Every finding on record at Lehigh Valley Hospital Tsu

Based on facility policy review, clinical record review, observation, and resident and staff interviews, it was determined that the facility failed to assess a resident's capability to self-administer medications for one of 12 sampled residents. (Resident 48)Findings include:Review of the facility policy entitled, Medications Self-Administration - Pharmacy, last reviewed April 8, 2026, revealed that self-administration of medications could only occur under direct observation by a licensed staff member for residents who are determined to be fully alert, oriented, and able to follow instructions. The policy also stated that nursing staff were to instruct the patient in the proper use of the medication and document this education in the interdisciplinary teaching record. Clinical record review revealed that Resident 48 had diagnoses that included recent left femur fracture from a fall that was surgically repaired, chronic pain, and difficulty with walking. A physician's order dated May 15, 2026, directed staff to place a pain patch (lidocaine 4 percent (%)) on Resident 48's left lower extremity daily at 9:00 a.m., and to leave it in place for 12 hours. Review of Resident 48's medication administration record for May 2026, revealed that the medication was refused on the morning of May 19, 2026, because Resident 48 wanted to shower. Observations on May 19, 2026, from 12:56 p.m., to 2:56 p.m., revealed that there was an open, unused lidocaine patch on Resident 48's bedside table dated May 19, 2026, and initialed by registered nurse (RN) 1 who was assigned to care for the resident for day shift (7:00 a.m. to 3:00 p.m.) There was no documentation to indicate that the facility had assessed Resident 48 for the ability to self-administer the lidocaine patch, and the medication was not secured.In an interview on May 20, 2026, at 2:23 p.m., the Director of Nursing confirmed that Resident 48 was not assessed to self-administer the medication, and the medication should not have been left on the resident's bedside table.28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on a review of facility policy, observation, interviews with residents and staff, and review of facility documentation, it was determined that the facility failed to ensure water temperatures in the central shower room and resident bathroom sinks were maintained at a safe temperature for the Transitional Skilled Unit (TSU). This failure placed residents on the TSU at risk for serious injury from thermal burns and resulted in an Immediate Jeopardy situation. Findings include: Review of facility policy titled, Water Intrusion Response Algorithm, dated April 7, 2025, revealed that the facility was to maintain hot water temperatures allowable by state regulations or codes for nursing care facilities between 95 degrees Fahrenheit (F) and 110 degrees F to help minimize the risk of scalding. Observation of the TSU, on April 15, 2025, between 12:30 p.m. and 12:50 p.m., with the Employee 1 (Facilities Management) and Employee E2 (Engineering Maintenance), revealed the following: In room [ROOM NUMBER], the hot water from the resident hand sink in the bathroom was 122.5 degrees F. In room [ROOM NUMBER], the hot water from the resident hand sink in the bathroom was 126.1 degrees F. In room [ROOM NUMBER], the hot water from the resident hand sink in the bathroom was 125.0 degrees F. In room [ROOM NUMBER], the hot water from the resident hand sink in the bathroom was 130.0 degrees F. In room [ROOM NUMBER], the hot water from resident hand sink in the bathroom was 134.2 degrees F. In room [ROOM NUMBER], the hot water from the resident hand sink was 125.1 degrees F. Observation of the thermostatic mixing valves (valves that blend hot water with cold water to ensure constant, safe shower and bath outlet temperatures to prevent scalding, using a built-in thermostat to control the temperature of the mixed water) on April 15, 2025, at 12:52 p.m., with Employee E1 and Employee E2, revealed the temperature on two of three thermostatic mixing valves was identified between 120 and 130 degrees F. At the time of the observation, Employee E1, stated that the thermostatic mixing valves should not exceed 110 degrees F, and that the mixing valves regulated the hot water to all residents' rooms, the shower room, and all care areas on the TSU. He further stated that the temperatures were to be recorded weekly. A review of March and April 2025 water temperature logs revealed hot water temperatures were not recorded. In an interview on April 15, 2025, at 12:15 p.m., Resident 5, stated that the hot water from his hand sink inside his bathroom was too hot. During interviews on April 15, 2025, between 1:35 p.m. and 2:00 p.m., Residents 33, 35, 83, and 84 stated that the hot water was too hot and they were able to independently use the hand sink in their rooms. In an interview on April 15, 2025, at 2:05 p.m., a nurse aide (Employee 3) stated that the hot water temperatures in the shower rooms had been too hot for up to two months. In an interview on April 15, 2025, at 2:10 p.m., a nurse aide (Employee 4) stated that the hot water temperatures in the shower rooms had been too hot for a few weeks, and that there were no thermometers available to check the water temperature prior to providing showers. During an interview on April 15, 2025, at 2:24 p.m., the occupational therapist (Employee 12) stated that no thermometers were available in resident shower rooms. Based on the above findings, notification of Immediate Jeopardy to the safety of the residents on the TSU was provided to the Nursing Home Administrator on April 15, 2025, at 3:35 p.m., for failure to ensure that hot water temperatures were maintained to ensure the safety of residents in the facility. The Nursing Home Administrator was provided with the Immediate Jeopardy Template (document which included information necessary to establish each of the key components of immediate jeopardy) and an immediate action plan was requested. On April 15, 2025, at 6:15 p.m., the facility provided the following corrective action plan. - At 1:00 p.m., when the TSU was alerted regarding the high temperatures on the TSU, the facility also identified that a bypass valve was left in the open position which prevented the hot and cold water from mixing. The valve was immediately closed and high temperatures were reset. A lockout tag was installed on the bypass valve to prevent the bypass valve from being placed in the open position. - At 2:30 p.m., the water temperatures were rechecked after the bypass valve was closed and temperatures were noted to be 106 degrees F. - The facility checked the sink water temperature in all resident rooms and shower rooms on the TSU after a lockout tag was placed on the bypass valve. All temperatures were noted to be below the 110-degree F threshold. There were no additional high temperatures identified. - A policy for the TSU was to be developed to address water temperature safety and monitoring by April 16, 2025. - Employees that were working on the day and evening shift were educated on the water temperature policy, including acceptable hot water temperature ranges, appropriate methods to check hot water temperatures, and measures to take if temperatures were outside acceptable parameters. All staff were to be educated by the next shift worked. Methods included: - Water temperatures will be checked using a thermometer that is accessible and available on the unit prior to assisting a resident in the shower. - Facilities Management or designee will conduct random audits of a minimum of ten sinks daily for four weeks. Water temperatures will be recorded. - Facilities Management or designee will complete a daily log with visual inspection of the lockout tags being in place. - The logs (temperature and visual inspection) will be audited by the Nursing Home Administrator or designee weekly. The team will review the findings with the Quality Assurance Performance Improvement Committee for recommendations. - Facilities Management will educate maintenance staff on temperature monitoring required for random water temperature audits and on documentation of temperatures by the completion of their next shift. - Staff will be re-educated on temperature monitoring required for showers by the Nursing Home Administrator or designee by completion of the next working shift and documented on a sign-in sheet. - If the water feels or measures out of range, engineering will be contacted for immediate correction. - The Medical Director was updated on the Correction and Removal-Abatement Plan, as well as occurrences of which this plan pertains. Monitoring will be initiated and completed by the Administrator and/or designee as indicated above. Maintenance and supervisory staff were observed checking water temperatures and completing audit logs. Water temperature logs were reviewed and revealed appropriate water temperatures. The water temperature policy was reviewed on April 16, 2025, and safe processes for monitoring water temperatures had been developed. Interviews were conducted on April 15, 2025, between 4:00 p.m. and 7:00 p.m., with nursing staff. Nursing staff were able to verbalize the facility's water policy, including that water temperatures should not exceed 110 degrees F, what to do prior to assisting a resident in the shower, what to do if water temperatures were found to be too hot, and how to check water temperatures. The hot water on the TSU at residents' hand sinks and in the Central Shower Room were tested and verified that they did not exceed 110 degrees F. Following verification of the implementation of the immediate action plan, review of water temperature logs, and review of staff education documentation, the Immediate Jeopardy was lifted on April 15, 2025, at 7:37 p.m. 28 Pa. code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.18(b)(1)(3) Management. 28 Pa. Code 205.63(c) Plumbing and piping systems required for existing and new construction. 28 Pa. Code 211.12(d)(5) Nursing services. .

