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 observation, interview and record review the facility failed to store, prepare, and distribute food in
accordance with professional standards for food safety for 1 of 1 kitchen reviewed for food safety.
Residents Affected - Many
The facility failed to ensure that all food items being served to residents, were within their expiration or best
by dates.
This failure could place residents at risk of food-borne illness and a diminished quality of life.
Findings included:
On 6/11/24 beginning at 9:31AM an initial observation of the kitchen was conducted.
An observation of the dry panty revealed:
(3) 5-ounce cans LaChoy Chow Mein Noodles with expiration date 3/23/24.
(1) 5-ounce can LaChoy Chow Mein Noodles with expiration date 12/2/23.
(4) 3-ounce cans LaChoy Asian-style Crunchy Noodles with expiration date 12/18/23.
(1) 19-ounce can Progresso Chicken and Sausage Gumbo Soup with expiration date 3/23/24.
(2) partial 15-ounce bottles of Lime Juice with exp. date of 11/16/23. Refrigerate after opening stamped on
both bottles by manufacturer. Both were in dry pantry.
(1) 2-pound bag Honey Nut Cereal Rounds-no date received.
2 loaves white bread with no date received and a best by date of 6/5/24.
2 loaves white bread with no date received and a best by date of 6/10/24.
An observation of the freezer revealed:
(1) partial 3-pound bag of frozen triple berry blend fruit-open to air.
(1) partial 2-pound zip seal bag of tortilla quarters-no label/no date.
(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:
675973
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
675973
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/13/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
McLean Care Center
605 W Seventh St
McLean, TX 79057
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
An observation of the refrigerator revealed the following:
Level of Harm - Minimal harm
or potential for actual harm
(5) 30 count fresh eggs-with no date received or use by date.
(1) partial 12-ounce bottle of brown mustard with exp. date 6/7/24.
Residents Affected - Many
An interview with the Dietary Manager on 6/12/24 at 1:13PM revealed the negative outcome of serving
residents expired food would be sickness, interaction with medications and possible food aversions, if
residents were aware of which food(s) made them sick.
Record review of the facility's Sanitation and Food Handling Policy and Procedure dated 2012 revealed:
o
All unused food must be securely covered. All items are to be labeled and dated as to their content.
o
Stock is to be rotated on a first in, first out basis.
Record review of the facility's Food Safety Policy and Procedures dated 2012 revealed:
o
Food is to be tightly wrapped or sealed and covered in clean containers. Opened food shall be labeled,
dated, and stored properly.
o
Do not keep potentially hazardous foods in refrigerator past the labeled expiration date.
Record review of the facility's undated Recommended Maximum Storage Period of Unopened Food
revealed:
o
Eggs in shell: Follow expiration date.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675973
If continuation sheet
Page 2 of 2
