Health inspection·September 11, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care was provided such care, consistent with professional standards of practice for 2 (Resident #9 and Resident #12) of 6 residents observed for oxygen management. The facility failed to ensure oxygen in use signage was on Resident #9's and Resident #12's doorway. This failure could place residents at risk of hazards such as explosions which could lead to physical harm.The findings included: Record review of Resident #9's admission record, dated 09/10/2025, indicated she was admitted to the facility on [DATE]. Diagnosis included COPD ((chronic obstructive pulmonary disease) (A group of lung diseases that cause airflow obstruction and breathing problems)). She was [AGE] years of age. Record review of Resident #9's quarterly MDS assessment, dated 06/26/2025, indicated in part: BIMS = 10 indicating the resident was moderately impaired. Section O - Special Treatments, Procedures, and Programs = Oxygen therapy while a resident. Record review of Resident #9's order summary report, dated 09/10/25, indicated Resident #9 had an order for oxygen at 2 lpm (Liters per minute) via nasal cannula effective 04/17/25. Record review of Resident #9's undated care plan indicated in part: Resident is unable to lay flat r/t (related/to) will become SOB. May have oxygen at 2-4L/min (L/min = liters per minute) via nasal cannula PRN oxygen below 90%. Date revised: 07/29/2025. During an observation and interview on 09/10/2025 at 09:48 AM, indicated no oxygen sign posted outside of Resident #9's door. Resident #9 was sitting up in her room on her recliner. The resident was observed wearing a nasal cannula that was connected to the oxygen concentrator. On the back of her wheelchair was an oxygen tank as well. Resident #9 said she had been using oxygen for a long time. Record review of Resident #12's admission record, dated 09/10/2025, indicated he was admitted to the facility on [DATE]. Diagnosis included chronic obstructive pulmonary disease (A group of lung diseases that cause airflow obstruction and breathing problems). He was [AGE] years of age. Review of Resident #12's quarterly MDS assessment, dated 08/25/2025, indicated, in part a BIMS score of 15 indicating the resident was cognitively intact. Record review of Resident #12's order summary report, dated 09/10/25, indicated Resident #12 had an order for oxygen at 2 lpm via nasal cannula effective 04/17/25. Record review of Resident #12's undated care plan indicated in part: Resident is at risk for ineffective breathing pattern and activity intolerance r/t Dx: COPD, CHF, Atrial Fibrillation, and is an active smoker. May have oxygen at 2-4L/min via nasal cannula PRN oxygen level below 90%. Date revised: 08/01/2025. During an observation and interview on 09/10/2025 at 09:58 AM, Resident #12 was observed outside in the smoking area sitting up in his wheelchair. The resident was wheeling himself back into the facility. Resident #12 said he used oxygen when he was in his room and when he went to bed. Observation of Resident #12's door reflected there was no oxygen signage displayed. During an interview on 09/10/2025 at 11:05 AM, LVN C said Resident #12 wore his oxygen whenever he was in his room due to shortness of breath. The LVN said the resident did spend a lot of time sitting outside in the smoking area but when he was in his room, he Residents Affected - Some Page 1 of 9 675880 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some would use the oxygen. LVN C said Resident #12 wore his oxygen most of the time and also when he went to bed. During an interview on 09/11/2025 at 2:02 PM, the DON said it was expected for oxygen signs be posted outside of resident rooms that were using oxygen. The DON said she was not sure why there were no signs on the 2 rooms as they usually had them posted. She said the signs might have fallen off. The DON said the signs were supposed to be posted for safety of the residents or fires. During an interview on 09/11/2025 at 2:22 PM, the Administrator was made aware of the observation of the resident rooms without oxygen signs posted outside of the doors. The Administrator said it was expected for those resident rooms to have the signs and that they must have forgotten to post them. Record review of the facility undated policy, titled Oxygen administration, indicated in part: Supplies/equipment - appropriate oxygen signs for door and room. Place appropriate oxygen signs per facility policy. 