Health inspection·October 5, 2023

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 reviewed for food safety. 1.The facility failed to ensure food items in the refrigerators (3), freezer and dry storage room were labeled and stored in accordance with the professional standards for food service. 2. The facility failed to discard items stored in the dry storage that were not properly labeled or past the 'best buy', consume by or expiration dates. 3. The facility failed to ensure the ice machine's vent/grate and outer surface were free from dirt and dust. 4. The facility failed to ensure handwashing sink #1's trash receptacle was in good repair with a secure fitting lid. 5. The facility failed to empty handwashing sink #1's trash receptacle once it was full. These failures could place residents at risk for food-borne illness and cross contamination. Findings included: Observation of the kitchen on 10/03/23 at 09:50 AM revealed the following: -Handwashing sink #1' trash receptacle was overflowing with garbage and the lid could not be closed. -Handwashing sink #1's trash receptacle had trash other than paper towels inside. There was gloves, plastic, non-food product packaging. -Ice machine plastic vent, located on the left side of the machine, the vent slats had dust on them. -In the right corner, across from reach-in refrigerator #1 there were 2 white plastic bins with 3 clear drawers each, which contained condiments in each drawer: -Bin #1 (left side), the top drawer contained non-dairy creamer, no received by date, no consume by Page 1 of 4 455832 455832 10/05/2023 Windsor Gardens 2535 W Pleasant Run Lancaster, TX 75146

F 0812 or discard by date. Level of Harm - Minimal harm or potential for actual harm -Bin #1, the middle drawer contained pepper packets, no received by date, consume by or discard by date. Residents Affected - Few -Bin #1, the bottom drawer contained individual grape and strawberry reduced sugar jelly containers/packs, no received by date, no consume by or discard by date. Bin #2 (right side), the top drawer contained sugar substitute (pink packets) there was, no received by date, no consume by or discard by date. Bin #2, the middle drawer contained salt packets there was no label of item description, no received by date, no consume or discard by date. Bin #2, the bottom drawer contained individual containers/packs of grape and strawberry jam, no received by date, no consume by date or discard by date. -On top of the 2 bins was a gray multi-compartment tray with individual containers of pancake syrup, containers of grape, mixed fruit, reduced sugar strawberry jelly and containers of grape & strawberry jams, there was no label of item descriptions, no received by date, no consume by or discard by date. -The prep. table next to the white plastic bins, across from reach-in-refrigerator #1, under the prep. table there was an extra-large square clear plastic container with a lid labeled cornmeal, dated 03/17/23, no consume by date or discard by date. -On the right side of reach-in-refrigerator #1 was a microwave dirty on the outside with greasy residue smudges. Observations of Reach-in Refrigerator #1 on 10/02/23 at 09:57 AM revealed the following: -The right-side door needed to be cleaned, to be free of greasy residue smudges and stains. - Inside on Right side, top shelf there was an 8 oz. can of diet energy drink, had no received by date, no consume by or use by date. Observations of Reach-in-Refrigerator #2 on 10/02/23 at 10:21 AM revealed the following: -Reach-in-Refrigerator #2 was in a separate area, the floor in that area had a slippery residue and the floor had small amounts of small bits of paper and small pieces of food debris on it. -The right-side door: -1 large box of cooked pork topping (crumbled /ground pork) dated 10/02, no opened date, packaged date was 07/19/23. -1- 5lbs. bag of cooked pork topping, open to air, no open date, no consume by or discard by date. Observations of Walk-in Freezer #1 on 10/02/23 at 10:34 AM revealed the following: -The floor was sticky. 455832 Page 2 of 4 455832 10/05/2023 Windsor Gardens 2535 W Pleasant Run Lancaster, TX 75146

