Record review of Policy & Procedure Manual - Food Storage with a copyright of 2019 states: 8. All containers must be legible and accurately labeled and dated. 9. Scoops are.kept covered in a protected area near the containers. 11. Leftover food will be stored in covered containers or wrapped carefully and securely. Each item will be clearly labeled and dated before being refrigerated. 12. Refrigerated food storage (f) All foods should be covered, labeled and dated. 13. Frozen Foods (c) All foods should be covered, labeled and dated Record review on 11/22/2022 of Policy & Procedure Manual - Use of Leftovers with a copyright of 455486 Page 4 of 5 455486 11/22/2022 Ennis Care Center 1200 S Hall St Ennis, TX 75119

F 0812 2019 states: Level of Harm - Minimal harm or potential for actual harm 2. Leftovers will be covered, labeled, and dated; then stored appropriately (refrigerated or frozen if necessary) immediately after the end of the meal service. Residents Affected - Many Record review on 11/22/2022 of Policy & Procedure Manual - Resource: Food Safety for Your Loved One with a copyright of 2019 states: Food or beverage items without a manufacturer's expiration date should be dated upon arrival in the facility and thrown away 7 days after the date marked. 455486 Page 5 of 5