Health inspection·October 21, 2024

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to post daily information that included the facility name, current date, total number and actual hours worked by registered nurses, licensed practical or licensed vocational nurses, certified nurse aides directly responsible for resident care per shift and the resident census for 2 days (10/15/2024 to 10/16/2024) of 2 days reviewed. Residents Affected - Many The facility did not post the required current nurse staffing information from 10/15/2024 to 10/16/2024. This failure could place all residents, their families, and facility visitors at risk of not having access to information regarding staffing data and the facility census. Findings included: During an observation on 10/17/2024 at 09:03 a.m., a document labeled [facility name] Daily Staffing of Nursing Personnel dated 10/14/2024, was posted in a vertical sign holder on the nurses' station. The census on the document was noted as 45. During an observation and interview on 10/17/2024 at 09:05 a.m., the MDS Nurse stated she and the ADON were responsible for updating the daily census and nurse staffing document daily and tried to have it posted before 9 o'clock. The MDS Nurse stated she and the ADON covered the responsibility when the other was not available. The MDS Nurse stated she could not find the scheduling book on the morning of 10/17/2024 which was why it was posted after 09:00 a.m. The MDS Nurse stated she was not sure why the posted document said the 14th. The MDS Nurse was observed removing the posted document, labeled [facility name] Daily Staffing of Nursing Personnel and dated 10/14/2024, and replaced it with a document, labeled [facility name] Daily Staffing of Nursing Personnel and dated 10/17/2024, during the conversation. The census on the document dated 10/17/2024 was noted as 47. During an interview on 10/17/2024 at 08:22 p.m., the RCN stated the facility did not have a policy on staffing but did have a checklist that was used for required postings in the facility. During an interview on 10/18/2024 at 11:45 a.m., the RCN stated every facility she worked with was different and the nursing facility company did not have company wide requirement for who was responsible for posting the daily census and nurse staffing posting. The RCN stated she did not feel there would be an impact on the posting being late or missed because there was a sign-in sheet that the facility staff used, and it would let the staff know where their assignment was and identify the other staff scheduled to work. Page 1 of 3 676242 676242 10/21/2024 Ganado Nursing and Rehabilitation Center 107 E Rogers Ganado, TX 77962

F 0732 Level of Harm - Potential for minimal harm Residents Affected - Many During an interview on 10/18/2024 at 01:37 p.m., the ADON confirmed she was normally responsible for posting the daily census and nurse staffing document and stated she tried to get the MDS Nurse to cover for her when she was not available. The ADON stated she was not sure who her actual back-up was for this task. The ADON stated that the facility goal was to post the daily census and nurse staffing document by 09:00 a.m., after the morning meeting. The ADON stated because she came in late on Tuesday, 10/15/2024, and was doing medication administration on Wednesday and Thursday morning, 10/16/2024 and 10/17/2024; the posting was missed or late. Record review of facility document, Mandatory Posting, undated, revealed Daily Staffing by shift of Licensed and Unlicensed Nursing Staff. 676242 Page 2 of 3 676242 10/21/2024 Ganado Nursing and Rehabilitation Center 107 E Rogers Ganado, TX 77962

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 for 1 of 1 kitchen reviewed for the safe storage, preparation, distribution, and serving of food, in that: The facility failed to discard an expired food item in the facility reach-in refrigerator. This failure could affect residents who received their meals from the facility's only kitchen, by placing them at risk for receiving expired food items. Findings included: During an observation on 10/18/2024 at 08:25 a.m. in the facility's reach-in refrigerator, there was a plastic container labeled pineapple, dated 10/07/2024, and Use by: 10/14/2024. During an observation and interview on 10/18/2024 at 08:25 a.m., [NAME] A stated the kitchen staff were told to date leftover items for use by 7 days after having been opened and stored. [NAME] A stated all kitchen staff were responsible for pulling food items out that were past their use-by date. When questioned, [NAME] A was observed taking the container labeled pineapple with Use by: 10/14/2024 from the investigator and stated she would take care of the item. [NAME] A stated there was not a concern for the pineapple having been left in the refrigerator past its use-by date because it had not been served. During an interview on 10/18/2024 at 11:45 a.m., the RCN stated she did not see an impact for an item having been in the refrigerator past it's use-by date if the item was not used. Attempted interview of the RDN on 10/18/2024 at 03:24 p.m. was unsuccessful. The DM and the ADMIN were unavailable for interview on 10/18/2024. Record review of the facility policy titled Food Storage and Supplies, dated 2012, reflected .9 . Perishable items that are refrigerated are dated once opened and used within 7 days . Review of the Food and Drug Administration Food Code, dated 2022, reflected, .3-501.17 Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking. (A) . refrigerated, ready-to-eat, time/temperature control for safety food prepared and held in a food establishment for more than 24 hours shall be clearly marked to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded when held at a temperature of 5°C (41°F) or less for a maximum of 7 days. The day of preparation shall be counted as Day 1 .Open and hold cold (B) . refrigerated, ready-to-eat, time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in § (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacture's use-by date if the manufacture determined the use-by date based on food safety. 676242 Page 3 of 3