F 0812 Level of Harm - Minimal harm or potential for actual harm -The right-side shelf: 2nd row (near door)-1 tray with 6-4 oz. cups with lids of red (3), orange (2) and light amber colored liquid (1) with a dish with individual packets of butter and a pitcher with yellowish liquid. There was a label that read Drinks lunch dated 10/03/23, no list of names of the types of liquids in the cups, no label on the butter, no label of item description on the pitcher, no opened date, no consume by or discard by date. Residents Affected - Few -1- Large zip top bag with lettuce and shredded carrots dated 10/03/23, there was no label of item description, no consume by or discard by date. -1 Bunch of celery dated 10/01/23, no label of item description, no consume by or discard by date. -1 Extra-large bag of shredded lettuce dated 10/03/23, there was some browning on at least half of the lettuce in the bag, no consume by or discard by date. -1 Medium zip top bag with 6 individual small tubes of sour cream, bag dated 10/02/23, manufacturer's expiration date on tubes was 10/03/23. Observations of Walk-in Freezer #2 on 10/03/23 at 10:44 AM revealed the following: -1 Large bag dated 09/21/23 labeled chicken that had darkened, slightly dried (freezer burn) on the bottom portion of the contents of the bag, the top portion of the bag had a large amount of ice crystals. Observations of the dry storage room on 10/03/23 at 10:48 AM revealed the following: -2-36 oz. boxes of rice pilaf, no received by date, no manufacturer's best by or expiration date, no consume by or discard by date. -1 Large box labeled yellow cake mix, previously opened, with 6-5lbs. bags/pouches of cake mix, box dated 10/02/23. There was no open date, no consume by or discard by date. -1 Extra-large zip top bag of dry elbow noodles, previously opened, dated 09/25/23. There were 3 separate previously opened bags of elbow noodles inside the zip top bag, no label of item description, no open date for 2 of the 3 bags, no consume by or discard by date. -2-16 oz. bags of mini marshmallows dated 06/15/23, manufacturer's expiration date 06/21/23. Observations of the main dining room on 10/04/23 at11:10 AM revealed the following: -On the counter, there was a stainless steel & black plastic coffee dispenser. Beneath the spicket on the dispenser on the counter is a dried shiny coffee stain. The coffee dispenser had no label of item description, no pull/open date, no consume by or discard by date. -On the same counter was, a clear plastic liquid dispenser with a clear liquid, no label of item description, no pull/open date, no consume by or discard date. In an interview on 10/03/23 at 11:40 AM with the NSD, she stated condiments like jelly are rotated out at 12 months. The NSD said, the cooks do the inventory for the refrigerator & freezers. The dietary aides do inventory for pantry. She stated the cornmeal expires/ kept by the facility for 6-12 455832 Page 3 of 4 455832 10/05/2023 Windsor Gardens 2535 W Pleasant Run Lancaster, TX 75146

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few months. When asked how long was flour, rice and other dry good areas placed in the large bins on the floor was kept after opening, the NSD stated they are kept 6-12 months, we go by the list (the storage guidelines). She stated there is a posted list for cleaning assignments and everyone has an assignment for cleaning. The NSD confirmed the storage guideline list was for unopened items since opening items shortens the shelf life of a lot of food items. The NSD stated canned goods without manufacturer's expiration dates were kept in their facility for 12 months. She stated cereals prepackaged in bowls that had no manufacturer's date are kept for 6 months. The NSD stated dry cereals that are opened are kept 4-5 days. She said, dust or surfaces that were not clean could cause harm to the residents by contaminating their food and causing illness. Review of the facility's Nutrition Services Policy & Procedures Food Production & Food Safety dated March 2009: Revision March 2019, reflected Food Storage Policy: Sufficient storage facilities are provided to keep foods safe, wholesome, and appetizing. Food is stored, prepared, and transported at an appropriate temperature and by methods designed to prevent contamination. Procedure: . 4. All food items should be dated with the received date, unless labeled with a readable label from the food vendor. 5. Plastic containers with tight-fitting covers must be used for storing cereals, cereal products, flour, sugar, dried vegetables and broken lots of bulk foods. All containers must legible and accurately labeled, including the date the package was opened. 7. Scoops are to be washed and sanitized on a weekly bases, or as needed. 8. Hand s must be washed after unloading supplies and prior to handling food items. 9. All stock must be rotated with each new order received. Rotating stock is essential to ensure the freshness and highest quality of all foods. A. Old stock is always used fist (First in- First out method.) b. Supervision is necessary to make sure that the person designated to put stock away is rotating int properly. 13. Leftover food is stored in covered containers or wrapped carefully and securely. Each item is clearly labeled and dated before being refrigerated. Leftover food is used within 2-3 days or discarded. 15. Refrigeration .e. All foods should be covered, labeled and dated.16. Frozen Foods .c. Foods should be covered, labeled and dated. FDA Food Code 2022 reflected: 3-302.12 Food Storage Containers, Identified with Common Name of Food. Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding FOOD or FOOD ingredients that are removed from their original packages for use in the FOOD ESTABLISHMENT, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the FOOD. 455832 Page 4 of 4