Storypoint Medina East

Based on medical record review, observation, interview, and policy review, the facility failed to ensure staff washed/sanitized their hands during medication administration. This affected four (Resident #100, #107, #110, and #113) out of four residents observed during medication pass. The facility census was 30.

Findings Include:

1. Review of the medical record revealed Resident #107 was admitted on 12/29/21. Diagnoses included Diabetes Mellitus with Diabetic Chronic Kidney Disease, Iron Deficiency Anemia, Malignant Neoplasm of Connective and Soft Tissue of Lower Limb, Including Hip, Basal Cell Carcinoma, Hypertension, Hyperlipidemia, Chronic Gout, Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease, Allergic Rhinitis, Osteoporosis, Heart Failure, Insomnia and Atypical Atrial Flutter.

Review of the current physician orders revealed an order for Osteo Bi-Flex triple strength (a medication for osteoarthritis) oral tablet, ferrous sulfate (iron supplement) 325 milligram (mg), acetaminophen (pain reliever) 500 mg, lisinopril (antihypertensive medication) 10 mg, furosemide (antidiuretic medication) 20 mg, Metamucil (medication for constipation) four in one packet, Eliquis (an anticoagulant) 5 mg, and Vitamin D3 (a supplement).

2. Review of the medical record revealed Resident #100 was admitted on 06/01/26. Diagnoses included right hip fracture, cognitive communication deficit, chronic kidney disease, anemia, gastro-esophageal disease, hypertension, osteoarthritis, overactive bladder and anxiety disorder.

Review of the active physician orders revealed Resident #100 had orders for Voltaren arthritis pain gel one percent, a lidocaine pain patch four percent, aspirin 81 mg, ferrous sulfate 325 mg, amlodipine (antihypertensive medication) 5 mg, magnesium oxide (supplement) 400 mg, mirabegron (a medication for overactive bladder) extended release (ER) mg, acidophilus (Lactobacillus) 1 capsule, and acetaminophen 500 mg.

3. Review of the medical record revealed Resident #113 was admitted on 03/02/26. Diagnoses included Chronic Obstructive Pulmonary Disease (COPD), Parkinson, urinary tract infection, hypothyroidism, anemia, Gastro-Esophageal Reflux Disease (GERD), depression, hypertension, Vitamin D deficiency and insomnia.

Review of the active physician orders revealed Resident #113 had orders for refresh tears ophthalmic solution instill 2 drops in both eyes, ammonium lactate external cream 12 percent, calmoseptine external ointment 0.44-20.6 percent, protonix (a medication for GERD) 40 mg, bupropion (an antidepressant medication) ER 300 mg, Anoro Ellipta inhalation aerosol powder 62.5-25 micrograms (mcg) inhale one puff inhale orally daily for COPD, levothyroxine (a synthetic hormone) 100 mcg, carbidopa-levodopa 25-100 mg for Parkinson's, cyanocobalamin (a supplement) 1000 mcg, carvedilol (antihypertensive medication) 6.25 mg, Osteo Bi-Flex tablet, fish oil 1000 mg, multivitamin, Allegra allergy 180 mg, Colace one capsule for constipation, amlodipine 2.5 mg.

4. Review of the medical record revealed Resident #110 was admitted on 05/02/26. Diagnoses included dementia, COPD, postmenopausal atrophic vaginitis, Vitamin D Deficiency, and heart failure.

Review of the active physician orders revealed Resident #110 had orders for Aspirin 81 mg, Glucosamine 500 mg, and magnesium oxide 400 mg.

