Health inspection·March 27, 2025

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, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen, in that: Residents Affected - Some The facility failed to ensure: A. 1 of 1 walk-in coolers were clean and free from sticky substances. B. Kitchen floor on the left side and underneath 1 of 1 ice machines were clean and from a brown sticky substance and dust. The facility's failure could place residents receiving oral nutritional intake at risk for foodborne illness and a decline in health status. The findings included: Observations on n 03/26/25 beginning at 9:30 AM, during the initial tour of the kitchen, revealed 1 of 1 walk-in cooler had a brown sticky substance on the floor and underneath the bottom shelves a brown sticky substance and dust on the left side and underneath 1 of 1 ice machine. In a follow-up interview and observation of the kitchen on 03/26/25 at 11:00 AM, there was no change in the soiled floor on the left side and underneath 1 of 1 ice machine or the brown sticky substance on the floor and underneath the bottom shelves in 1 of 1 walk-in cooler. The cleaning schedule titled Daily Cleaning Schedule for March of 2025. revealed the tasks were completed on a daily basis and initialed by the assigned staff as task completed. In an interview with the Dietary Manager on 03/27/25 at 2:15 PM, The dietary manager stated the walk-in cooler and the entire kitchen floor were swept and mopped on a daily basis by the assigned staff she further stated, she was responsible to make sure the tasks were completed on a daily basis however the dietary department has been short staffed with the dietary manager having quite often be the cook and the cleaning tasks was an oversight on her part. Stated, not sweeping and mopping the floor on a daily basis could cause foodborne illness. In an interview with the Administrator on 03/27/25 at 2:45 PM, he said it was his expectation for the kitchen to be cleaned daily. If food was spilled, it should be cleaned up at that time. Failure to do so had the potential for infection and pests. (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 3 Event ID: 676212 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 676212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE College Park Rehabilitation and Care Center 1715 Martin Dr Weatherford, TX 76086 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)