Health inspection·September 5, 2024

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure menus and nutritional adequacy met the nutritional needs of residents in accordance with established national guidelines for 2 of 2 observed meals reviewed for meal accuracy. The facility failed to ensure there was 7 days' worth of food available from 09/01/2024 through 09/03/2024 to prepare and serve their planned and/or alternate menu on 09/01/2024 through 09/03/2024 for breakfast, lunch, and dinner. This deficient practice could place residents at increased risk for inadequate nutrition. Findings included: During an observation on 09/02/2024 at 12:19 PM, in the facility's main dining room, revealed the following: -Lunch served was ½ of a grilled cheese sandwich, 1 bowl of vegetable soup, and a piece of German chocolate cake. -Dry pantry revealed: (2) 6.56-pound cans of corn, (2) 104-ounce cans of sliced apples, (1) 6.12 pound can of black beans, (10) 14.5-ounce cans of diced red peppers, (11) 35-ounce bags of dry cereal, (1) bag of biscuit gravy mix, and (2) 102-ounce cans of mushrooms. -the walk-in cooler revealed: 1 case of (6) 5-pound containers of seasoned scrambled eggs, (3) bags of shredded lettuce, and 1 box of diced green peppers. -the walk-in freezer revealed: 1 box of diced potatoes, There were no Emergency food supplies in the kitchen. During an interview on 09/03/2024 at 12:48 PM, the DM said she had worked at the facility for about 8 months. She said the grocery delivery truck usually delivered on Tuesdays but was late due to the Labor Day holiday. She said she normally placed her grocery orders on Mondays and Fridays, and they were delivered on Tuesdays and Thursdays. She said she had placed her grocery order on Friday 8/30/24 and the Administrator had approved it but corporate had not approved it because she had spent too much and was over budget. She said her grocery orders were often not approved due to her budget. She said she had switched the dinner meal and the lunch meal on 9/03/2024 due to not having the Page 1 of 4 455684 455684 09/05/2024 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many ingredients for the dinner meal. She said the lunch meal on 9/03/2024 was supposed to be cream of potato soup, whole wheat crackers, turkey club on croissant, margarine, pear a la cream, and a pickle spear. She said the meal that was served was ½ a grilled cheese sandwich, vegetable soup, and German chocolate cake. She said she told the cook to add pasta to the soup and the cook also had accidently added the hamburger meat to the soup. The DM said there was not a recipe for the soup that was cooked and served. She said the reason it was substituted was because she did not have cream of potato soup, whole wheat crackers, turkey meat, or the pears. She said she did not have the ingredients because her grocery order had not come, and staff had used the turkey meat for sandwiches for the dialysis residents. When asked where the emergency food supply was kept, she said there was not a separate area, and it was mixed in with all the available food supply. She said she did not think the current food supply was enough food to feed the census of 123 residents for 7 days. During an interview on 9/3/24 at 12:48 PM [NAME] A said she had opened 4 cans of minestrone soup and added hamburger meat and pasta for lunch. She said she was told by the DM to add the pasta to the soup but had added the hamburger meat on her own. She said she did not follow a recipe for the soup. Said she did not have the ingredients to cook what was on the menu. She said she did not think the food supply would feed the census of 123 for 7 days . During an interview on 9/3/24 at 12:56 PM the DM said due to the grocery delivery not being delivered on Tuesday they did not have the food to serve what was listed on the menu over the weekend of 8/31/24 and 9/1/24. She said initially she thought she had submitted her grocery order on Friday (8/30/24) but had her cook submit the order on Monday 9/2/24. She said she did not submit the grocery order until Monday (9/2/24) because she waited until the new month so she would not be over budget. She said since the order was submitted on Monday (9/2/24) on Labor Day, the order did not get approved by corporate until 9/3/24. She said the grocery order would not be delivered until 9/4/24. She said the dinner meal for 9/3/24 on menu was supposed to be grilled fish, yellow rice, broccoli, wheat bread, margarine, and a chilled fruit cup. She said she had made substitutions due to not having the ingredients and would be serving salmon patties, scalloped potatoes, and broccoli. She said the procedure for substituting was to write the substitution on the substitution log and the next time the dietician came she would sign off on it. She said she did not reach out to the dietician before the substitution was served to ensure adequacy. During an interview on 9/3/24 at 2:30 PM [NAME] B said she cooked lunch over the weekend of 8/31/24-9/1/24, and dinner on Monday (9/2/24). She said on Sunday (9/1/24) the menu was chicken Florentine, rice, roasted vegetables, wheat roll, and peanut butter cake. She said she had the chicken but took some cans of mushrooms and tomatoes with bell peppers and made a homemade sauce. She said she did not follow a recipe, she just cooked what she had to feed the residents. She said she also cooked scalloped potatoes and corn. She said on Monday (9/2/24) the dinner menu was supposed to be ham and beans, California vegetables, cornbread, margarine, and peach cobbler. She said what she cooked was hamburger patties, sausage and pasta with red sauce, and mashed potatoes. She said for dinner on 9/3/24 the menu was supposed to be grilled fish, yellow rice, broccoli, wheat bread, margarine, and chilled fruit cup. She said she would be cooking salmon patties, scalloped potatoes, and broccoli. She said the DM ordered the food and did not think the food supply was adequate to feed the census of 123 residents for 7 days . During an interview on 9/3/24 at 3:16 PM the Administrator said she had petty cash available at all times, so if something was needed all staff had to do was let her know and she could go and pick it up. She said she had gone and bought bread a few times with petty cash. She said she was not aware the food supply in the kitchen was low. She said for several months there had not been a problem in 455684 Page 2 of 4 455684 09/05/2024 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many the kitchen but in the last 2 months she felt like something was not right. She said they should have enough food in the kitchen for the residents for 7 days of nonperishables and 2 days of perishables. She said she had checked with the DM, and they had what they needed for dinner on 