The Gardens And Guardian

Penalty

1 days payment denial

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to maintain a clean and sanitary kitchen, resulting in conditions that could lead to cross-contamination and foodborne illness for the 40 residents who consumed meals prepared in the kitchen. During the initial kitchen tour, surveyors observed significant accumulations of food debris, grease, and residue on equipment such as the ice machine, ovens, meat slicer, and food preparation surfaces. The dish and cookware storage areas were also found to be unsanitary, with dried substances and food debris present on shelves and racks intended for clean items. Floors throughout the kitchen, walk-in cooler, and dry storage room were dirty, with sticky residues, food debris, and spoiled produce observed. Additionally, the kitchen wall near the walk-in cooler was splattered with dried food debris, and there was no documentation of temperature monitoring for a refrigerator containing food items. Food storage practices were also deficient, with numerous refrigerated items found to be unlabeled, undated, or expired, including salad dressings, juices, sandwiches, and various containers of food. Some food items, such as cucumbers and hot dog buns, were visibly spoiled or moldy. Staff interviews confirmed a lack of knowledge regarding the safety and storage duration of these items, and staff were observed preparing to serve unlabeled and undated food to residents. The facility's cleaning schedule was not being followed, as no cleaning was observed between meal services, and staff could not provide evidence of when scheduled cleaning tasks had last been completed. Interviews with the dietary manager, dietary aide, administrator, and infection preventionist confirmed awareness of the unsanitary conditions and acknowledged failures in oversight and adherence to food safety policies. The dietary manager admitted to not monitoring the kitchen's cleanliness, and the infection preventionist recognized that the conditions could put residents at risk for foodborne illness. The registered dietician and other staff also confirmed that the kitchen was not being maintained in a clean and sanitary manner, and that food storage practices were not in compliance with professional standards.

Removal Plan

• Interviewed dietary manager and dietary staff to assess knowledge of regulations and sanitation processes.
• Reviewed dietary policy and procedures regarding food storage, sanitation, cleaning schedules, and temperature checks.
• In-serviced dietary manager and staff on facility's policy and procedures with pre/posttest to ensure understanding.
• Ongoing training for all remaining dietary staff prior to their work shift.
• Administrator to set up education in-service with the registered dietician.
• Registered dietician to round and audit kitchen area.
• Administrator to round in the kitchen until compliance is met.
• Prepared and provided supper for residents from the facility's sister facility after kitchen closure.
• Arranged for all meals to be prepared and provided by the sister facility until the kitchen reopens.
• All meals to be served from the secondary steam table located outside the main kitchen area.
• Initiated immediate sanitation process in the kitchen with assistance from corporate staff.
• Discarded molded bread and vegetables.
• Discarded all unlabeled and expired refrigerated foods.
• Checked and ensured all other items were labeled and dated.
• Provided verbal in-service to dietary staff on kitchen hood inspection and cleaning, maintaining a sanitary tray line, food safety requirements, sanitation inspection, cleaning schedules, and temperature checks.
• Utilized pre/posttest for continued education to ensure understanding with dietary staff.
• Implemented Dietary Sanitation Orientation checklist for all current and new dietary staff.
• Registered dietician to make sanitation rounds at the facility until compliance is met.
• Administrator to round in the kitchen.
• Administrator to monitor: sanitary storage and safety, refrigerator and freezer cleanliness, work area cleanliness, major equipment and utensils cleanliness, storage area cleanliness, food coverage, labeling and dating, separation of food and non-food supplies, trash container cleanliness and coverage, food storage off the floor, proper scoop storage, posted cleaning schedule, clean utility area for mop storage, clean dishwashing area, dishes without stains and residue, proper wash/rinse temperatures, clean pots and pans, staff personal hygiene, use of hair restraints, proper storage of personal items, and proper hand washing techniques.
• Disciplinary actions to be taken if further non-compliance is noted.
• Plan to be implemented into the facility QAPI process and reviewed with IDT at meetings.
• Implemented a detailed cleaning schedule for specific kitchen areas and equipment by day of the week.
• Implemented a master cleaning schedule with frequency for extractor hood, filters, grease traps, oven, flat top, grill, cookers/burners, oil fryer, equipment legs/supports, gas pipes/taps, warmer, cleaning equipment, refuse areas, floors, doors, and walls.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to accurately document a resident's code status in the medical record, which is a violation of its policy regarding advance directives. The policy mandates that decisions about advance directives and treatment should be periodically reviewed and documented in the resident's medical record. However, for one resident, the care plan inaccurately indicated a full code status, despite the presence of a physician's order and a LaPOST form indicating a DNR status with comfort measures only. This discrepancy was confirmed during a record review and interview with the Assistant Director of Nursing. The resident in question was admitted with multiple diagnoses, including Metabolic Encephalopathy, Type 2 Diabetes Mellitus, Heart Failure, and Chronic Kidney Disease. Despite the physician's order and LaPOST form both indicating a DNR status, the care plan incorrectly documented the resident as a full code. This inconsistency in documentation could potentially affect the care provided to the resident, as the care plan did not reflect the resident's actual wishes regarding resuscitation and medical interventions.

Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to complete a discharge Minimum Data Set (MDS) assessment for a resident who was sampled for resident assessment. This deficiency was identified during a review of the resident's electronic health record, which showed that the resident was admitted to the facility with a displaced trimalleolar fracture of the right lower leg and was later discharged back to her assisted living center home. Despite the discharge occurring on 03/15/2024, no discharge MDS assessment was completed for that date. An interview and record review with the Director of Nursing confirmed that the resident was admitted and discharged on the specified dates, and that a discharge assessment should have been completed but was not. This oversight had the potential to affect the facility's census of 41 residents.