Health inspection·August 13, 2024

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observations, interviews, and record review , the facility failed to provide sufficient support personnel with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service for 5 (Dietary A, Dietary B, Dietary C, Dietary D, and Dietary E) of 9 dietary staff. The facility did not ensure 5 (Dietary A, Dietary B, Dietary C, Dietary D, and Dietary E) of 9 dietary staff had a current food handler's certificate from the date of hire until August 13, 2024 . This failure could place all residents who consumed food prepared from the kitchen at risk of foodborne illness. Findings included: Review of records dated 08/13/2024 revealed Dietary Staff A, Dietary Staff B, Dietary Staff C, Dietary Staff D, and Dietary Staff E did not have food handlers' certificates while employed at the facility. In an interview with the DM on 08/13/2024 at 03:25 PM she stated the employees were required to go through Relias (a computer-based education system) training and then work with her for on the job training and onboarding for multiple days, but at minimum 3 days. She acknowledged that it was required for all dietary staff to have an accredited food handlers' certificate before working in the kitchen. She said the last person was hired over 6 months ago. She stated that this could put the residents at risk for foodborne illness if not trained properly. In an interview with the Administrator on 08/13/2024 at 3:35 PM she stated that employees were required to spend the first week of employment completing the Relias training required by their corporate office. She said that she relied on corporate for training policies and a training system to ensure accreditation standards were up to date. She said she knew all kitchen staff needed a food handlers' certification, but thought Relias was accredited because of guidance from her corporate office. She refused to acknowledge the question about any potential negative outcomes due to a lapse in training. She stated that in-service training's were reactionary, and all staff departments were provided in-services after events had happened. She stated that there has been in-service training performed for dietary staff but failed to provide records for in-services. In an interview on 08/13/2024 at 3:40pm with the Relias customer service phone line he stated that Relias was not affiliated with any state level accreditation programs but has objectives that could serve to meet competencies. No in-service training for dietary aids was provided by the time of Page 1 of 4 675201 675201 08/13/2024 Hillside Medical Lodge 300 S. Highway 36 Bypass Gatesville, TX 76528

F 0802 exit. Requested the policy for dietary new hire training but it was not available. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 675201 Page 2 of 4 675201 08/13/2024 Hillside Medical Lodge 300 S. Highway 36 Bypass Gatesville, TX 76528

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for sanitation. The facility failed to ensure Dietary Aide C served food in accordance with professional standards and facility policy. These failures could place residents at risk of foodborne illnesses. Findings included: Observation on 08/13/24 12:00 PM of lunch service on 200 hall bistros. Dietary Aide C used her thumb and index finger on her right hand to pick up the pickles and onions and place them in the residents sandwich. She did not wear gloves or use a utensil for the pickles and onions. Surveyor observed her make 7 trays in this manner. ADON was observing as well and did not try to correct Dietary Aide C. In an interview on 08/13/24 12:48 PM Dietary Aide C stated she should have used utensils when grabbing the pickles and onions because of the risk for cross-contamination and possibly making the residents' sick. She stated it is the policy to use gloves or utensils when serving ready to eat foods. 08/13/24 01:00 PM In an interview ADON stated she observed Dietary Aide C touch the pickles and onions with her fingers, and she should not have done that because it is their policy not to touch the food with hands. She stated it is an infection control issue and she should have used gloves or utensils. In an interview on 08/13/24 at 02:00 PM, the DM stated she trained new kitchen staff herself after they go through general facility orientation which includes proper handling and serving of food, and she also trained all staff with regular in-services. She stated she does not have any documentation of the training. She also stated she was very surprised to hear of the issue with Dietary Aide C during lunch service in the bistro. She stated the crew knows better and she is disappointed. She further stated she tells her staff It only takes one little germ to make the residents sick. She stated the policy regarding plating food is to use utensils or gloves for ready to eat foods and she prefers for her staff to use utensils because there is less room for error. In an interview on 08/13/24 at 02:10 PM, the DON stated during orientation nursing staff were trained on meal service and hand hygiene. Dietary Staff receive their own training by their manager. 675201 Page 3 of 4 675201 08/13/2024 Hillside Medical Lodge 300 S. Highway 36 Bypass Gatesville, TX 76528

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 08/13/24 at 02:15 PM, the Administrator stated all new dietary personnel receive general facility orientation, job specific training through RELIAS, as well as three to five days on the job training with the dietary supervisor. She stated the dietary supervisor worked very closely with new staff and provided ongoing training through in-services. Record Review of RELIAS training on 8/13/2024 for seven dietary staff, including Dietary Aide C, reflected all received training on infection control and prevention, food safety fundamentals, and handling food safely. Record Review on 8/13/202 of in-service training dated 08/12/2024 reflected staff received training on hand hygiene proper policy/procedure and frequency including Dietary Aide C. Record Review on 8/13/2024 of Nutrition Services Indications for Glove Use and Sanitation facility policy dated 01/01/2010 reflected food employees may not contact ready- to-eat food or food that will not be subsequently cooked with their bare hands and shall use suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment. 675201 Page 4 of 4