Original Inspection report

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Honor the resident’s right to a dignified existence, self-determination, communication,
and to exercise his or her rights.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure a
resident’s right to personal privacy was protected during personal care by not ensuring
window blinds were keep in good repair. Window blinds were broken and unable to close,
exposing the resident during care. This affected two sampled residents (Resident #116 and
Resident #4). The census was 139.
1. Review of Resident #116’s care plan, updated 2/28/18, showed the following:
-Problem: Requires total assistance with toileting, pericare, lower extremity dressing and
dressing related to [MEDICAL CONDITION];
-Approach: Provide good pericare after each incontinent episode.
Review of the resident’s Minimum Data Set (MDS), a federally mandated assessment
instrument completed by facility staff, dated 5/17/18, showed the following:
-[DIAGNOSES REDACTED].
-No short/long term memory problems;
-Required extensive staff assistance for bed mobility, dressing, toilet use, and personal
hygiene;
-Required total staff assistance for transfers and bathing.
During an interview on 6/7/18 at 9:33 A.M., during the tour of the facility, showed the
resident lay in bed. He/she said the blinds to his/her window has been broken for some
time. He/she does not like to be exposed to the outside while staff provides care.
Observation at this time showed several broken and missing vertical window blinds. The
view from the resident’s window showed an alley and an apartment building across the alley
from the resident’s window.
Observation on 6/8/18 at 9:36 A.M. and 6/11/18 at 7:40 A.M., showed missing and broken
vertical window blinds.
2. Review of Resident #4’s handwritten POS, dated 5/14/18, showed the following:
-[DIAGNOSES REDACTED].
-Hospice.
Review of the resident’s significant change in status MDS, dated [DATE], showed the
following:
-Clear speech – clear distinct intelligible words;
-Understood/understands;
-Limited assistance of one person required for dressing and personal hygiene.
Observation on 6/7/18 at 11:01 A.M., showed the resident lay in bed. His/her bed was
against the wall and window. A sheer curtain hung in the window. A long side walk that
connected the facility parking lot to the front lobby was located on the outside of the
wall. Staff and visitors used the sidewalk.
Observation on 6/8/18 at 5:44 A.M., showed the resident lay in bed. Certified Nursing
Assistant (CNA) B turned on the room light as it was still relatively dark outside. The
CNA removed the resident’s gown and incontinence brief and began to provide incontinence
care. The surveyor went outside during the incontinence care observation and looked
through the window. The sheer curtain provided no privacy as the surveyor was able to
clearly see the CNA fastening a new incontinence brief on the resident. At 6:18 A.M., the
Director of Nurses looked through the window from the sidewalk outside. She could clearly
see the resident laying in bed. She would not want receive personal care in front of the
sheer curtain. She had no idea how long the sheer curtain had been up, but said it was a
privacy issue.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0550

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 1)
Observation on 6/8/18 at 9:06 A.M., showed staff had replaced the sheer curtain with a
curtain that provided privacy.
During an interview on 6/11/18 at 10:14 A.M., the resident was told that the sheer
curtains that were in his/her window provided no privacy as anyone walking on the sidewalk
could see him/her as staff provided care. The resident said, I don’t like that.
3. During an interview on 6/13/18 at 12:25 P.M., the Maintenence Director said he was
aware of broken blinds in resident’s rooms. New blinds have been ordered three weeks ago.
The facility has considered putting up curtains until the blinds are delivered but they
don’t have any curtains.
F 0568

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Properly hold, secure, and manage each resident’s personal money which is deposited
with the nursing home.

Based on interview and record review, the facility failed to reconcile the resident trust
fund account for four of the 11 months reviewed. The census was 139
Review of the resident trust accounts statements showed no reconciliation for (MONTH)
(YEAR) through (MONTH) (YEAR).
During an interview on 6/13/18 at 10:10 A.M., the Director of Finance said the
reconciliation was not completed due to a research concern. There was money taken out
twice and sent to the Social Security Office. The company was waiting for a refund before
during the reconciliations.

F 0570

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Assure the security of all personal funds of residents deposited with the facility.

Based on interview and record review, facility staff failed to purchase a surety bond in
an amount sufficient to assure security of all personal funds the facility holds for 112
residents. The census was 139.
Review of the resident trust fund account for (MONTH) (YEAR) through (MONTH) (YEAR),
showed an average monthly balance of $101,241.37 which requires a surety bond of
$153,000.00. The current ledger amount is $133,023.79.
Review of the Department of Health and Senior Services (DHSS) database, showed the
facility has an approved non-cancelable Escrow Agreement Account in the amount of
$90,000.00.
Review of the resident trust fund showed no reconciliation for (MONTH) (YEAR) through
(MONTH) (YEAR) to determine an correct average monthly balance.
During an interview on 6/13/18 at 9:20 A.M., the administrator said she was not aware
there were high balances on the resident trust bank statements. She was not aware the bond
needed to be increased.

