Health inspection·August 14, 2025

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure each resident received food prepared by methods that conserve nutritive value, flavor, and appearance and was provided food that was palatable, attractive and at a safe and appetizing temperature for meals prepared and served from 1 of 1 kitchen. 1. Mechanically altered chicken and macaroni and cheese were not reheated prior to being placed on the steamtable during observation of the lunch meal preparation on 8/14/2025.2. Cold milk was used while preparing pureed hot food items during the lunch meal preparation on 8/14/2025.3. Hot food item holding temperatures were not maintained at a minimum of 140 degrees Fahrenheit on the steamtable for the lunch meal on 8/14/2025.4. A sample test tray with a regular diet for the lunch meal on 8/14/2025 was determined to be luke warm. These failures placed the residents at risk for receiving food that was not at a palatable temperature, decreased nutritional intake, compromised nutritional health status, and foodborne illness.The findings included: Record review of the facility's Resident Diet Order Report, printed 8/12/2025, documented the diet orders for 37 residents (36 residents in-house and 1 resident in the hospital), including 11 residents who received mechanical soft diets, 1 resident who received ground meats, and 2 residents who received pureed diets. Record review of the facility's Spring Summer 2025 - Week 2 Menu for 8/11/25 8/17/25, signed at the bottom by the Registered Dietician, revealed the planned lunch menu for 8/14/2025 consisted of oven fried chicken, white gravy, macaroni and cheese, parslied carrots, dinner roll, mandarin oranges, and choice of beverage. Observation on 8/14/2025 at 11:25 AM, during a return visit to facility kitchen to observe the lunch meal preparation, revealed hot prepared food items in stainless-steel pans, covered with lids, were on the steamtable. During an interview and observation on 8/14/2025 at 11:26 AM, the DM stated she had cooked the lunch meal. She stated 14 residents received mechanical soft diets and 2 residents received pureed diets. Observation on 8/14/2025 beginning at 11:28 AM, during the mechanically altered diet preparation by the DM, revealed the following:- 14 pieces of boneless chicken meat were removed from a pan on the steamtable and were placed in the food processor for the 14 residents with orders for mechanical soft diets. The DM poured the ground meat into a small square stainless-steel pan, placed it on the steamtable and covered the pan with a stainless-steel lid.- The food processor was washed in the dish machine between food items.- Cold milk from a beverage glass was used when preparing the pureed diets for 2 residents. The DM stated she had not warmed the milk. The beverage glass with milk was cold and had beads of condensation on the exterior surface. The DM stated the recipe directed to use milk as the liquid when preparing the pureed food items.- 2 pieces of boneless chicken were placed in the food processor and ground; an unmeasured amount of cold milk was poured from the beverage glass and was added to the food processor and the chicken was blended until smooth; the pureed chicken was poured into a square stainless-steel pan and was placed on the steamtable.- Two (2) 4-ounce (1/2 cup) scoops of macaroni and cheese were removed from the rectangular pan on the steamtable and placed in the food processor; an unmeasured amount of cold milk Residents Affected - Some Page 1 of 3 455555 455555 08/14/2025 Avir at Graham 1224 Corvadura St Graham, TX 76450

