Eastern Star Masonic Home

In the surveyor’s words

From the most serious findings on record at Eastern Star Masonic Home, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF803Sep 14, 2023

  Based on observation, menu review, and staff interview, the facility failed to follow the menu for 69 of 69 residents reviewed. The facility also failed to assure the menu was followed for 1 of 69 residents (Resident #29) requiring a mechanically altered diet. The facility reported a census of 69 residents. Findings include: The Minimum Data Set (MDS) for Resident #29, dated 6/20/23 identified the presence of short and long-term memory impairment. A review of Resident #29's orders revealed that she had a general diet order for mechanical soft texture. […]

• No harm, potential for more than minimal, patternF812Apr 24, 2025

  Based on observations, kitchen record review, and staff interview, the facility failed to ensure food safety was maintained by not obtaining food temperatures and not maintaining temperature logs. The facility also failed to ensure food was properly stored and labeled and all areas of the main kitchen were clean. The facility reported a census of 73. Findings include: 1. During a kitchen observation on 4/21/25 at 10:00 AM, food thermometers were identified in the food prep area. Review of the main kitchen food temperature logs from the past 4 months revealed the following: a. For the month of January 2024, a total of 9 out of 96 meals for the month had food temperatures documented b. […]

• No harm, potential for more than minimal, patternF803Apr 9, 2024

  Based on observation, clinical record review, facility menus and staff interview the facility failed to follow the menu for 18 of 18 residents in the unit. The facility reported a census of 72 residents. Finding include: Review of the January 2024 evening menu revealed on 1/25/24, residents to receive: *Open face hot turkey sandwich *Mashed potatoes *Turkey gravy *Brown sugar peaches *Cottage cheese *Milk Interview on 4/9/24 at 11:00 a.m., the facility assistant Dietary Manager confirmed and verified that the menu was not followed on 1/25/24 evening meal. […]

• No harm, potential for more than minimal, patternF812Apr 9, 2024

  Based on observation, and staff interviews, the facility failed to ensure open items were dated, and labeled in the coolers and walk-in freezer in the kitchen. The facility reported a census of 72 residents. Findings include: Observation on 4/8/24 at 11:35 a.m., in the main kitchen revealed the following: *Cooler #2, half opened clear bag of mild cheddar cheese, not dated *Cooler #1, clear pitcher with 3/4 full of brown liquid, not dated or labeled clear container of round brown items, not dated or labeled. […]

• No harm, potential for more than minimal, isolatedF605May 21, 2026

  Based on clinical record review, staff interviews, and review of the facility's policy the facility failed to document 3 non-pharmacological approaches to minimize the need for as needed (PRN) psychotropic medications for 1 out of 5 residents sampled (Resident #30). The facility also failed to limit use of PRN psychotropic medications to 14 days for 2 out of 5 residents sampled (Resident #7 and #9). The facility reported a census of 73 residents. Findings include: 1. The Minimum Data Set (MDS) dated [DATE] for Resident #30 identified a Brief Interview for Mental Status (BIMS) score of 3 which indicated severe cognitive impairment. The MDS documented the resident exhibited physical and verbal behavioral symptoms directed toward others 4 out of 6 days of the 7-day look back period. […]