F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

Ensure services provided by the nursing facility meet professional standards of
quality.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to follow their
policy regarding blood sugars and failed to monitor a resident’s low air loss mattress
which was deflated for two days. This affected three of 34 residents sampled. (Resident
#3, #89 and #4). The census was 139.
Review of the facility’s policy on Blood Glucose Monitoring, dated 4/6/17, showed the
following:
-Purpose: To define accurate procedures to be followed when checking a blood sugar. To
identify what measures will be taken in the event that a blood sugar falls out of the
defined therapeutic range;
-#7: In the event the blood sugar is greater than 250, sliding scale insulin will be given
per the physician’s orders [REDACTED].
-#8. If the resident’s blood sugar over 400, the physician will be notified and orders
followed.
1. Review of Resident #3’s quarterly Minimum Data Set (MDS), a federally mandated
assessment instrument completed by facility staff, dated 3/8/18, showed the following:
-[DIAGNOSES REDACTED].
-No short/long term memory problems;
-Required staff supervision for dressing, personal hygiene and bathing;
-Received insulin injections seven of the last seven days.
Review of the resident’s Medication Administration Record [REDACTED] -Blood glucose checks with meals;
-Notify physician of blood sugars (normal blood sugar range 70 to 99) greater than 450;
-4/7/18 at 7:30 A.M. a blood sugar of 566. No documentation whether staff recheck blood
sugar;
-4/8/18 at 7:30 A.M. a blood sugar of 572. No documentation whether staff rechecked the
resident’s blood sugar.
Review of the resident’s nurse’s notes, showed the following:
-4/7/18 at 11:40 A.M., showed no documentation whether rechecked the resident’s blood
sugar after administering sliding scale insulin;
-No documentation in the nurse’s notes for 4/8/18.
Review of the resident’s physician’s orders [REDACTED].
-Order dated 12/1/17 for blood glucose checks four times per day;
-Blood sugars greater than 450 call the physician.
2. Review of Resident #89’s admission MDS, dated [DATE], showed the following:
-[DIAGNOSES REDACTED].
-Short/Long term memory loss;
-Independent with bed mobility;
-Required limited staff assistance for transfers, dressing, toilet use and personal
hygiene;
-Extensive staff assistance for bathing;
-Received insulin during the last seven days.
Review of the resident’s nurse’s note, dated 3/9/18 at 12:28 P.M., showed the following:
-Blood sugar registered Hi on the blood glucose machine;
-Physician notified;
-New order for sliding scale insulin of [MEDICATION NAME] three times per day and at
bedtime;
-No documentation whether staff rechecked the resident’s blood sugar.
Review of the resident’s written POS, showed the following:
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0658

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Few

(continued… from page 3)
-Order dated 3/9/18;
-Blood glucose checks three times per day;
-[MEDICATION NAME] sliding scale insulin three times per day and at bedtime;
-Call physician for blood sugars greater than 450.
Review of the resident’s care plan, updated 4/17/18, showed the following:
-Problem: At risk for hyper/hypoglycemic episodes related to a [DIAGNOSES
REDACTED].>-Approach: Monitor blood glucose checks as ordered. Monitor for signs and
symptoms of hyper (hi blood sugar) hypo (low blood sugar) episodes.
During an interview on 6/12/18 at 11:30 A.M., the Assistant Director of Nursing (ADON)
said she would expect the staff to recheck the blood sugar.
3. Review of Resident #4’s handwritten POS, dated 5/14/18, showed the following:
-[DIAGNOSES REDACTED].
-Hospice.
Review of the resident’s significant change in status MDS, dated [DATE], showed the
following:
-Clear speech – distinct intelligible words;
-Understood/understands;
-Independent for bed mobility;
-Limited assistance of one person required for transfers;
-No pressure ulcers.
Observation on 6/7/18 at 11:01 A.M., showed the resident lay on a low air loss (LAL)
mattress (The mattress is inflated with air and there is an on/off switch on a control
panel at the foot of the bed. If the control panel is turned off, the mattress deflates.
It’s purpose is to prevent or assist in healing pressure ulcers by alleviating pressure.).
The switch on the control panel had been turned off.
Observation on 6/8/18 at 5:44 A.M., showed the resident lay on a LAL mattress. The switch
on the control panel remained in the off position. During an interview, the resident said
the mattress felt lumpy. At 5:58 A.M., Certified Nursing Assistant B said he/she had been
taking care of the resident all night and had been in the resident’s room a couple of
times. He/she did not notice the LAL control panel had been turned off. He/she turned the
switch on the control panel to the on position and the mattress began to inflate.
During an interview on 6/8/18 at 6:18 A.M., the DON said the LAL mattress, in this
resident’s case, is for pressure ulcer prevention. Staff have been trained to monitor the
control panels to ensure they are on. She did not know why the LAL mattress had been
turned off.
F 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Try different approaches before using a bed rail. If a bed rail is needed, the
facility must (1) assess a resident for safety risk; (2) review these risks and benefits
with the resident/representative; (3) get informed consent; and (4) Correctly install and
maintain the bed rail.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interview and record review, the facility failed to ensure side/bed
rails were thoroughly assessed for risks of entrapment and/or the resident had an order to
use the side/bed rail. The facility identified 13 residents that were present during the
survey as having orders for side/bed rails. Of Of those 13, seven were sampled and
problems were found with six. (Residents #45, #113, #119, #4, #22 and #108). The census

