Inspection·July 25, 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 observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen in that: Residents Affected - Some -Three dented cans were stored with other cans used for resident meals in the dry storage room. -Two storage bins of dry bulk items had scoops stored inside the bins. These deficient practices could place 99 residents who received meals from the kitchen at risk for food borne illness. Findings included: Observation on 7/23/24 at 8:47 am of the dry storage room revealed the following: -One 50 oz can of vegetable soup with a large dent at the top of the seam -One 50 oz can of chicken noodle soup with a small dent at the top of the seam -One 50 oz can of chicken noodle soup with a large dent at the top of the seam -One storage bin labeled flour with a plastic scoop and Styrofoam cup inside the bin. -One storage bin labeled biscuit mix with a plastic scoop inside the bin. Interview on 7/24/24 at 2:38 pm the Food Service Manager said [NAME] A had dropped a package of cans on Monday 7/22/24 when they received the groceries. [NAME] A was responsible for checking the cans for dents and staff were supposed to go behind her to double check for dented cans. She said the risk to the residents was food poisoning. The Food Service Manager said the kitchen staff knew not to store scoops and measuring cups inside the bins for dry bulk foods. She said one of the cooks forgot to take the scoop out of the flour and biscuit mix. The Food Service Manager said the measuring cups and scoops should be stored separately in a Ziploc bag to avoid cross-contamination. She said the night kitchen staff should have been checking the containers. She said the risk to residents from cross-contamination could also lead to food born illness and residents could get sick from cross-contamination. Interview on 7/24/24 at 2:53 pm, [NAME] A said she had worked at the facility for 8 years. [NAME] A (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: 676201 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 676201 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tuscany Village 2750 Miller Ranch Rd Pearland, TX 77584 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)