675880 Page 2 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure food was prepared in a form designed to meet individual needs for two of five residents (Residents #5 and #11) reviewed for food meeting residents' needs, in that: Resident #5 did not receive a puree diet (a diet consistency of highly blended food) as recommended by the physician.Resident #11 did not receive a puree diet as recommended by the physician. This deficient practice could place residents at risk of choking, poor intake, and/or weight loss. The findings included:Resident #5Record review of Resident #5's admission Record, dated 9/11/25, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including dementia (a neurological disorder affecting memory) dysphagia (difficulty swallowing) and protein-calorie malnutrition (a condition where the body does not absorb protein and may use resident tissue including muscle to replace the depleted nutrient) Review of Resident #5's Quarterly MDS Assessment, dated 9/1/25, revealed a BIMS of 9 of 15 indicating she was moderately cognitively impaired and was on a mechanically altered diet. Review of Resident #5's Care Plan Report, updated 8/12/25, revealed: Problem: Resident #5 was at risk for imbalanced nutritional status related to a diagnosis of dysphagia, Vitamin B-12 deficiency, and hypomagnesemia (low magnesium level). She had diagnoses of protein calorie malnutrition and weight loss may be unavoidable related to terminal diagnosis. The identified goal was Resident #5 would be offered an appropriate substitute if less than half of her meal was consumed or if Resident #5 had a problem with the food that was being served, initiated 8/20/2020. Identified interventions included: Serve diet as ordered: Pureed texture, Resident #5 may have mechanical soft solids at her request, initiated 9/9/25. Review of Resident #5's Care Plan Report, updated 4/23/25, revealed: Problem: Aspiration (choking): Resident #5 was at risk for aspiration related to diagnosis of Dysphagia revised on 4/23/25. Goal: Resident #5 would not aspirate during review period, revised 7/22/25. Identified interventions included: Serve diet as ordered per doctor: Puree. Review of Resident #5's Order Summary Report, dated 9/11/25, revealed orders:Puree texture, regular consistency, Patient may have mechanical soft solids at her request. Start date 9/9/25. Review of the Meal Service Report, dated 9/9/25, revealed Resident #5 had an order for a Pureed diet and resident could have mechanical soft on request. Resident #11Review of Resident #11's admission Record, dated 9/11/25, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnosis including moderate protein-calorie malnutrition, Barrett's Esophagus with Dysplasia (the lining of the lower esophagus resembles the lining of a small intestine developing pre-cancerous changes),and dysphagia. Review of Resident #11's Annual MDS Assessment, dated 8/6/25, revealed:She scored a 3 of 15 on her BIMS (indicating severe cognitive impairment) and was on a mechanically altered diet. Review of Resident #11's Care Plan, revised 7/29/25, revealed:Problem: Resident #11 was at risk for imbalanced nutritional status related to mechanically altered diet and diagnosis of Dysphagia. Resident #11 had a diagnosis of Moderate Protein Calorie Malnutrition. Goal: Resident #11 would maintain adequate nutritional status as evidenced by stable weights. Interventions included: Puree diet, plate guard with meals to help reduce food spillage. Review of Resident #11's Order Summary Report, dated 9/11/25 revealed:Regular diet puree texture. Start dated 7/11/25. Review of the Meal Service Report, dated 9/9/25, revealed Resident #11 had an order for a puree texture. Observation and interview of the noon meal on 09/09/2025 at 11:46 AM, revealed Resident #5 had puree diet that showed the meat portion blended to rice sized pieces and the pasta serving looked like it was chopped up (approximately 1/4 inch pieces) and a piece of regular bread. Interview with LVN E stated the facility was offering Resident #5 both mechanical soft and a puree diet. Interview and 675880 Page 3 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some observation on 09/09/2025 at 11:57 AM, the Speech Therapist looked at Resident #5's plate. The Speech Therapist stated the puree serving should be a little smother. The Speech therapist stated the chunks of food had a chance of choking Resident #5. The Speech Therapist stated Resident #5 had an order for a mechanical soft diet on request. The Speech Therapist said it was not the safest, but it was Resident #5's choice. The Speech Therapist said she was more worried about Resident #11 choking. The Speech Therapist said she did not know who was responsible for training the dietary staff on how to do the right consistency diet. The Speech Therapist said she fed residents prior to the observation and had not identified an issue with puree diets. Observation on 9/11/25 at 12:00 