F 0812
Level of Harm - Minimal harm
or potential for actual harm
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** The following
acronyms were used:
Residents Affected - Some
DC A: Dietary [NAME] A
DC B: Dietary [NAME] B
DM: Dietary Manager
DON: Director of Nursing
OM: Operations Manager
MDS: Minimum Data Set
CMS: Centers for Medicare and Medicaid Services
PCC: Point Click Care
Tag: 812
S/S= F
Surveyor Name(s): Steffanie Brand
Immediate Supervisor: [NAME] Sill
Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve
food in accordance with professional standards for food safety service for 2 of 2 meals observed.
The facility failed to ensure that Dietary [NAME] A and Dietary [NAME] B performed proper hand hygiene
while preparing food in the kitchen.
This failure could place residents at risk of infection or cross contamination.
Findings included:
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 3
Event ID:
675458
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
675458
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Nursing and Rehabilitation Center
1501 S Main St
Lockhart, TX 78644
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
On 07/29/2024 at 11:10AM an observation was conducted in the kitchen of the puree process by DC A. DC
A completed the chicken puree. DC A had placed the blender in the dishwashing and sanitizing
compartment with gloves on. DC A took off her gloves, lifted the trash can lid up, and tossed the gloves in
the trash can. DC A did not perform hand hygiene after she tossed her gloves in the trash and when she
had grabbed the blender.
Residents Affected - Some
On 07/29/2024 at 11:15AM an observation was conducted in the kitchen where DC A had performed hand
hygiene. DC A washed her hands properly with soap and warm water then turned off the faucet with her
clean hand. She then grabbed a paper towel and continued with her kitchen duties.
On 07/30/2024 at 11:00AM an observation was conducted in the kitchen of the puree process by DC B. DC
B completed the beef tips puree. DC B had placed the blender in the dishwashing and sanitizing
compartment with gloves on. DC B took off his gloves, discarded them in the trash can and performed
proper hand hygiene with soap and warm water then turned off the faucet with his clean hand . He then
grabbed a paper towel and continued with his kitchen duties.
On 07/30/2024 at 11:10AM an interview was conducted with DC B regarding the hand hygiene process. DC
B described proper hand hygiene as always washing your hands between touching different menu items.
DC B stated that a potential negative outcome of not using proper hand hygiene is cross contamination.
On 07/30/2024 at 11:20AM an interview was conducted with DC A regarding the hand hygiene process. DC
A described proper hand hygiene as 20 seconds of washing the hands under warm to hot water with soap,
grab a paper towel to dry your hands, throw the towel away, grab a new paper towel and turn off the faucet .
DC A stated that a potential negative outcome of not using proper hand hygiene is salmonella and
potentially death.
On 07/31/2024 at 10:47AM an interview with Dietary Manager regarding the hand hygiene process in the
kitchen. DM described proper hand hygiene as they need to wash their hands with soap, rinse their hands
off, and grab a paper towel to turn off the water. DM stated that staff in the kitchen should have gloves on
when handling spills and raw foods. DM stated that once they remove the gloves, they should wash their
hands before continuing their task. DM stated a potential negative outcome of not performing proper hand
hygiene in the kitchen could result in cross contamination.
On 07/31/2024 at 01:40 PM an interview was conducted with the DON regarding hand hygiene. DON
stated that the policy on handwashing/hand hygiene is it should be performed any time your hands are
soiled. DON stated that the steps of performing handwashing/hand hygiene are to turn the faucet on, lather
hands with soap, rub vigorously for 20 seconds, rinse with water, grab a paper towel and use the paper
towel, after drying your hands, to turn off the faucet. DON stated a potential negative outcome that could
come from not performing accurate hand hygiene is infection.
On 07/31/2024 at 01:58PM an interview was conducted with the ADM regarding hand hygiene. ADM stated
that the policy on handwashing/hand hygiene is to wash your hands as much as possible, between other
tasks to reduce cross contamination. ADM stated that the steps that should be taken when performing
handwashing/hand hygiene are to rinse, apply soap, scrub for 30 seconds, and dry your hands. ADM stated
a potential negative outcome that could occur from not performing accurate handwashing/hand hygiene is
infection issues, cross contamination and someone could get sick.
Record review of facility provided document titled Handwashing/Hand Hygiene Policy dated August
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675458
If continuation sheet
Page 2 of 3
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
675458
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/31/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkview Nursing and Rehabilitation Center
1501 S Main St
Lockhart, TX 78644
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
2019 stated the following:
Level of Harm - Minimal harm
or potential for actual harm
Washing Hands:
1.
Residents Affected - Some
Wet hands first with water, then apply an amount of product recommended by the manufacturer to hands.
2.
Rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
3.
Rinse hands with water and dry thoroughly with a disposable towel.
4.
Use towel to turn off the faucet.
5.
Avoid using hot water because repeated exposure to hot water may increase the risk of dermatitis.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675458
If continuation sheet
Page 3 of 3
