Health inspection·November 22, 2023

F 0812 -Blue cheese was opened to air and was not sealed. Level of Harm - Minimal harm or potential for actual harm Observation of the convection oven to the back of the kitchen revealed an accumulation of burnt food particles in the oven. The metal rack in the oven was black. The walk-in-freezer had bits of paper and food particles on the floor. Residents Affected - Some Observation of the dry storage room revealed the following : -Mango peach tea was open to the air and was not sealed. -Instant vanilla and instant chocolate pudding were not dated. -Shell pasta in plain pasta were not labeled and not dated. -Pantanella Orzo and pearl [NAME] were not dated. In an interview with [NAME] A on 11/10/2023 at 1:45 p.m., she said foods should be discarded after three days and frozen foods after 7 days. She said foods were placed in the refrigerator to thaw out which might take up to two days. She said the used dates were the wrong dates on the food items . At that point, she told one of the aides to sweep the walk-in-freezer. Interview on 11/10/2023 at 1:50 p.m., Dietary Aide B said the foods should be disposed of after 7 days. She then said she was not sure if it was 3 or 7 days . In an interview on 11/10/2023 at 2:05 p.m. with Dietary Staff G, she said the equipment was cleaned once a month and as needed. She said the oven was last cleaned in October. She said she was going to clean the oven at the end of her shift . In an interview on 11/10/2023 at 1:10 p.m. with the Food Service Director, he said leftovers should be used within 72 hours. He said if it was not used within that time, it should be discarded. He said frozen foods had a longer shelf life, it's usually 7 days. He said if foods were not labeled, sealed and dated then it could lead to food spoilage, because one would not know exactly when to discard the foods and that could cause resident to get sick if they were not labeled and dated properly. He said he was going to in-service the staff on the storage of foods, sealing, labeling, dating of foods and cleaning of equipment. In an interview on 11/10/2023 at 5:30 p.m., the Interim Administrator said the Food Service staff were expected to label, seal and date foods when they were opened. He said they should have a cleaning schedule to clean equipment routinely and as needed. He said he was going to talk to the Food Service Director, on in-servicing food service staff. Record review of the facility's Nutrition Services Policies and Procedures, dated 8/12/2019, read in part .Refrigerated Storage Guidelines: 12. Refrigerated, ready to eat Time/Temperature Control Safety Foods are properly covered, labeled, dated with a use -by date and refrigerated immediately. [NAME] them clearly to indicate the date by which the food shall be consumed or discarded. The day of preparation or day original container is opened shall be considered day 1. Discard after three days unless otherwise indicated. Refer to Cold Storage Chart Record review of Texas Food Code Chapter 228 Subchapter A Department of state health services and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 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 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 retail food establishments Level of Harm - Minimal harm or potential for actual harm Food Code 2022 read on part . Residents Affected - Some (C) Packaged Food shall be labeled as specified in LAW, including 21 CFR 101 FOOD Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18. 3-202.15 Package Integrity. FOOD packages shall be in good condition and protect the integrity of the contents so that the food is not exposed to adulteration or potential contaminants. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 3 of 3