Health inspection·November 30, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored in permanently affixed compartments during medication storage inspection for 1 (cart #1) of 4 medication carts reviewed for storage in that: The facility failed to ensure medication cart #1 was locked and secured while unattended. This failure could result in a drug diversion. Findings included: During an observation on 11/28/23 at 01:58 PM, the medication cart at the nurse's station was unlocked with no staff present or within eyesight. There was also a resident sitting in her wheelchair at the nurse's station less than 6 feet away from unlocked medication cart in proximity to the medication. At 2:04 PM, staff nurses were observed coming from hall 100. The unlocked cart contained all prescription and OTC medications that included, but not limited to eye meds, stool softeners, antipsychotics, Insulins, Blood Pressure Medications, and Narcotics. During an interview on 11/28/2023 at 2: 04 PM, RN-A stated the open medication cart was hers and she was responsible for leaving it unlocked. She stated she was trained on locking the medication cart when not in use. RN-A stated residents could have possibly opened the cart drawers with medications that could have caused harmful side effects such as an overdose or an allergic reaction. During an interview on 11/28/2023 at 2:10 PM, the DON stated that RN-A had her training previous to this date and in-serviced over medication storage and keeping the medication cart locked. She stated it was the DON and Nurse Managers duty to monitor the medication carts while on the hallways. The DON stated there was the possibility of potential harm for residents if medications were ingested such as choking or having an allergic reaction with the possibility of death. She also stated the failure was at the nurse's station as the nurses were supposed to have been monitoring the medication cart if left unlocked and within resident reach. She stated she was not there at the time the incident occurred and was unable to say completely what the failure was in her opinion. The DON stated her expectation was for the medication cart to be locked at all times when not in use and should never have been unattended. Record Review of facility In-service Attendance Record dated 11/21/2023 revealed; Subject: Please ensure all medication and treatment carts are kept locked when not in use. Page 1 of 5 675645 675645 11/30/2023 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0761 The RN-A staff members signature was documented and noted to have taken this in-service. Level of Harm - Minimal harm or potential for actual harm Record Review of facility policy Medication Access and Storage not dated revealed; Residents Affected - Few Policy: It is the policy of this facility to store all drugs and biological in locked compartments. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medication: Record Review of facility policy Medication and Treatment Carts not dated revealed; Policy: It is the policy of this facility to use the mobile medication and treatment cart to facilitate administration of medications to residents. Procedures: 2. The medication and treatment carts are locked at all times when not in use. 3. Do not leave the medication or treatment cart unlocked or unattended in the resident care areas. 4. Lock the section of the cart designated for controlled medications at all times except when the controlled medication is being prepared for administration. 675645 Page 2 of 5 675645 11/30/2023 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

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 observations, interviews, and record review the facility failed to properly store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed. The facility failed to ensure that food was discarded after its use by date. The facility failed to ensure food temperatures were taken and recorded prior to service. These failures could place residents that eat out of the kitchen at risk for food borne illnesses. Findings included: During an observation on 11/28/2023 between 10:20 AM and 10:45 AM in the kitchen revealed: Refrigerator #1 1. 2 bags of cabbage with a use by date of 11/24/2023 2. 3 bell peppers that had a white substance on them that appeared to be mold 3. A plastic container that contained ranch with a prep date of 10/28/2023 and a use by date of 10/31/2023 4. 2 packages of boiled eggs with a use by date of 11/27/2023 5. 