Health inspection·August 18, 2023

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 prepare food in accordance with professional standards for food service safety in 1 of 1 kitchen on hall 200 observed for food preparation. Residents Affected - Few The facility failed to ensure Vendor J wore a hairnet when replacing the coffee maker in the 200 hall kitchen while Food Server was taking temperatures of the food at the steam table. This deficient practice could affect all residents in the 200 hall who ate from the kitchen and could contribute to the spread of food borne illnesses and diseases. The findings were: Observation and interview on 8/17/23 at 11:32 AM revealed Vendor J in the kitchen on the 200 hall. He was not wearing a hair net. Further observation revealed Food Server K was reviewing the meal tickets while in the kitchen. Interview with Vendor J stated he was replacing the broken coffee maker. He stated no one had told him he had to wear a hair net while in the kitchen. Observation and interview on 8/17/23 at 11:43 AM revealed Food Server, K, taking temperatures of the food on the steam table. The lids to the steel containers had been removed. The food items were exposed. Vendor J continued to work on removing the coffee maker while standing about 4 to 5 feet away from the steam table Food Server K stated Vendor J was not in the kitchen when she arrived and had not noticed he did not have a hair net on. She stated he should be wearing a hair net because she was taking temperatures of the food but had not said anything to him. Further observation revealed FSS walked into the kitchen and Food Server K started talking with the FSS. Interview on 8/17/23 at 11:47 AM with the FSS revealed he talked with Vendor J when he started the job and expected he would be done with the job before lunch time. The FSS stated Vendor J was not wearing a hair net. The FSS stated he anticipated telling Vendor J to put on a hair net if he was not done by lunch time. The FSS further stated he was distracted but would expect Food Server K to tell Vendor J he needed to put on a hair net before taking the temperature of the food to prevent cross contamination. He stated ultimately it was staff's responsibility to ensure the residents maintained good health by not eating food that was possibly contaminated. The FSS stated the residents could get sick as a result. Interview on 8/18/23 at 11:00 AM with the FSS revealed he would provide a facility policy for wearing a hair net while in the kitchen. The FSS did not provide a facility policy by the end of the survey. (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 4 Event ID: 676228 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 676228 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kendall House Wellness & Rehabilitation 1050 Grand Blvd. Boerne, TX 78006 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)