PM revealed the residents on a puree diet (Resident #5 and#11) did not get the recommended bread serving (the cook failed to follow the menu and provide the recommended calories to the resident) and were served regular (soft) potatoes, including Resident #5 and Resident #11. Interview on 9/11/25 at 12:00 PM, the Dietary Manager stated a chopped diet was supposed to be cut in to 1/4 inch cuts cups, a mechanical soft diet was supposed to be blended into very small pieces, and a puree diet should be blended to look like baby food. Interview on 09/11/2025 at 1:16 PM, [NAME] F stated she worked as the cook for about a year. [NAME] F stated she really did not get any training on how to do a puree diet. [NAME] F said she was throw in and was trying to learn as she went. [NAME] F stated a puree diet had to be like baby food, but Resident #5 would not eat even though it was on her orders. [NAME] F said she was not the cook on 9/9/25. [NAME] F said no one came behind her to check if the puree was correct. [NAME] F stated a mechanical soft diet was supposed to be the size of ground beef. [NAME] F said the roast pork that was served for the lunch meal on 9/11/24 was not that sized, it was just shredded. [NAME] F said she would add the bread to the meat portion of the puree diet because the residents did not the puree bread by itself. [NAME] F admitted she forgot to add the bread to the meat puree because the meal ticket read diced potato for the puree diets and everyone was staring at her to get the lunch meal out on time. Interview on 09/11/2025 1:36 PM, LVN C stated she passed out trays as they came out the window. LVN C said when the food came out the window, she was supposed to check the meal ticket against what was on the tray. LVN C said chopped pieces on a diet meant it was usually bite sized, she described it as 2 centimeters. LVN C stated a mechanical soft diet usually meant the diet had to be able to be smooshed with a fork. LVN C said a puree diet was almost like a smoothie and all blended. LVN C stated she had not noticed a wrong texture issue. LVN C stated she did notice there was no mechanical soft diets on 9/11/25 noon meal and thought the shredded was mechanical soft. Interview on 09/11/2025 at 1:49 PM, CNA G stated she did feed residents of all textured of diet depending on what the resident could eat. CNA G described a chopped meat diet as probably pea sized, a mechanical soft diet as shredded, and a puree texture like pudding. CNA G said she did pay attention to what the residents were fed. CNA G stated she sometimes noticed issues with the diet textures. CNA G stated when there was a problem, if she knew the resident was on a different texture than what ordered she would bring it back. CNA G said if a resident had an issue with the nursing department had to run it by the speech therapist. CNA G said there was a problem with the diet textures probably once a month. CNA G said one of the residents got a chopped diet on 9/11/25 noon meal instead of mechanical soft and she had to cut the meat up more finely. Interview on 09/11/2025 at 2:01 PM, the ADON stated the facility offered specialized diets including mechanical soft, chopped diet, and puree. The ADON stated the chopped diets needed be tiny approximately pea sized. The ADON said mechanical soft just needed to be soft and the puree needed to be liquid. The ADON described the process to ensure the resident had the right diet as the nurses checked trays as they came out the window and were supposed to be checking consistency. The ADON said there was not an issue to her knowledge. The ADON 675880 Page 4 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some said Resident #5 had an order for mechanical soft for pleasure feeding. The ADON stated she did not normally supervise meals, usually the charge nurse did. Interview on 09/11/2025 at 2:17 PM, the DON stated mechanically altered diets needed to be soft so the resident could chew it, and she want the residents to have some sort of gravy to moisten dry meat. The DON said a chopped meat diet had meat that was chopped to probably dime sized and a mechanical soft had to be about 1 centimeter. The DON said a puree diet needed to be a pudding consistency. The DON said the charge nurse should be at the window checking tickets to make sure the ticket and the plate matched. The DON stated if the texture was wrong, she expected the nurse to ask for the correct texture and not give it to the resident. The DON stated rice sized pieces of food was not puree. The DON stated the nurses did not catch it and were trusting what came out kitchen was ok. The DON added the CNAs should have probably caught too, because the aides knew the residents. The DON said