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Based on record reviews and staff interviews, it was determined the facility failed to ensure "Discharge Summaries" were completed and placed in the patient's medical record within 30 days following discharge for two of four discharge patients in the selected sample of 30 (#5 and #6).

1. Review of Patient #5's closed medical record revealed the patient was admitted to the facility on 10/27/09 and discharged on 11/02/09. The patient's "Discharge Summary" was not placed in the medical record until 12/10/09, which was not within 30 days of discharge.

2. Review of Patient #6's closed medical record revealed the patient was admitted to the facility on 10/24/09 and discharged on 11/24/09. The patient's "Discharge Summary" was dictated on 11/20/09, which was four days before the patient was discharged. The "Discharge Summary" was transcribed by the medical records department on 11/23/09, which was one day before the patient was discharged. The patient's "Discharge Summary" was in the patient's medical record before the patient was discharged from the facility. Patient #6's was to be discharged to a rehabilitation facility on 11/21/09. However, the patient remained in the facility four additional days with no addendum disclosing the course of treatment and/or updated discharge summary.

An interview was conducted with the Medical Records Director on 2/03/10 at 1:40 PM. She revealed she was not aware "Discharge Summaries" had to be in the medical record within 30 days following the patient's discharge. She stated she thought the doctors had 30 days to dictate the "Discharge Summary." She further revealed Patient #6's record should have been flagged and an addendum should have been included after the patient was discharged.

Based on staff interviews and direct observations, it was determined the facility failed to ensure food was prepared and stored in accordance with the recognized standards of sanitation in the Kentucky Retail Food Code (KRS 217).

A tour was conducted of the Dietary Department with the Director of Food Services on 02/03/10 at 2:15 PM. The following problems were observed:

1. One box of opened Cream of Rice was not dated when opened with the expiration date of 03/21/05.

2. Two 1 liter bottles of opened lime juice were not dated when opened. Both bottles were expired. The first bottle expired on 08/04/08 and the second expired on 09/14/08. Both bottles were sticky and had a red colored substance on the outside.

3. One bottle of decorating "Sprinkles" expired on 09/26/08.

4. Three bars of "Bakers semi-sweet chocolate" were expired on the following dates: 03/04/09, 03/10/09, and 05/25/09.

5. One bottle of opened hardened chocolate syrup was dated as opened on 05/21/09.

6. One box of opened "Equal" sweetener was not properly sealed or dated when opened. The sweetener was hard and the box was dusty.

7. One large opened plastic bag of shortening was greasy on the outside and was not dated when opened.

8. There were items too numerous to list of opened food which were not dated as to when they were opened and/or if the items were dated. The dates did no include the year opened.

9. There were numerous stored food items which were not sealed and open to air. The food items were as follows:

1 box of "Cream of Wheat"

1 box of muffin mix

2 bags of pretzel salt

1 box of grits

1 box of "Rainbow Sprinkles"

1 box of buttermilk biscuit mix

10. The kitchen had a build-up of food residue on the floors and appliances.

11. The cook top hoods had a build-up of grease, dust, and were rusted in areas.

12. The "Tray Line" refrigerator temperature was 47 degrees Fahrenheit (F) on 02/03/10 at 2:30 PM and 52 degrees F on 02/04/10 at 9:30 AM. The refrigerator contained food items on both observation dates. The acceptable refrigerator temperature should not exceed 41 degrees F.

13. The "Cake" freezer temperature was 17 degrees F on 02/03/10 at 2:20 PM and 5 degrees F on 02/04/10 at 9:25 AM. The acceptable freezer temperature should not exceed 0 degrees F.

14. Two male employees were observed in the dietary department on 02/03/10 at 2:20 PM with beards. One at the dish washing area and the other in the food preparation area. Neither of the bearded employees were wearing a beard cover. On 2/4/10 at 9:35 AM a bearded male employee was observed working the tray line without a beard cover.

Interviews were conducted with the Director of Food Services on 02/03/10 at 2:45 PM and on 02/04/10 at 9:35 AM. She revealed she was "surprised" by the tour findings and stated she needed to retrain staff and inspect the dietary areas more often herself. She stated all food items should be properly sealed after they were opened and dated to include the month, day, and year. She revealed the refrigerator and freezer temperatures were monitored every shift and the temperatures observed during the tour were not acceptable temperatures. She further revealed the hood was suppose to be cleaned monthly by maintenance but had not been cleaned since 11/09/09. The Director of Food Services stated they had no policy regarding the covering of facial hair.