2 containers of ricotta cheese with a use by date of 11/22/2023 During an observation on 11/28/2023 between 11:10 AM and 12:15 PM, in the kitchen, [NAME] B took chicken out of the oven and failed to check the temperature of the chicken. [NAME] B then prepared the chicken from the oven, pureed part of the chicken, and chopped part of the chicken for the mechanical soft diet. The DM started plating food without taking the temperature of any of the food on the steam table. After prompting, the DM took temperatures of all food on the steam table. During interview on 11/28/2023 at 11:55 AM, the DM stated the cooks take the food temperatures when put on the steam table, record the temperature on the log, or on another piece of paper, and transfer to the temperature log after lunch service. The DM stated she was not aware [NAME] B had not taken temperatures so she would take the food temperatures at that time. During interview on 11/28/2023 at 12:05 PM, [NAME] B stated he knew he should have taken the food temperatures, but he had been a cook long enough to know what chicken looked like when it was done. [NAME] B stated when he had taken the temperatures of food , he would write them down after lunch service . During an interview on 11/30/2023 at 1:30 PM, the DM stated her expectation was that food should have been thrown out after its use by date. The DM stated that all staff are responsible to dispose of food when it was past its use by date and it ultimately falls back on her as the DM. The DM stated 675645 Page 3 of 5 675645 11/30/2023 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many if the residents were to eat food past the use by date it could have caused residents to have gotten sick. The DM stated she had focused on ensuring foods were labeled and dated correctly and that led to the failure of not checking the use by dates. The DM stated her expectation was that the temperature of food should have been taken when it was cooked, when put in the steam table, and again during food service to ensure food remained at the appropriate temperature. The DM stated the cooks were responsible for taking the food temperatures and recording the temperatures. The DM stated residents could have gotten sick from eating food that was not cooked to appropriate temperature. The DM stated what led to failure was the cook got nervous, was focused on making sure things were good, forgot to take the temperatures of the food, and record the temperatures. During an interview on 11/30/2023 at 1:50 PM, the ADMN stated her expectation was that food be disposed of after its use by date and should not be used. The ADMIN stated all dietary staff were to monitor food but ultimately it was the DM's responsibility. The ADMN stated that there could have been negative effects on residents if they had eaten food that was passed its use by date. The ADMN stated what led to failure was staff not checking the dates. The ADMN stated the expectation was temperatures be taken prior to food being served from steam table and again in the middle of food service. The ADMN stated the DM was responsible to ensure temperatures were taken and recorded in temperature log. The ADMN stated residents could have gotten sick from eating food that was not cooked to the correct temperature. The ADMN stated what led to failure was staff were nervous and did not take the temperatures. Record review of facility documents, titled Sample Food Temperature Form dated 11/26/23 to 11/30/23, revealed no evidence of food temperatures being taken for the lunch meal on 11/28/23. Record review of facility policy titled, Food Temperatures, not dated, revealed, The temperatures of all food items will be taken and properly recorded prior to service of each meal. Record review of facility policy titled, Food Storage, without a date, revealed, It is the policy of this facility that food storage areas shall be maintained in a clean, safe, and sanitary manner. Food out of the package can only be stored for 7 days. Review of the FDA Food Code 2022 https://www.fda.gov/food/retail-food-protection/fda-food-code accessed 11/30/2023 revealed: 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers. (B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement; (2) If made from two or more ingredients, a list of ingredients and sub-ingredients in descending order of predominance by weight, including a declaration of artificial colors, artificial flavors and chemical preservatives, if contained in the FOOD; (3) An accurate declaration of the net quantity of contents; 675645 Page 4 of 5 675645 11/30/2023 Mesa Springs Healthcare Center 7171 Buffalo Gap Rd Abilene, TX 79606

F 0812 (4) The name and place of business of the manufacturer, [NAME], or distributor; and Level of Harm - Minimal harm or potential for actual harm (5) The name of the FOOD source for each MAJOR FOOD ALLERGEN contained in the FOOD unless the FOOD source is already part of the common or usual name of the respective ingredient. Pf Residents Affected - Many (6) Except as exempted in the Federal Food, Drug, and Cosmetic Act § 403(q)(3) - (5), nutrition labeling as specified in 21 CFR 101 - Food Labeling and 9 CFR 317 Subpart B Nutrition Labeling. (7) For any salmonid FISH containing canthaxanthin or astaxanthin as a COLOR ADDITIVE, the labeling of the bulk FISH container, including a list of ingredients, displayed on the retail container or by other written means, such as a counter card, that discloses the use of canthaxanthin or astaxanthin. Time/temperature control for safety refrigerated foods must be consumed, sold or discarded by the expiration date. 675645 Page 5 of 5