Observation on 06/04/26 at 9:15 A.M., Licensed Practical Nurse (LPN) #226 prepared and administered seven medications to Resident #107. LPN #226 had not washed or sanitized her hands prior to preparing the medications. LPN #226 proceeded to the dining room and handed the medications to Resident #107. LPN #226 returned to the medication cart and began preparing medications for Resident #100. At no time had LPN #226 washed or sanitized her hands. LPN #226 prepared seven medications, closed the computer, locked the medication cart, donned a pair of gloves and entered Resident #100's apartment. LPN #226 handed medications in a plastic medication cup to Resident #100 and then adhered a Lidocaine patch to the resident's lower back removed her gloves and donned new gloves prior to application of the Voltaren gel to the resident's right knee removed gloves and LPN #226 returned to the medication cart, wrote a note and proceeded to administer medications to another resident. At no time was LPN #226 observed washing or sanitizing her hands. At 9:50 A.M., LPN #226 prepared 12 medications for Resident #113, closed the computer, locked the medication cart and entered Resident #113's apartment where Resident #113 was in her apartment at her dining table. LPN #226 handed Resident #113 the plastic medication cup containing the medications along with plastic cup of water. LPN #226 then inserted two Refresh eye drops into each of Resident #113's eyes using a tissue to dab the remaining drops/tears from the resident's cheek, provided Resident #113 with her inhaler after opening it for Resident #113 to administer. At no time was LPN #226 observed washing her hands. At 10:10 A.M., LPN #226 returned to the medication and prepared three medications for Resident #110 closed the computer, locked the medication cart, and entered Resident #110's apartment and administered medications. At no time was LPN #226 observed washing or sanitizing her hands.

Interview on 06/04/26 at 10:45 A.M., LPN #226 verified not using hand sanitizer or following hand hygiene protocols during the medication administration for Resident #107, #100, #113, and #110.

Interview on 06/04/26 at 11:00 A.M., the Executive Director and the Director of Nursing verified LPN #226 failed to follow the facilities Medication Administration Standard Precautions and provided a re-education for LPN #226 dated 06/04/26.

Review of the facility policy titled Medication administration standard precautions, undated revealed Infection control during medication administration in assisted living requires strict adherence to Standard Precautions. The most critical practices include performing hand hygiene before and after each resident interaction, wearing gloves for contact with bodily fluids or non-intact skin, and sanitizing medication carts between passes. Hand Hygiene and Glove Use to included:

Alcohol-based Rubs: Use an Alcohol-Based Hand Rub (Purell) before and after administering medications to each resident, and after touching any potentially contaminated surfaces.

Gloves: Change gloves and wash hands between residents. Never wear the same pair of gloves to administer medication to multiple individuals, as this is a primary driver of cross-contamination.

Visible Soilage: Wash hands with soap and water for at least 20 seconds if hands are visibly soiled, rather than relying solely on sanitizer.

Based on observation, interview, facility food temperature logs, facility refrigerator and freezer logs, and facility policy review, the facility failed to ensure food temperatures were being taken and recorded consistently, failed to ensure the refrigerator and freezer temperatures were being monitored and recorded, and failed to ensure employees were wearing hairnets and beard guards while in the kitchen as required. The facility also failed to ensure modified texture diets were served as ordered. This had the potential to affect one resident (#35) of three residents reviewed for modified diets and all 36 residents receiving meals from the kitchen. The facility census was 36.

Findings include:

1. Observation on 07/16/25 at 2:04 P.M. through the kitchen window revealed Executive Chef #100 walking in the kitchen without a hairnet or beard guard on. Server #105 was also observed without a hair net walking in the kitchen carrying a plate of food. Interview at the time of the observation with Server #100 confirmed he was not wearing a hairnet and stated he was told since he was a server he did not need to wear one. Interview at the time of the observation with Executive Chef #100 confirmed he was not wearing a hair net or beard guard and stated he was told by the local health department employees did not have to wear hairnets or beard guards unless they were on the serving line.

Observation on 07/16/25 at 4:20 P.M. with Chef #106 revealed he was not wearing a beard guard. Interview at the time of the observation revealed he was told if the beard was not longer than one and a half inches, they were not required to wear a beard guard.

Observation on 07/17/25 at 9:50 A.M. of Cook #114 revealed he was walking in the kitchen without a hair net or beard guard.

Interview with Cook #114 at the time of the observation confirmed he was not wearing them.

2. Review of the medical record for Resident #35 revealed an admission date of 05/20/25. Diagnoses included but were not limited to chronic obstructive pulmonary disease (COPD), gastro-esophageal reflux disease (GERD), and dysphagia. Resident #35 was noted to be independent for eating.