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 4)
was 139.
1. Review of Resident #45’s quarterly Minimum Data Set (MDS), a federally mandated
assessment instrument completed by facility staff, dated 4/5/18, showed the following:
-Sometimes understood;
-Usually understands;
-Extensive assistance of one person required for bed mobility;
-Total dependence of two (+) persons required for transfers;
-Bed rails not used.
Review of the resident’s physician’s orders [REDACTED].
Review of the resident’s Side Rail Assessment, dated 5/21/18, showed the following:
-Recommendation: One left and one right upper 1/4 partial side rail at all times when
resident is in bed;
-The assessment did not address the risk of entrapment.
Observation on 6/13/18 at 8:15 A.M., showed the resident lay in bed with quarter sized
right and left metal bed rails up.
2. Review of Resident #113’s Side Rail Assessment, dated 4/18/18, showed the following:
-Recommendation: One left and right upper 1/4 partial side rail at all times when resident
is in bed;
-The assessment did not address the risk of entrapment.
Review of the resident’s admission MDS, dated [DATE], showed the following:
-Sometimes understands;
-Independent for bed mobility;
-Limited assistance of one person required for transfers;
-Diagnsoes of diabetes mellitus (DM) and [MEDICAL CONDITION]/[MEDICAL CONDITION] (weakness
or paralysis of one side of the body);
-Bed rails not used.
Review of the resident’s POS, dated 5/15/18 through 6/14/18, showed an order for[REDACTED].
Observation on 6/11/18 at 10:10 A.M. and 6/13/18 at 6:18 A.M., showed the resident lay in
bed with quarter sized right and left metal bed rails up.
3. Review of Resident #119’s Side Rail Assessment, dated 4/20/18, showed the following:
-Recommendation: One left and right upper side rail and one left and right upper and lower
full side rail at all times when resident is in bed;
-The assessment did not address the risk of entrapment.
Review of the resident’s admission MDS, dated [DATE], showed the following:
-Understood/understands;
-Limited assistance of one person required for bed mobility;
-Total dependence of two (+) persons required for transfers;
-[DIAGNOSES REDACTED].
-Bed rails used daily.
Review of the resident’s POS, dated 5/15/18 through 6/14/18, showed an order for[REDACTED].
Observation on 6/8/18 at 5:39 A.M. showed the resident lay in bed with one right and left
quarter sized bed rails up.
4. Review of Resident #4’s Side Rail Assessment, dated 5/15/18, showed the following:
-Recommendation: One left and right upper 1/2 side rail at all times when resident is in
bed;
-The assessment did not address the risk of entrapment.
Review of the resident’s significant change in status MDS, dated [DATE], showed the
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0700

