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Based on observation, interview, and record review, it was determined that the Critical Access Hospital (CAH) did not ensure that all foods were stored appropriately.

Findings include:

On 7/19/16 at 1:48 PM, a tour of the kitchen was completed.

1. The following items were found on a cart in the dry storage room of the kitchen:

a. A glass measuring cup filled with two cups of what appeared to be oatmeal with no dates or label as to what the food item was;

b. A plastic measuring cup filled with what appeared to be butter with no dates or label as to what the food item was.

2. The following items were found in the walk in refrigerator:

a. An open carton of liquid whole eggs with no open date;

b. An open plastic container filled with chopped garlic with no open date;

c. Two zip lock bags filled with what appeared to be shredded yellow cheese with no dates or label as to what the food item was;

d. An open container of garlic spread with an expiration date of 6/2/2016.

3. The following items were found in the walk in freezer:

a. A zip lock bag labeled " Mozzarella " with no open date.

On 7/19/16, immediately following the tour of the kitchen an interview was conducted with the facility Dietary Manager (DM). The DM stated dietary staff was supposed to label open food packages with an open date. The DM also stated if staff transferred a food item from the original packaging the new packaging was to be labeled with what the food item was and open date.

On 7/20/16 at 1:50 PM, a second tour of the kitchen was completed.

1. The following items were found in the walk in refrigerator:

a. Two zip lock bags filled with what appeared to be shredded yellow cheese with no dates or label as to what the food item was;

b. A cookie sheet filled with slices of bacon with no date;

c. A cookie sheet filled with what appeared to be rising rolls with no dates;

d. An open package of spinach with an expiration date of 7/5/16;

e. A zip lock bag labeled " Mozzarella " with no open date;

f. Three plastic wrapped stacks of yellow cheese with no open date;

g. Three plastic wrapped stacks of white cheese with no open date

On 7/20/16, immediately following the tour of the kitchen an interview was conducted with Dietary Aide (DA) 1. DA 1 stated she had been told yesterday by the DM that dietary staff needed to label food with an open date once it was opened, as well as label packages of food that they had re-packaged. DA 1 confirmed all of the items above should have been labeled with an open date. DA 1 also confirmed food which had been taken out of the original packaging should have been labeled with what the food item was.

A " R.D. (Registered Dietician) Consultation Report " dated 6/16/16 revealed the following information, " ...Be sure to date and label, date opened and use by dates on all foods in the fridge and freezer. "

Based on observation, interview, and record review it was determined Critical Access Hospital (CAH) did not ensure that 1 of 20 sample residents had the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident ' s medical symptoms. Specifically, a restraint was in place without documentation to show an evaluation for the need of the restraint was completed. Resident identifier: 8.

Findings include:

Resident 8 was admitted to the facility on 11/3/15 with diagnoses which included Alzheimer ' s dementia, anxiety, and radius fracture.

A review of resident 8 ' s medical record was completed on 7/20/16.

A physician order dated 2/16/16 revealed the following information, " Lap Belt Restraint while in Wheelchair " .

No documentation could be found in resident 8 ' s medical record to show an evaluation was completed for the need of a restraint.

On 7/20/16 at 10:50 AM, an interview was conducted with Licensed Practical Nurse (LPN) 1. LPN 1 stated resident 8 had a lap restraint in place while in her wheelchair because, " She keeps getting up and falling " . LPN 1 further stated patient 8 could not take off her lap restraint.

On 7/20/16 at 10:52 AM, an interview was conducted with the Long Term Care (LTC) Director of Nursing (DON). The LTC DON stated patient 8 had a restraint because she had several falls and was, " Not stable enough to stand on her own " . The LTC DON stated she did not have any documentation to show that a restraint evaluation was done prior to implementation of patient 8 ' s restraint.

On 7/20/16 at 11:01 AM, an observation was made of patient 8. Patient 8 was up in her wheelchair with her soft lap restraint in place. The restraint was across patient 8 ' s lap and was secured to the tipping levers behind the wheelchair.