Review of the 05/20/25 physician orders for Resident #35 revealed an order for a regular level four pureed diet (foods that are smooth, creamy, and moist with no lumps or liquid separation).

Observation on 07/17/25 at 11:50 A.M. revealed Cook #114 preparing pureed beef pot pie. Cook #114 added an unmeasured amount of water since the puree was not smooth. Cook #114 stated he was finished with the puree preparation. Interview at the time of the observation with Cook #114 confirmed he did not use a recipe to prepare the pureed and just does it by eye.

Interview on 07/17/25 at 11:55 A.M. with Executive Chef #100 stated the pureed foods should be a smooth consistency, confirmed the pot pie puree was not completely smooth and proceeded to blend it longer. Executive Chef #100 confirmed he did not have a recipe for staff to follow for making pureed items, stated they just eye it. Executive Chef #100 instructed Cook #114 to puree the beef pot pie further and added an unmeasured amount of gravy to it. Executive Chef #100 stated following the puree process, the foods are put back in the oven or in the refrigerator till serving.

Interview on 07/17/25 at 12:05 P.M. with Cook #103 confirmed she usually follows the recipes but does not need to use the recipe as she has worked here over a year and has memorized them all. Observation of lunch time temperatures with Cook #103 were as follows: beef pot pie in a ramekin 171 degrees Fahrenheit (F), mashed potatoes 155 degrees F, gravy 190 degrees F, peas 165 degrees F, herb roasted potatoes 173 degrees F, egg salad 46 degrees F, and pasta salad 39 degrees F. Interview at the time of the observation with Cook #103 when asked what the appropriate temperature was for cold foods, revealed Cook #103 stated cold foods had to be under 65 degrees F.

Observation on 07/17/25 at 12:15 P.M. near the serving line revealed the previously prepared pureed items for Resident # 35 sitting in the same clear plastic containers on a tray with no visible heat source.

Interview on 07/17/25 at 12:45 P.M. with Server #115 confirmed the trays sitting on the counter were going to be loaded and taken to resident rooms. The surveyor intervened and stopped Server #115 and asked Executive Chef #100 to take temperatures of the pureed items on the tray for Resident #35. Pureed mushroom soup was 96 degrees F, ice cream was melted and was 47 degrees F, pureed beef pot pie was 108 degrees F, and mashed potatoes were 102 degrees F. Executive Chef #100 confirmed the items were not cooled or heated following puree process and did not feel warm enough and should not have sat that long. New items were prepared and served to Resident #35.

3. Review of the kitchen temperature logs for 07/01/25 through 07/16/25 revealed only two items were recorded for lunch on 07/01/25, three items recorded for lunch on 07/02/25, no temperatures recorded for lunch on 07/03/25, no temperatures recorded for lunch and dinner on 07/05/25, on 07/06/25 only three items recorded for lunch and two items for dinner, no temperatures recorded for lunch on 07/08/25, two items recorded for lunch on 07/09/25, no temperatures recorded for lunch on 07/10/25, no breakfast or lunch temperatures were recorded for 07/11/25, no temperatures were recorded for breakfast and lunch on 07/12/25, and no temperatures were recorded for breakfast and lunch on 07/16/25.

Review of the temperature logs for the refrigerators, coolers and freezers from 07/01/25 to 07/16/25 revealed no morning refrigerator or freezer temperatures were recorded for 07/10/25, 07/11/25, 07/12/25, and 07/16/25.

Review of the undated facility policy called Sanitation and Safety Guidelines revealed hostess and wait staff with long hair; shoulder length or longer must be pulled back with a hair restraint. All cooks, dietary aides and dishwashers must wear hats or hairnets at all times. Temperature checks will be taken on all hot foods to be served with a calibrated thermometer. The temperature will be documented on temperature log.

This violation represents non-compliance investigated under Complaint Number OH00166999 and is a recite to the annual survey completed 05/22/25.