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 5)
following:
-Understood/understands;
-Independent for bed mobility;
-Limited assistance of one person required for transfers;
-Bed rails not used.
Review of the resident’s POS, dated 6/7/18 through 6/14/18, showed no order for the use of[REDACTED] Observation on 6/7/18 at 11:01 A.M., 6/11/18 at 10:14 A.M. and 1:09 P.M., showed the
resident lay in bed with two quarter sized metal bed rails up.
Observation on 6/8/18 at 5:44 A.M., showed the resident lay in bed with one metal quarter
sized bed rail up on the exit side of the bed.
5. Review of Resident #22’s POS, dated 5/15/18 through 6/14/18, showed no order for the
use of [REDACTED] Review of the resident’s Side Rail Assessment, dated 5/21/18, showed the following:
-Recommendation: One left and right 1/4 partial rail at all times when the resident is in
bed.
Review of the resident’s quarterly MDS, dated [DATE], showed the following:
-Understood/understands;
-Limited assistance of one person required for bed mobility;
-Total dependence of two (+) persons required for transfers;
-[DIAGNOSES REDACTED].>-Bed rails used daily.
Observation on 6/7/18 at 10:50 A.M., 6/11/18 at 1:14 P.M. and 6/13/18 at 6:14 A.M., showed
the resident lay in bed with two metal quarter sized bed rails up.
6. Review of Resident #108’s admission MDS, dated [DATE], showed the following:
-Understood/understands;
-Extensive assistance of one person required for bed mobility;
-Total dependence of two (+) persons required for transfers;
-[DIAGNOSES REDACTED].
-Bed rails used daily.
Review of Resident #108’s POS, dated 5/15/18 through 6/14/18, showed no order for the use
of [REDACTED] Review of the resident’s Side Rail Assessment, dated 5/21/18, showed the following:
-Recommendation: One left and right upper 1/2 rail at all times when the resident is in
bed.
Observation on 6/8/18 at 5:20 A.M. and 6/13/18 at 6:09 A.M., showed the resident lay in
bed with two metal 1/2 bed rails up.
7. During an interview on 6/13/18 at 9:23 A.M., the administrator said she was not aware
residents that use side rails needed to be assessed for risk of entrapment. The Director
of Nurses said she was aware, but their side rail assessments had not been updated yet to
address entrapment. Physician orders [REDACTED].
F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

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 fail to ensure food and
thawed health shakes were dated in the walk in refrigerator and failed to ensure

DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
PRINTED: 7/11/2019
FORM APPROVED
OMB NO. 0938-0391
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENNTIFICATION NUMBER:

265500

(X2) MULTIPLE CONSTRUCTION
A. BUILDING ___________
B. WING ___________
(X3) DATE SURVEY COMPLETED

06/13/2018

NAME OF PROVIDER OF SUPPLIER

BERNARD CARE CENTER

STREET ADDRESS, CITY, STATE, ZIP

4335 WEST PINE BLVD
SAINT LOUIS, MO 63108

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)
F 0812

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

(continued… from page 6)
unpasteurized eggs were cook thoroughly. This deficient practice had the potential to
affect residents who ate at the facility.
Observation of the kitchen on 6/8/18 at 8:29 A.M., showed the following:
-One small package of slice yellow cheese slices and a large package of white cheese
slices in the walk in refrigerator did not have a date;
-Approximately 30 various flavors of health shakes did not have a date in the walk in
refrigerator.
Observation on 6/13/18, of the kitchen showed the following:
-7:16 A.M., Cook A cracked approximately 30 eggs and place the on the grill, after
approximately three minutes, Cook A flipped the eggs. After approximately another two
minutes the eggs were removed and placed in a pan.;
-7:20 A.M., observation of one of the eggs showed it to have a runny yellow yolk.
Observation of the egg cardboard container showed the eggs were not pasteurized. During an
interview at that time, Cook A said he/she did not know if the eggs were pasteurized.
During an interview on 6/13/18 at 1:07 P.M., the Dietary Manager (DM) said items in the
walk in refrigerator should be wrapped, labeled and dated. The thawed health shakes should
have a date of 14 days out from the time they are pulled from the freezer. The DM said the
eggs were not pasteurized and should be cooked thoroughly. The DM said undercooked
unpasteurized could cause food bourne illness.
F 0921

Level of harm – Minimal harm or potential for actual harm

Residents Affected – Some

Make sure that the nursing home area is safe, easy to use, clean and comfortable for
residents, staff and the public.

Based on observation, interviews, and record review, the facility failed to ensure the
walls, vents, and floor of the main kitchen were maintained in good repair. The census was
139.
Observation of the main kitchen on 6/7/18 at 8:29 A.M., 6/8/18 at 5:27 A.M. and 6/13/18 at
7:13 A.M., showed, the wall behind the stove and fryer were covered with brown grease. The
wall near the convection oven and the wall near the three vat sink had dirt and grime. The
vent above the preparation table was covered with dirt.
During an interview on 6/13/18 at 1:07 P.M., the Dietary Manager said the Porter should be
cleaning those areas. He did not know why it was not being completed.

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