Health inspection·February 22, 2024

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. Based on interviews, observation and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for the facility's only kitchen. Residents Affected - Some The Facility failed to ensure food in the facility's refrigerator was discarded by the use by date according to the facility guidelines. This failure could place residents who receive food prepared in the facility kitchen at an increased risk of exposure to food born illness. Findings Included: Observation on 02/20/2024 at 9:40 am revealed in the walk-in refrigerator a rolling cart, with a tray containing 12 small cups of cheese with use by 02/17/2024 dates on them. Observation on 02/22/2024 at 11:30 am revealed in the walk in refrigerator a salad sitting on a rolling cart with a use by date of 02/21/2024 sitting with other salads. An interview on 02/22/2024 at 11:33 am with the Dietary Manager revealed that staff were supposed to throw away food on the use by date. She stated that staff know to throw away things when they have a use by date on them or don't look right. She stated that she would be conducting an in-service later today with all staff. She stated that she understands the requirement to properly date and store food for the safety of the residents and food safety practices in general. In an interview on 02/22/2024 at 11:40 am with [NAME] A, she stated that she basically handles only the uncooked food items and she checks dates before she starts preparing them to cook. She stated the dietary aides handle the cooked foods and salads. She stated that she understands why dates and temperatures are important in a setting like this as foodborne illness could be serious for the residents. An interview on 02/22/2024 at 2:35 pm with the Administrator revealed he was not aware of the outdated foods in the kitchen and wanted to know specifically what foods were out of date. He stated that he could provide the facility policy concerning the dating of foods and retention of foods. Record review of the facility policy Menu Service Policy and Procedure 2017. Details on Page 19, Section c bullet point 10 reads as follows Check expiration date of milk, (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 2 Event ID: 675806 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 675806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Laurenwood Nursing and Rehabilitation 330 W Camp Wisdom Rd Duncanville, TX 75116 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)