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was poured from the beverage glass and was added to the food processor to the thin the macaroni and cheese; the pureed macaroni and cheese was poured into a square stainless-steel pan and placed on the steamtable.- Two (2) 4-ounce (1/2 cup) scoops of diced parsley carrots were removed from the rectangular pan on the steamtable; an unmeasured amount of vegetable juice was removed with a serving spoon from the rectangular pan containing carrots and was added to the carrots in the food processor; the pureed carrots were poured into a square stainless-steel pan and placed on the steamtable.- Two (2) wheat dinner rolls were placed in the food processor and an unmeasured amount of cold milk was added; the rolls were blended until smooth and poured into a square stainless-steel pan which was placed on the food preparation counter located to the left of the steamtable.- Mandarin oranges from 2 dessert bowls were poured into the food processor and 3 tablespoons of food thickener were added to the mandarin oranges. The DM divided and poured the pureed mandarin oranges into 2 dessert bowls without measuring the amount for each serving. The DM stated each bowl had contained a 1/2 cup serving. During an interview and observation on 8/14/2025 at 11:52 AM, the DM stated the mechanically altered hot food items would be warmed enough on the steamtable, and she did not place the food in the oven to reheat. The DM had documented the temperature of the regular diet bone-in chicken at 170 degrees F on her food temperature log. She stated the temperature had been measured when she had taken the chicken out of the oven and placed it on the steamtable. She did not say what time she had placed the pan with chicken on the steamtable. Observation on 8/14/2025 at 11:55 AM revealed the DM measured food holding temperatures for the steam table hot food items with a digital thermometer, and alcohol wipes were used to sanitize the thermometer between food items. Food temperatures were measured at less than 140 degrees F for the following:- The regular diet bone-in chicken was measured at 133.8 degrees F but another piece was measured at 145.8 degrees F.- The mechanical soft diet ground chicken was measured at 133.7 degrees F.- The pureed macaroni and cheese was measured at 123.8 degrees F. Observation on 8/14/2025 at 12:14 PM revealed the last hall meal tray cart was sent from the kitchen for Hall E. The cart contained 5 resident meal trays plus one test tray with a regular diet as had been requested. Thermal plate holders and covers were used for hall cart meal trays and plastic wrap was placed over beverage glasses and dessert bowls. Observation on 8/14/2025 at 12:19 PM revealed the last meal tray was served to the residents for Hall E. Observation on 8/14/2025 at 12:20 PM, 6 minutes after the Hall E meal tray cart was sent from the kitchen, the sample test tray with a regular diet was evaluated by the survey team. The food was luke warm but was not hot. The cheese sauce for the macaroni and cheese was very thick and tasted bland. Record review of the facility's policy and procedure for Food Preparation Guidelines, dated as reviewed/revised 7/23/25, revealed the following [in part]:Policy:It is the policy of this facility to prepare foods in a manner to preserve a resident's nutrition and hydration status.Definitions:Food palatability refers to the taste and/or flavor of the food.Proper (safe and appetizing) temperature means both appetizing to the resident and minimizing the risk for scalding and burns.Policy Explanations and Compliance Guidelines:1.Prepare menu items following the menus and standardized recipes.2.Prepare food by methods that conserve nutritive value, flavor and appearance.a. Minimize exposure to light and air when storing food.b. Prepare foods as directed such as using the appropriate amount of liquid.c. Minimize holding time prior to meal service.3. Food and drinks shall be palatable, attractive, and at a safe and appetizing temperature. Strategies include:a. Meals that vary in color and texture. b. Season food with spices or herbs in accordance with recipes and resident preference.c. Serve hot foods/drinks hot and cold food/drinks cold . Record review of the facility's policy and procedure for Food Production Food Temperatures, dated as revised 5/01/2014, revealed the following [in part]:Guideline:Foods should be served at 455555 Page 2 of 3 455555 08/14/2025 Avir at Graham 1224 Corvadura St Graham, TX 76450

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some proper temperature to insure food safety and palatability.Procedure:1.Wash, rinse and sanitize a dial face, metal probe-type thermometer with alcohol wipe .2. Insert thermometer into center of product. Allow time for stabilization. Wait until there is no movement for 15 seconds .3. Record reading on Meal Temperature Record .at beginning of tray-line. If temperatures do not meet acceptable serving temperatures, reheat the product (to 165 F) or chill the product to (< 41 F) the proper temperature. Take the temperature of each pan of product before serving.4. Acceptable serving temperatures are:Meat, entrees > 140 but preferably 160-175 FPotatoes, pasta, rice > 140 but preferably 160-175 FPureed foods, hot > 140 but preferably 160-175 FVegetables > 140 but preferably 160-175 F . Review of the USDA Food Safety and Inspection Service website, 2025, specified the following [in part]: Leaving food out too long at room temperature can cause bacteria (such as Staphylococcus aureus, Salmonella Enteritidis, Escherichia coli O157:H7, and Campylobacter) to grow to dangerous levels that can cause illness. Bacteria grow most rapidly in the range of temperatures between 40 F and 140 F, doubling in number in as little as 20 minutes. This range of temperatures is often called the Danger Zone.Keep Food Out of the Danger ZoneNever leave food out of refrigeration over 2 hours. If the temperature is above 90 F, food should not be left out more than 1 hour.Keep hot food hot-at or above 140 F. Place cooked food in chafing dishes, preheated steam tables, warming trays, and/or slow cookers.Keep cold food cold-at or below 40 F. Place food in containers on ice. 455555 Page 3 of 3