Based on policy review, observations, and staff interview, it was determined that the facility failed to properly store food items and failed to maintain sanitary conditions in the dietary department. Findings include: Review of the facility's policy entitled, Food and Supply Storage, last reviewed January 2020, revealed that all food, non-food items and supplies used in food preperation was to be stored in such a manner as to prevent contamination to maintain the safety and wholesomeness of the food for human consumption. The procedure was to cover, label and date unused portions and open packages. Review of the facility policy entitled, Area and Equipment Cleaning, dated January 2020, revealed that there were procedures available regarding daily and weekly (as needed) cleaning for all areas and equipment in the department. The procedure was to assign daily cleaning responsibilities and file and retain records for three months (equipment cleaning logs). Observation during an environmental tour of the food service department on July 7, 2021, at 10:00 a.m., revealed dirt and debris on the floor throughout the kitchen area. Observation of walk in cooler number one revealed that there was dirt and debris on the floor. Observation of walk in cooler number two, revealed that there was three containers of fruit covered with plastic that were not labeled or dated. Observation of walk in freezer number one revealed an accumulation of ice build up on the floor, on the pipes, on the fans that were located on the upper wall of the freezer and there was ice accumulated on several boxes of food. In addition, there were two bags of corn, two bags of carrots, one bag of peas and one bag of green beans that had been opened but were not re-sealed, labeled or dated. There was also a bag of sweet plantain that had been opened and was not re-sealed, labeled or dated. Observation of walk in freezer number two revealed a large bag of pepperoni that had been opened but was not re-sealed, labeled or dated. There was a bag of five to six large links of frozen kielbasi that was not labled or dated. There was a slab of beef that had been cut and resealed but was not labeled or dated. There was a tray of scallops that were not dated. There were three mini-containers of puree food product that was sealed but not labeled or dated. There was an open sleeve of veggie burgers that was not re-sealed, labeled or dated. There was a large bag of pierogies, a bag of french fries, and a bag of frozen potato slices that had been opened but was not re-sealed, labeled or dated. Observation of a food preperation area in the dietary department revealed four large bags of dry pasta that was not re-sealed, labeled or dated. There was an opened bag of dry rice that was re-sealed, but was not labeled or dated. Observation revealed dirt and debris over the steamer. There was an accummulation of dirt, grease and debris on the oven doors and on the inside of both convection ovens. The broiler was soiled, covered with grease and stained on the inside and outside. Observation of the small catering storage area located in the dietary department revealed that there was dirt and debris covering the drain/grate in this area. In an interview on July 8, 2021, at 11:53 a.m., the Director of Dietary stated that there was no documented evidence of cleaning logs as per the facility policy. 28 Pa. Code 201.14(a) Responsibility of licensee