9/3/24 and she was going to the store to pick up bacon for breakfast in the morning. She said the DM had called the grocery delivery company and they would not allow them to pick up the groceries, but they would be delivered first thing in the morning on 9/4/24. She said the DM was responsible for ordering the groceries and said the food supply in the kitchen was not adequate to feed the census of 123 residents for 7 days . She said by not having the correct food supply and following the menu could ultimately lead to weight loss in residents. During an interview on 9/3/24 at 5:01 PM the Dietician via phone interview said the procedure for substitutions was for the DM to look at the substitution guide and choose any food within the same list as a substitute for the unavailable food item. She said she would prefer that the DM reach out to her via phone or email and notify her of substitutions, but the facility had not contacted her regarding any food substitutions over the last month. She said she was not aware of the low food supply at the facility. She said she would be at the facility on 9/4/24 . During an interview on 9/4/24 at 8:43 AM the Dietary Aide said he had worked at the facility for about 5 months. He said he had been the cook up until about 2 weeks ago and had since been the dietary aide. He said the grocery truck had been delivered that morning on 9/4/24. He said the DM had always ordered the food supply and in his opinion the grocery supply that had been delivered was not enough to feed the residents for 7 days . During an interview on 9/4/24 at 8:45 AM the DM said the grocery truck had been delivered that morning on 9/4/24. She said in her opinion the grocery supply that had been delivered was not enough to feed the residents for 7 days. She said she had placed another grocery order that would be delivered on 9/5/24. She said she did not know what she would do in an emergency if the delivery trucks were not able to deliver the groceries. She said she was responsible for ordering the food supply at the facility. She said if the menus were not followed it could lead to weight loss in residents. During an interview on 9/4/24 at 9:00 AM the Regional Clinical Specialist said in his opinion the grocery supply that had been delivered was not enough to feed the residents for 7 days . He said the DM was responsible for ordering the food supply at the facility. He said by not having the appropriate food supply to follow the menus could lead to weight loss in residents. During an interview on 9/4/24 at 9:02 AM the Dietician said she could not give an answer if the food supply that was delivered would be adequate to feed the residents for 7 days. When asked if the lunch meal on 9/3/24 was sufficient nutritional value she said she would have to see the recipe that was used to create the meal. After the DM and [NAME] A revealed to her that a recipe was not followed, she said the meal was short 1 fruit, 1 carb, and 180-200 calories. She said over time if meals were not prepared according to the menus and recipes it could lead to weight loss in residents. During an interview on 9/4/24 at 9:05 AM the Administrator said the grocery truck had been delivered that morning on 9/4/24. She said she had put up the cold food herself. She said in her opinion the grocery supply that had been delivered was enough to feed the residents for 7 days. She said the Dietician was going to do the calculations and determine if the food supply was sufficient. During an interview on 9/4/24 at 3:02 PM the Administrator said the dietician had done the calculations of the food supply and it was not sufficient to feed the residents for 7 days. She said the 455684 Page 3 of 4 455684 09/05/2024 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0803 food supply would be sufficient by the end of the day . Level of Harm - Minimal harm or potential for actual harm During an interview on 9/5/24 at 8:44 AM the DM said she had received another food delivery that morning and she felt like the food supply was sufficient to meet the needs of the residents for 7 days. Residents Affected - Many During an interview on 9/5/24 at 9:23 AM the Administrator said the facility had received another food delivery that morning and felt like the food supply was adequate to feed the residents for 7 days. She said she would personally be over seeing the food supply in the kitchen and the low food supply would never happen again. Record review of the facility's Menu substation log revealed the following changes were made and not signed off by the RD: -9/3/24 Lunch meal vegetable soup was substituted for menu item potato soup. Record review of the facility's Menu substation log revealed the following changes were made and signed off by the RD: -8/6/24 Lunch meal chicken patties were substituted for menu item chicken noodle soup. -8/2/24 Lunch meal [NAME] slaw was substituted for menu item Caesar salad. -7/18/24 Lunch meal beef patties were substituted for menu item ham and beans. -6/14/24 Lunch meal Boston cream pie was substituted for menu item apples. Record review of the facilities Menu Substitution policy dated 12/01/11 and revised on 5/10/18 revealed: The FSD and nutrition consultant will review menu substitutions made to ensure that residents are receiving a balanced diet and to identify training needs in ordering and preparing food. The menus should be served as planned except for emergency situations when a food item is unavailable. 1. The nutrition consultant will provide a Menu Substitution Guide (see guide provided in this section) to the facility to use when substitutions must be made. 2. The nutrition consultant will provide a Menu Substitution Approval Form (see form provided in this section) to the Dietary Manager. The nutrition consultant will instruct the Dietary Manager and staff to record all changes to the menu on the Menu Substitution Approval Form. 3. The nutrition consultant will review the Menu Substitution Approval Form with the Dietary Manager on each visit to determine trends in substitutions and accuracy of substitutions so that appropriate training can be provided if needed. 4. The nutrition consultant will initial off the Menu Substitution Form and review. The Menu Substitution Form will be retained with the dated menus for a 12-month period. Record review of the facilities Emergency and Disaster Planning policy dated 10/1/18 and revised on 9/10/21 revealed: The facility is committed to ensuring that its residents, staff, and any incoming residents from other facilities are provided with adequate nutrition during emergencies or natural disasters. Food: Adequate food supplies will be maintained for a seven-day period. The food may be in regular use and does not need to be separated from weekly supplies. 455684 Page 4 of 4