Inspection·October 10, 2024

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview and record review, the facility failed to employ sufficient staff with the appropriate competencies, and skills set to carry out the functions of the food and nutrition service for eight (8) of seventeen (17) dietary staff reviewed for qualified dietary staff, in that: The facility failed to ensure the DS#1, DS#2, DS#3, DS#4, DS#5, DS#6, DS#7 and DS#8 had their Texas Food Handler Certificate. This failure could place residents who ate food from the facility's kitchen at risk of not having their nutritional needs met and place them at risk for food born illnesses. Findings included: During an interview on 10/10/2024 at 11:25 am with DS#1 , he stated there were no Food Handler's Certificates posted in the kitchen. He stated the former DM was working on getting them posted but she left a month ago. DS #1 stated he did not know where the certificates were kept. During an interview on 10/10/2024 at 12:19 am with DS#1 and the AD present, DS#1 handed the AD a stack of Food Handler's Certificates and stated he had found them in the DM's office. The AD stated she would look into the certifications for the rest of the dietary staff. Review of six (6) certificates with completion dates ranging from 8/11/2023 to 9/18/2023. Certificates were titled Texas Food Handler Certification and indicated, renewal due 2 years from completion date. It was noted that certificates for DS#1 - DS#8 were not found in this stack of certificates. During an interview on 10/10/2024 at 1:35 pm, the DRS stated she had been in the Dining Room Supervisor position for about a year and that kitchen staff needed a food handler's certificate to prepare and cook food. She stated she thought the certificates were all redone in August of 2024 when the former DM was here at this NF. She stated there was one kitchen that served both the independent living side of the building and the nursing facility side of the building. She stated she did not have responsibility for the kitchen, just the dining room on the nursing facility side and had the appropriate certification to be able to handle food. During an interview on 10/10/2024 at 3:00 the AD stated she had checked and not all the dietary staff had current certificates . She stated the CDM was acting as the dietary manger since the former DM left. She stated he was in charge of the kitchen on the independent living side but was covering the nursing facility side as well. She stated the independent living side did not require a CDM so he (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: 676364 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 676364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morada Temple 4312 S 31st St Temple, TX 76502 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)