Health inspection·February 26, 2025

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record review, the facility failed to provide food that was palatable, attractive, and at a safe and appetizing temperature for 1 of 1 meal (lunch meal) reviewed for palatability, attractiveness, and appetizing. Residents Affected - Few The dietary staff failed to provide food that was palatable and at an appetizing temperature for the lunch meal observed on 02/26/2025. Resident's #1, #2, #3, and #4 complained the food was served cold. These failures could place residents at risk of decreased food intake, hunger, unwanted weight loss, and food borne illnesses. The findings included: During an interview on 02/26/2025 at 09:30 AM, an anonymous family member stated, during a visit on 1/31/2025, a resident's meal was served cold. The family member stated she was assisting the resident eat and touched the food and it was cold. The family member stated the resident ate in the dining room on this date with other residents. During an interview on 02/26/2025 at 10:55 AM, Resident #1 stated his meals were served cold almost every day. The resident stated he ate in the dining room daily. The resident stated his meals were rarely ever hot or warm enough. During an interview on 02/26/2025 at 11:13 AM, Resident #2 stated his meals were served cold often. The resident stated he ate in the dining room daily. The resident stated meal services rarely ever had hot or warm food. The resident stated his food did not taste good because it was not hot or warm enough. During an interview on 02/26/2025 at 11:22 AM, Resident #3 stated his food was served cold almost every day. The resident stated he ate in his room daily. The resident stated this had been an ongoing issue and most meals had been served cold. The resident stated he rarely ever received warm or hot food during meal services. During an interview on 02/26/2024 at 11:30 AM, the KM stated they planned to serve lunch around 11:40 AM. A test tray was requested after all residents were served. During an interview on 02/26/2024 at 12:37 PM MA stated residents complained often about food being cold. The MA stated residents' meal trays were delivered to the nursing station by the kitchen staff and the nursing staff had to double check each tray. The MA stated the trays were usually handed Page 1 of 4 675874 675874 02/26/2025 Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few out immediately. The MA stated nursing staff had to reheat food often for residents who stated their food was cold. During an observation on 02/26/2024 at 1:14 PM, a test tray was provided by the KM. The test tray contained a regular diet plate that included a slice of meatloaf, a serving of scalloped potatoes, a serving of green peas, a dinner roll, and a dessert of apple cake. The test tray also included a puree diet plate that included meatloaf, potatoes, green peas, and bread. The meatloaf on the regular diet plate was cold. The potatoes on the regular diet plate were slightly warm. The peas on the regular diet plate were slightly warm. The meatloaf on the puree diet plate was slightly warm. The potatoes on the puree diet plate were cold on top and slightly warm on the bottom. After stirring the potatoes, the potatoes were less than slightly warm. The peas on the puree diet plate were warm. The regular diet and puree diet plates were served on insulated clam shells on the test tray. During an interview on 02/26/2025 at 2:15 PM. Resident #4 stated his meatloaf was served cold on this date. The resident stated he ate in his room most days. The resident stated his meals were served cold on a lot of days. The resident stated he had to request staff to warm up his food on numerous occasions due to the food being served cold when he first received it. During an interview on 02/26/2025 at 2:22 PM. Resident #3 stated his lunch was served cold on this date. The resident stated he ate in his room on this date. The resident stated he had meatloaf and potatoes on this date for lunch. Record Review of the facility's document titled, Service Line Checklist dated 2/26/2025 revealed the following under Food Temperatures : Lunch: Meat Dish (regular)- 188 degrees with a marked-out temperature that is illegible; Meat Dish (puree)- 180 degrees; Vegetable (regular)- 190 degrees; and Vegetable (puree)- 182 degrees. During an interview on 02/26/2024 at 2:40 PM the KM stated residents always complained that their food was cold, and that was nothing new. The KM stated if food was not hot enough for a resident, it was reheated. The KM stated she took temperatures of each food item before it was served to ensure it was at a proper temperature. The KM stated temperature log was showing lunch was served at proper temperatures. The KM stated she verified the temperatures were adequate. The KM stated this was logged each meal including at lunch time on this date. The KM stated she did not know why the test tray contained food that was only slightly warm and/or cold. The KM stated the test tray was served after the last tray was served to the residents. The KM stated residents' meal trays were served to their room first, and then the residents in the dining room were served. The KM stated residents' room meal trays were taken to residents on a cart. The KM stated this cart was not heated. The KM stated the meal trays were taken to nursing staff at each hall and the nursing staff distributed the food to residents after the meals were checked for