Based on observation, interview, and record review, during a site visit conducted on 12/04/23, it was confirmed the facility failed to provide three daily nutritious, palatable meals with snacks available seven days a week. Findings include but are not limited to:

On 12/04/23, CS observed the following,

·Not all menu options listed on the menu were made or offered.

·No snacks available to residents.

·A sampled plate provided at 12:50 pm consisted of the following,

oMeatloaf-dry, greasy, and lukewarm.

oHaddock- flavorless with nothing served to accompany it, such as tartar sauce or lemon.

oRisotto- hot and flavored well.

oPotatoes- steamed with no flavor.

oMushrooms and broccoli- cooked evenly.

During an interview on 12/04/23 Staff 3 (Dining Service Coordinator) stated the following,

·"I did not have a menu chat meeting last month because I was tired of being criticized."  

·"Providing snacks has been an issue we have not been addressing."  

During lunch service on 12/04/23 CS interviewed residents who stated the following,

·"Meatloaf was dry, greasy, and had no flavor."

·"A lot of items listed on the menu are not available."

·"We are often served cold food."  

A review of the weekly menu of 12/03/23 through 12/09/23 stated the following menu options were available on 12/04/23:

·Zesty stewed tomatoes.

·Kale salad and mixed greens with pear and pecans.

·Pear crisp, sugar free vanilla pudding, honey cake, and sugar free blueberry cake.

·Baked haddock and meatloaf.

·Risotto and buttered potatoes.

·Steamed beets, mushrooms, and bell peppers.

·The "mid evening snack": fig newton bars.

A review of the resident comment and suggestion cards revealed several comments of the meals having been cold. The food temperature logs indicated the kitchen staff had not been consistent with taking the temperature for every meal. The menu chat meeting notes from 9/13/23 and 10/11/23 indicated the following complaints,

·"Snacks and coffee should be out daily."

·"Room trays missing desserts."  

·"Meat is always tough or overcooked."

It was confirmed the facility failed to provide three daily nutritious, palatable meals with snacks available seven days a week.

On 12/04/23, the findings were reviewed with and acknowledged by Staff 1.

Verbal plan of correction: The dining service coordinator will continue to have monthly meetings with residents and has comment card for daily feedback. S/he will continue to share resident feedback with staff to improve the food quality. The ED and dining service coordinator will ensure snacks are ordered and put out to be available to residents and will monitor the snack bar moving forward.

Based on observation, interview, and record review, conducted during a site visit on 12/04/23, it was confirmed the facility failed to provide a daily program of social and recreational activities. Findings include, but are not limited to:

The facility's "calendar changes and added activities" flyer indicated a Christmas tree decorating activity was to take place on Sunday, 12/03/23, at 1:00 pm.  

The facility's "Daily events" calendar indicated the activity was to take place on Monday 12/04/23 at 2:00 pm.

On 12/04/23, CS observed the Christmas tree decorating activity scheduled at 2:00 pm. Staff 4 (Activities Director) did not show up until 2:15 pm and provided no direction to the residents who had shown up. At 2:45 pm Resident 6 asked the receptionist what was going on. The front deck personal stated Staff 4 was looking for the lights for the tree. Staff 4 was not prepared for the scheduled activity and did not start the Christmas tree decorating until 3:00 pm.

During separate interviews on 12/04/23, Residents 1, 2, 4, and 6 stated the activities on the calendar often do not happen. Resident 2 stated, "The facility was without a bus driver for months so none of the outings that were scheduled happened." Resident 4 stated "None of the activities are planned around residents who are in wheelchairs."

During an interview on 12/04/23, Staff 2 (Dining Service Coordinator) stated, "There is an activities calendar, however, it is not followed and often the activities are canceled. On Sundays when management is not here all the activities are canceled."

On 12/04/23, the findings were reviewed with and acknowledged by Staff 1 (Executive Director).

It was determined the facility failed to provide a daily program of social and recreational activities.

Verbal plan of correction: Staff 1 will meet with the activities director to ensure s/he is prepared for the planned activities. The activities director will meet with residents to determine the types if activities they would prefer to see on the calendar.

Based on interview and record review, during a site visit conducted on 12/04/23, it was determined the facility failed to ensure a resident monitoring and reporting system is implemented 24-hours a day for 1 of 1 sampled resident (#1). Findings include, but not limited to:

During an interview on 12/04/23, Staff 1 (ED) indicated the facility was to monitor Resident 3's weight monthly. On 11/20/23 the facility changed Resident 3's weigh ins from monthly to weekly.

A review of Resident 3's weights and vitals summary indicated the facility had not monitored Resident 3's weight between 06/04/23 through 10/30/23.

A review of Resident 3's July, August, and September 2023 MARs indicated the following,

·On 07/07/23, Monthly weight unable to get, will get tomorrow.

·On 08/07/23, stated "This MT ran out of time, resident will be put on the need to get vitals list."  

·On 09/07/23 resident had refused monthly weigh in.  

It was determined the facility failed to ensure a resident monitoring and reporting system is implemented 24-hours a day.

On 12/04/23, the findings were reviewed with and acknowledged by Staff 1.

Verbal plan of correction: The facility had switched from monthly to weekly weight ins.

Based on observation and interview, conducted during a site visit on 12/04/23, it was confirmed the facility failed to ensure the staff person who administered the medication visually observed the resident take the medication for 2 of 2 sampled residents (#1 and 2). Findings include, but are not limited to:

On 12/04/23, Resident 2 provided CS with individual packets of medication s/he had found throughout the facility. The medication consisted of Zolpidem for insomnia, Losartan for hypertension, Amlodipine for hypertension, and Tylenol.

During an interview on 12/04/23, Resident 2 indicated s/he had found multiple medications on the floors in the hallways and common areas. S/he had brought the concern to management on separate occasions.

A review of an email correspondence from Staff 7 (LPN) listed Resident 1 and Resident 2's self- administered medication which indicated neither resident was prescribed any of the listed above medication.

It was confirmed the facility failed to ensure the staff person who administered the medication visually observed the resident take the medication.

On 12/04/23, the findings were reviewed with and acknowledged by Staff 1.

Verbal plan of correction: None was provided.