she thought there was confusion when a resident got mechanical soft verses a puree diet. The DON said Resident #5 was supposed to get both and the order did say on request. Surveyor requested a policy and any in-services on what the nurses were responsible for doing regarding a specialized diet. Interview 09/11/2025 at 2:51 PM, the Administrator said his understanding of a chopped meat diet was up to dime sized pieces. The Administrator stated when he usually saw a mechanical soft diet it looked like ground up hamburger meat. The Administrator said a puree diet had to have some consistency like mashed potatoes, not runny. Review of the Diet Guide for the cooks, undated revealed:Soft Chopped Diet is food cut by hand into even bite sized pieces or as prescribed by a doctor. Food must be moist throughout and cannot include any food that is hard, sticky, or crunchy. Ground Diet - is food that is moist, soft-textured and easily formed in a rounded ball in the mouth. Meats are ground or minced into pieces no larger than a quarter inch; all pieces are moist and stick together slightly (cohesively).Pureed Diet is food with very smooth consistency or foods that have been well processed in a food processor or blender to a very smooth consistency or texture. No solid pieces or parts can be noticed in the food. Pureed food has no lumps and feels very soft and smooth in the mouth. Review of the Meal Service Report, dated 9/9/25, revealed there were 5 residents on a chopped meats diet, 2 residents on a mechanical soft diet, and 2 residents on a puree diet. 675880 Page 5 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 2 residents (Resident #2) reviewed for infection control, 26 of 26 cans of foam hand sanitizer reviewed for expiration dates and 2 of 2 bottles of gel hand sanitizer reviewed for expiration dates. CNA A failed to change her gloves after they became contaminated during incontinent care while assisting Resident #2. The facility failed to prevent the use of expired alcohol-based hand sanitizer (foam and gel). These failures could place residents at risk for cross contamination and the spread of infection. Findings included: INCONTINENT CARE Record review of Resident #2's electronic admission record dated [DATE] indicated he was admitted to the facility on [DATE] with diagnosis of cerebral palsy (A group of conditions that affect movement and posture). He was [AGE] years of age. Record review of Resident #2's quarterly MDS dated [DATE] indicated in part: Cognitive Skills for Daily Decision Making = 3. Severely impaired - never/rarely made decisions. Bladder and bowel: Urinary continence = Always incontinent. Bowel continence = Always incontinent. Record review of Resident #2's undated care plan indicated in part: Skin/Pressure Ulcer: Resident is at risk for impaired skin integrity/Pressure Ulcer r/t bowel/bladder incontinence. Provide incontinence care for resident after each incontinent episode. Date revised: [DATE]. During an observation on [DATE] at 2:32 PM, CNA A and CNA B performed incontinent care for Resident #2 in his room. Both CNAs entered the resident's room, washed their hands, put on gloves, and put on PPE such as a disposable gown as the resident was on enhanced barrier precautions. CNA A took some wet wipes and wiped Resident #2's penis and scrotum area. Both CNAs turned the resident on his side and CNA A wiped the resident's rectal area with some wet wipes. While still wearing the same gloves CNA A opened the bed side dresser and took a packet of skin protectant cream and applied it to the resident's buttocks and rectal area. While still wearing the same gloves CNA A took the new brief and fastened it to Resident #2 and helped reposition him in bed. During an interview on [DATE] at 2:44 PM, CNA A said she had thought about changing her gloves once they became contaminated but had not done it as she had gotten nervous. CNA A said not changing her gloves could lead to the spread of infections. CNA A said with her not changing her gloves she possibly contaminated the clean items. CNA A said the failure occurred because she had gotten nervous as the surveyor was watching her perform the care. During an interview on [DATE] at 2:00 PM, the DON was made aware of the observation of the incontinent care performed by CNA A. The DON said it was expected for staff to remove their gloves once they became contaminated and sanitize or wash their hands before putting on a new pair of gloves. The DON said if the staff did not change their gloves once they became contaminated then they could cross contaminate, spread germs and possibly infect all the areas they had touched. During an interview on [DATE] at 2:20 PM, the Administrator was made aware of the