accuracy. The KM stated she did not know how long it took for nursing staff to distribute residents' room trays. The KM stated it was her expectation the trays were served as soon as they were delivered. The KM stated room trays were served on insulated clam shell plates. The KM stated the plates were heated as well to keep food warm. The KM stated she did not know why the residents complained of cold food since kitchen staff ensured food was at an adequate temperature before it was sent out to residents. The KM stated residents' room trays were served from the kitchen, and residents who eat in the dining room were served from the steam table in the dining room. The KM stated she did not know why residents who ate in the dining room would complain that their food was cold. The KM stated the temperature taken on this date were from the kitchen, not the serving line. The KM stated it was her expectation that residents were served hot food. The KM stated it was the kitchen staff's responsibility to ensure food was served hot. The KM stated if 675874 Page 2 of 4 675874 02/26/2025 Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720

F 0804 food was not served at a safe temperature residents could get sick. Level of Harm - Minimal harm or potential for actual harm During an interview on 02/26/2024 at 3:00 PM CNA A stated residents complained often about food being cold and nursing staff would heat up the food for the resident. Residents Affected - Few During an interview on 02/26/2024 at 3:43 PM LVN A stated residents did complain about food being cold sometimes and nursing staff would heat up the food for the resident. LVN A stated the nursing staff checked each resident's tray before it was delivered to them to ensure they were getting an approved meal. LVN A stated this was usually done right away after the kitchen staff delivered the trays to the nursing station. During an interview on 02/26/2024 at 4:00 PM the ADM stated the KM was responsible for ensuring food was served at a proper temperature. The ADM stated cooks were responsible for ensuring food met proper temperatures. The ADM stated the KM was responsible for the cooks. The ADM stated they used an induction system to ensure food was served at proper temperatures. The ADM stated this included clam warmers for plates and two insulated food carts. The ADM stated nursing staff were responsible for handing out food trays after they were checked for accuracy to ensure residents receive their ordered diet. The ADM stated it was her expectation that food trays were served as soon as they were delivered to each hallway. The ADM stated all dietary staff were trained regarding safe food temperatures upon hire and through regular in-serves provided by the KM. The ADM stated if food was served cold or slightly warm, food may not be palatable since some residents would want their food to be hot. The ADM stated there was a concern for residents' safety and possible illness if food was not served at safe temperatures. During an interview on 02/26/2024 at 4:15 PM CNA B stated residents did sometimes complain about food being cold and nursing staff would request an alternative for the resident or warm the food up for them. During an interview on 02/26/2024 at 4:18 PM the DON stated she had not received any complaints about food being served cold. The DON stated some residents did prefer their food to be warmer than it was served, and they would heat up residents' food when needed. The DON sated the KM was over all kitchen staff and was ultimately responsible for ensuring food was served at proper temperatures. The DON stated residents' room trays were served on insulated shells. The DON stated when room trays were brought to the nursing staff to distribute, nursing staff were also responsible for ensuring food was not cold. The DON stated it was her expectation that food trays were served as soon as they were delivered to nursing staff. The DON stated if nursing staff were not available when meal trays were delivered to the nursing stations, the unit manager or the DON would also help distribute trays after they verified the meals were adequate for each resident's meal order. The DON stated all food should have been served at safe temperatures, and if food was cold a new tray should have been requested for the resident. The DON stated if food was not served at safe temperatures the resident could have been at risk of food borne illness or food may have not been pleasurable to the resident if it was not served warm enough. Record Review of the facility's policy titled, Food: Quality and Palatability dated 5/2014 and last revised on 02/2023 revealed the following: Policy Statement: Food will be prepared by methods that conserve nutritive value, flavor, and appearance. Food will 675874 Page 3 of 4 675874 02/26/2025 Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few be palatable, attractive, and served at a safe and appetizing temperature. Food and liquids are prepared and served in a manner, form, and texture to meet resident's needs. Definitions Proper (safe and appetizing) temperature Food should be at the appropriate temperature as determined by the type of food to ensure resident's satisfaction and minimizes the risk for scalding and burns. Procedures 2. The Cook(s) prepare food in a sanitary manner utilizing the principles of Hazard Analysis Critical Control Point (HACCP) and time and temperature guidelines as outlined in the Federal Food Code. 675874 Page 4 of 4