Buckingham Pavilion

In the surveyor’s words

From the most serious findings on record at Buckingham Pavilion, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Dec 5, 2025

  Based on observation, interview, and record review, the facility failed to ensure food items were properly labeled and dated. These failures have the potential to affect all 110 residents receiving food prepared in the facility's kitchen. Findings include:On 12/02/25 at 9:18 AM, V3 (Kitchen Supervisor) stated all food items are labeled with a delivery date, a prepared or opened date and a use by date. V3 stated if the item is labeled by the manufacturer with a use by date printed on the product, then that is the date the kitchen follows and items need to be discarded or used by this date. V3 stated it is everyone's responsibility to label and date food items and it is important for all items to be labeled and dated with use by dates so the staff knows when food should be discarded. […]

• No harm, potential for more than minimal, widespreadF732Dec 8, 2023

  Based on observation, interview and record review, the facility failed to post the daily nurse staffing data. This deficient practice had the potential to affect 87 residents who reside in the facility. Findings include: During an observation on 12/5/23 at 9:34 AM, the facility's daily staffing information was not observed. On 12/5/23 at 9:34 AM V3 (Receptionist) stated, I started working today at 7AM. I did not complete it and post the facility's daily staffing information. I been off work for the last ten days. I'm not sure the last time the facilities daily staffing information was posted. On 12/5/23 at 9:40 AM, V1 (Administrator) stated, The facility daily staffing sheet is not posted. The receptionist is responsible to post the information. […]

• No harm, potential for more than minimal, widespreadF812Dec 8, 2023

  Based on observations, interviews, and record reviews, the facility failed to use utensils or wear food handling gloves while handling a resident's (R31) food. The facility also failed to ensure food items were properly stored, failed to ensure staff was performing appropriate hand hygiene in between handling dirty and clean kitchen equipment, and failed to air dry the blender and lid after staff washed it in the three-compartment sink having the potential to affect all 85 residents receiving food prepared in the facility's kitchen. Findings include: On 12/05/23 at 9:45 AM, during initial kitchen tour with V10 (Food Service Manager) observed opened bag of potato pancake mix that was not fully closed in dry storage area. […]

• No harm, potential for more than minimal, widespreadF812Feb 2, 2023

  Based on observation, interview, and record review, the facility failed to ensure expired food was discarded on or before the expiration date in the walk-in cooler. This failure has the potential to affect 86 residents in the facility who are receiving an oral diet. The findings include: On [DATE] at 9:24am V14(Food Service Director) and surveyor observed a five-pound white plastic container of 2% low fat cottage cheese with a noted expiration date of [DATE], on a shelf in the walk-in cooler. On [DATE] at 10:55 AM V14 stated the purpose of removing expired foods from the walk-in cooler and freezer is because the residents can get sick from expired foods. The facility's Expired Food Policy dated [DATE] documents, in part, 1. […]

• No harm, potential for more than minimal, widespreadF812Apr 15, 2022

  Based on observations, interviews, and record reviews, the facility failed to store food in a sanitary manner, dispose of expired food, prepare pureed food according to their recipes and dry their blender prior to next use. This has the potential to affect all 71 residents being served food from the dietary. Findings include: On [DATE] at 9:55 AM, the surveyor toured facility's freezer with V3 (Dietary Manager). The surveyor observed a half bag of cheese closed with clear tape on the top shelf on the right racks. V3 stated it was parmesan cheese that was opened on [DATE]. Open date on bag reads [DATE]; however, the best by date is [DATE]. The surveyor also observed a second bag of parmesan cheese on the second shelf. Bag is unopened with a best by date of [DATE]. […]