observation of the incontinent care performed by CNA A. The Administrator said it was expected for the CNAs to change their gloves once they became contaminated to prevent cross contamination. Record review of the facility's undated policy titled Personal protective equipment - using gloves indicated in part: Purpose - to guide the use of gloves. To prevent the spread of infection, to protect wounds from contamination. When gloves are indicated use disposable gloves single-use gloves. Wash hands after removing gloves, gloves do not replace handwashing. Record review of the facility's undated policy titled Handwashing/hand hygiene a indicated in part: Basic responsibility - To thoroughly cleanse the hands with friction, soap and water. General instructions - wash hands - Before and after resident contact (i.e., meds, treatments, cares). Record Residents Affected - Many 675880 Page 6 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many review of the facility's undated policy titled Incontinence care: Steps for procedure - perform hand hygiene. Put on gloves. Wash all soiled skin areas washing from front to back, rinse and drywell, especially between skin folds. Remove gloves, perform hand hygiene, Use lightweight plastic protector or incontinence pad as necessary. Replace top linen and position resident comfortably with call light within reach. Record review of the facility's undated policy titled Infection prevention and control guideline indicated in part: Always observe standard precautions or other infection control standards as approved by the appropriate facility committee. Medical director or procedure. Always wash your hands before and after procedures. Follow your facility's hand hygiene protocol. Use alcohol-based hand rub (ABHR) for hand hygiene except when hands are visibly soiled. Follow your facility's hand hygiene protocols. Always wear gloves when working with or expecting to encounter body fluids. Record review of the facility's undated policy titled Infection prevention and control program indicated in part: An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help prevent the development of transmission of communicable diseases and infections, The IPCP is developed to address the facility -specific infection control needs and requirement identified in the facility assessment and the infection control risk assessment. The program is reviewed annually and updated as necessary. The program is based on accepted national infection prevention and control standards. HAND SANITIZER During on observation on [DATE] at 9:40 AM, two bottles of alcohol-based hand sanitizer gel on/in the MA Medication Cart expired 06/2022. One was on top of the cart and one was in the bottom drawer. Observed MA D use the bottle on top of the cart while dispensing medications to residents. During an observation on [DATE] at 11:00 AM, 25 cans of alcohol-based hand sanitizer foam in dispensers outside resident rooms (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 16, 17, 19, 20, 21, 22, 23, 24, 26, 27, 28) expired 02/2025. One can of alcohol-based hand sanitizer foam in a dispenser outside resident room [ROOM NUMBER] expired 04/2025. During an interview on [DATE] at 1:58 PM MA D said she was not aware the hand sanitizer on/in the MA cart had expired. MA D looked in the supply room behind the nurse's station. She said all the bottles in the supply room expired 06/2022. MA D said the ADON ordered items for the supply room and checked for expired items. She said the expired bottles were not effective and could cause lots of harm by spreading infections. During an interview on [DATE] at 2:32 PM, the Administrator said having hand sanitizer foam dispensers in the hallway was not required. He said they were ordered during COVID (Coronavirus disease 2019 is a contagious disease caused by the coronavirus SARS-CoV-2). The Administrator said if the can was empty, staff should tell the DON. He said there was not a designated person to check expiration dates or for reordering. In regard to the expired bottles of hand sanitizer gel, the Administrator said they were ordered during COVID and it was so long ago he was not sure where it was ordered from. He said checking for expired items on or in a med cart would be the responsibility of the staff that used the cart. He said ordering and checking expiration dates in the supply room was a nursing responsibility. During an interview on [DATE] at 2:40 PM the DON/IP - (Infection preventionist) said checking for expired items on or in the MA med cart was the responsibility of each charge nurse or the MA using the cart. She said the ADON was responsible for conducting inventory of, ordering for, and removing expired items from the