Health inspection·April 19, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to store and distribute food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for food safety. 1. The facility failed to ensure stored foods were properly labeled and dated. 2. The facility failed to ensure expired foods were discarded. 3. The facility failed to store foods in accordance with professional standards. These failures could place residents who ate the food from the kitchen at risk for food-borne illness. Findings included: On 4/17/24 at 8:54AM an initial observation of the kitchen was conducted. Inspection of the freezer revealed: 1 food service bag of frozen chicken quarters with no received date, no open date and open to air, 2 food service bags of frozen chicken quarters with no received date. 1 food service bag of frozen chicken [NAME] with no received date, 7 10-lb. chubs of frozen hamburger meat with no received date, 1 zip seal bag of frozen chicken nuggets no received date, and no open date, 2 3-gal. containers of vanilla ice cream with no received date, and no open date, 1 2.6-lb. frozen apple pie with no received date, no open date and, 1 10-lb. box of frozen sliced carrots with no received date, and no open date, and open to air. Inspection of the refrigerator revealed the following: Page 1 of 3 675016 675016 04/19/2024 Great Plains Nursing and Rehabilitation 315 E 19th Dumas, TX 79029

F 0812 2 4-lb. containers of hummus with an expiration date of 2/8/24, and Level of Harm - Minimal harm or potential for actual harm 1 partial food service bag of shredded mozzarella cheese with no received date, and no open date. Inspection of the dry pantry revealed the following: Residents Affected - Many 1 3-lb. bag of fresh potatoes with no received date, no open date and, open to air, 2 1-lb. bags of powdered sugar with no received date, 2 2-lb. bags of marshmallows with no received date, 5 1-lb. bags of alfredo sauce mix with no received date, 6 2.75-oz. bags of cherry gelatin with no received date, and 1-gal. pancake syrup with no received date or open date. An interview on 4/19/24 at 9:02 AM with the FSM revealed she was responsible for checking the food items into the kitchen when the truck delivered them to the facility. She stated the negative outcome of not having foods properly labeled and dated was that residents could become sick if they ate foods that are expired. She stated that foods which are not labeled as to what is in the package could cause problems for residents who might be served foods which they should not have. The FSM was asked how she knew when food was to be disposed of and she stated she used the first in/first out method and the expiration date on the product. Record review of the facility's Food Safety policy date 2012 revealed the following: 1. Food is to be tightly wrapped or sealed and covered in a clean container. Opened food shall be labeled, dated, and stored properly. 2. Do not keep potentially hazardous food in the refrigerator past the labeled expiration date. Record review of the facility's Dry Storage policy dated 2012 revealed the following: 1. Dry bulk foods (e.g., flour, sugar) are stored in seamless metal or plastic containers with tight covers or bins which are easily sanitized. Containers are labeled. 2. Open packages of food are stored in closed containers with tight covers, as dated as to when opened. 675016 Page 2 of 3 675016 04/19/2024 Great Plains Nursing and Rehabilitation 315 E 19th Dumas, TX 79029

F 0812 Record review of the facility's Storage Refrigerators policy dated 2012 revealed the following: Level of Harm - Minimal harm or potential for actual harm 1. Food must be covered when stored, with a date label identifying what is in the container. Residents Affected - Many On 4/19/24 at 9:09AM the FSM stated there was no specific Storage Freezers policy. 675016 Page 3 of 3