Based on observation, interview, review of facility menus, review of facility recipes, and review of facility policy revealed the kitchen staff were not following the facility approved menus for residents receiving meals at the facility. This affected all 36 residents receiving meals from the kitchen. The facility census was 36.

Findings include:

Review of the facility menu for week one, day five, which corresponded to the date of survey, revealed a lunch menu of beef pot pie bites, buttermilk mashed potatoes and gravy, buttered peas, egg salad croissant with bacon, lettuce and tomato, vegetable pasta salad, and herb roasted potatoes.

Interview on 07/17/25 at 9:40 A.M. with Cook #103 revealed she had prepared beef pot pie in ramekins instead of the beef pot pie bites as scheduled. Cook #103 confirmed she had not used the facility approved recipe and had followed an internet recipe instead of the approved recipe for the menu item.

Interview on 07/17/25 at 10:10 A.M. with Executive Chef #100 confirmed there was not a complete printed recipe book in the kitchen with all the recipes listed on the menu. Chef #100 stated they usually print the recipes for the day but had not printed them for the employees to reference. Executive Chef #100 confirmed Cook #103 should have used the approved recipe when preparing the meal.

Observation on 07/17/25 at 11:50 A.M. revealed Cook #114 preparing pureed beef pot pie and added an unmeasured amount of water which resulted in a consistency that was not smooth. Cook #114 stated he was finished with the puree preparation. Interview at the time of the observation with Cook #114 confirmed he did not use a recipe to prepare the pureed and just does it by eye.

Interview on 07/17/25 at 11:55 A.M. with Executive Chef #100 stated the pureed foods should be a smooth consistency, confirmed the pot pie was not completely smooth and proceeded to blend it longer. Executive Chef #100 confirmed he did not have a recipe for staff to follow for making pureed items, stated they just eye it. Executive Chef #100 instructed Cook #114 to puree the beef pot pie further and added an unmeasured amount of gravy to it.

Interview on 07/17/25 at 12:05 P.M. with Cook #103 confirmed she usually follows the recipes but does not need to use the recipe as she has worked here over a year and has memorized them all.

Review of the facility policy called Standard Operating Procedure dated 10/10/23 revealed the Executive Chef or designee will print the diet spreadsheets for the week and will post them in the main kitchen. The Executive Chef or designee will print production sheets for each meal from the facility menu program.

This violation represents non-compliance investigated under Complaint Number OH00166999.

Based on observation, interview, food temperature log review and policy review the facility failed to ensure the kitchen was maintained in a clean and sanitary manner and food was handled in a manner to protect against spoilage and contamination. This had the potential to affect all 27 residents.

Finding include:

1. An observation on 05/22/25 at 9:50 A.M. revealed Executive Chef (EC) #300 exited the walk-in cooler and began wiping down the counter in the food prep area with a solution from a small red pail. He was not wearing a hair net or beard cover.

An observation on 05/22/25 at 9:51 A.M. revealed EC #300 used a test strip to check the sanitizer level in the pail; however, the strip read zero. Interview with EC #300 revealed he put the sanitizer in the pail but it probably got watered down because he had cleaned the whole kitchen with it.

2. An observation on 05/22/25 at 9:52 A.M. revealed Assistant Dining Room Manager #302 walking throughout the kitchen and the food prep area without a covering on her long ponytail.

An observation on 05/22/25 at 9:53 A.M. revealed Server #303 was plating food with a hair net on top of their head but they had a long ponytail which was uncovered.

An observation on 05/22/25 at 9:54 A.M. revealed Breakfast Cook #304 was preparing food with a hair net on the top of their head and long braids were not covered.

3. An observation on 05/22/25 on 9:55 A.M. of the reach in cooler revealed two opened quart bottles of buttermilk and two large containers of yogurt, opened. No open dates were noted on the items.

An observation on 05/22/25 at 9:58 A.M. of the dry goods storage area revealed several opened bags of dry noodles with no open dates on them. Further observation revealed a large bottle of raspberry vinaigrette salad dressing dated as opened on 05/11/25. The bottle was sitting out on a counter. The label directions for the vinaigrette read