supply room. The DON/IP said she checked to see if the hand sanitizer foam cans were empty or missing outside the resident rooms. She denied checking expiration dates. During an interview on [DATE] at 2:50 PM, the ADON said she orders items for the supply room and was responsible for removing expired items. She said she was aware the hand sanitizer gel had expired three years ago, she just figured alcohol never really expired. Record review of the facility's undated policy titled Infection prevention and control 675880 Page 7 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many guideline indicated in part: Always observe standard precautions or other infection control standards as approved by the appropriate facility committee. Medical director or procedure. Always wash your hands before and after procedures. Follow your facility's hand hygiene protocol. Use alcohol-based hand rub (ABHR) for hand hygiene except when hands are visibly soiled. Follow your facility's hand hygiene protocols. Always wear gloves when working with or expecting to encounter body fluids. Record review of the facility's undated policy titled Infection prevention and control program indicated in part: An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help prevent the development of transmission of communicable diseases and infections, The IPCP is developed to address the facility -specific infection control needs and requirement identified in the facility assessment and the infection control risk assessment. The program is reviewed annually and updated as necessary. The program is based on accepted national infection prevention and control standards. 675880 Page 8 of 9 675880 09/11/2025 Sterling Nursing and Rehab 309 Fifth St Sterling City, TX 76951

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to maintain all mechanical, electrical, and patient care equipment in safe operating condition for 1 of 1 kitchen reviewed for physical environment. The facility failed to ensure the dishwasher met manufacturer's recommendation of 120 degrees Fahrenheit for the wash and sanitize cycle. This failure could place residents at risk of foodborne illnesses and residents and staff. Findings included: Observation and interview on 9/10/25 at 1:38 p.m. revealed DA H said the dish machine was supposed to get up to 120 degrees. DA H ran the machine three times, and the wash temperature got to 100 degrees, the sanitizer level reached 114 degrees. After reading the posted machine instructions DA H stated he needed to report the dish machine not reaching temperature to the Dietary Manager. Observation on 9/10/25 at 1:51 p.m. revealed Dietary Manager verified the machine was not reaching the correct temperature, took a picture of the dial and sent it to the Maintenance Director. Interview on 09/11/2025 at 2:41 PM, DA H stated the dish machine was brand new and he thought they turned down the water temperature because it had not worked correctly since the weekend. DA H said he did not tell anyone because he did not realize it needed to be reported. Interview on 09/11/2025 at 2:51 PM, the Administrator said the dish machine was just changed out. The Administrator said the thought maintenance lowered the temperature to raise the sanitization level. He said he did not know, he was not there. Surveyor requested the policy on dish sanitization if there was one. There was no policy provided. Review of the Dish Machine Logbook for September 2025 (9/1/25 - 9/10/25) revealed: AM Wash Temp AM Final Rinse9/1/25 95 degrees 114 degrees9/2/25 110 degrees 122 degrees 9/3/25 110 degrees 120 degrees 9/4/25 112 degrees 123 degrees 9/5/25 114 degrees 123 degrees9/6/24 115 degrees 120 degrees9/7/25 116 degrees 120 degrees9/8/25 115 degrees 120 degrees9/9/25 116 degrees 120 degrees9/10/25 112 degrees 121 degrees Noon Wash Temp Noon Final Rinse Temp 9/1/25 100 degrees 123 degrees9/2/25 105 degrees 121 degrees9/3/25 110 degrees 120 degrees9/4/25 106 degrees 120 degrees9/5/25 110 degrees 120 degrees9/6/25 110 degrees 121 degrees9/7/25 111 degrees 120 degrees9/8/25 116 degrees 120 degrees9/9/25 115 degrees 120 degrees 9/10/25 114 degrees 119 degrees PM Wash Temp PM Final Rinse Temp9/1/25 105 degrees 125 degrees9/2/25 110 degrees 122 degrees9/3/25 110 degrees 120 degrees9/4/25 111 degrees 120 degrees9/5/25 115 degrees 122 degrees9/6/25 114 degrees 120 degrees9/7/25 115 degrees 122 degrees9/8/25 114 degrees 120 degrees9/9/25 116 degrees 120 degrees Review of the posted General Operating Instructions, undated, by the manufacturer revealed:It is recommended that 140 degrees water be used. Report to your supervisor if it is lower than 120 degrees or higher than 160 degrees. Residents Affected - Many 675880 Page 9 of 9