Based on observation, it was determined that the facility failed to properly contain refuse in a sanitary manner. Findings include: Observation on July 7, 2021, at 10:30 a.m., of the compactor/dumpster area which is located outside of the building, revealed that there was dirt and debris on the ground that included milk cartons, water bottles, cardboard and an accumulation of dirt and debris near and on the side of the compactor area. 28 Pa. Code 207.2(a) Administrator's responsibility.

Based on clinical record review and staff interview, it was determined that the facility failed to provide non-pharmacological interventions before administering a [MEDICAL CONDITION] medication for one of 12 sampled residents. (Resident #15) Findings include: Clinical record review revealed that Resident #15 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On November 21, 2017, the physician ordered that staff administer an anti-anxiety medication ([MEDICATION NAME]) twice a day if needed for anxiety. According to the medication administration records, staff gave the resident [MEDICATION NAME] once on November 21, 23, and 30, 2017, and twice on November 26 and 27, 2017. There was no documentation in the clinical record of non-pharmacological or behavioral interventions attempted prior to the administration of [MEDICATION NAME]. On November 26 and 30, 2017, there was no documentation that the resident showed symptoms of anxiety prior to staff administering the [MEDICATION NAME]. In an interview conducted on November 30, 2017, at 2:26 p.m., the Director of Nursing confirmed that there was no documentation for non-pharmacological interventions prior to administration of [MEDICATION NAME]. 28 Pa Code 211.12(d)(5) Nursing services.

Based on observation, it was determined that the facility failed to ensure that full visual privacy curtains were provided for thirteen multi-bedded rooms on two of two nursing units. (Nursing Unit S and T) Findings include: During the initial environmental tour on November 8, 2016 through November 9, 2016, the privacy curtains in Rooms T26, 27, 28, 29, 30, 31, 32, 34, 35, 36, 37, 38, and S36 did not fully enclose each resident's bed to provide full visual privacy. 28 Pa. Code 201.14(a) Responsibility of licensee. 28 Pa. Code 201.29(j) Resident rights. Previously cited 12/03/15

Based on observation, it was determined that the facility failed to post the actual hours worked of licensed and unlicensed nursing staff directly responsible for nursing care on seven out of seven days reviewed. Findings include: Review of the POS [REDACTED]. 28 Pa. Code 201.18(a)(3) Management.

Based on observation and staff interview, it was determined that the facility failed to maintain safe water temperatures on two of two nursing units. (Trexler, Schaeffer) Findings include: Review of the facility's preventive maintenance program revealed that water temperatures in resident areas were not to exceed 110 degrees Fahrenheit. Water temperatures exceeded 110 degrees Fahrenheit (114 degrees Fahrenheit to 123.8 degrees Fahrenheit) in various handwashing sinks on the Trexler and Schaeffer units (Rooms 8, 9, 28, 43, Schaeffer shower room) on December 1, 2015, from 1:13 p.m. through 1:55 p.m. In an interview on December 1, 2015, at 1:55 p.m., a maintenance employee (Employee 1) stated that the above water temperatures exceeded the facility's hot water temperature standard. 28 Pa. Code 2015.63(c) Plumbing and piping systems required for existing and new construction. 28 Pa. Code 201.18(b)(1)(3) Management.

Based on clinical record review, it was determined that the facility failed to ensure that clinical record documentation was complete for six of 10 sampled residents. (Residents R5, R8, R11,R23, R26, R32) Findings include: Clinical record review revealed that Residents R5, R11, R23 and R32 received treatments in November and December 2015 to promote the healing of pressure sores. Staff failed to consistently document that the treatments were being provided. Clinical record review revealed that Residents R8 and R26 received physician ordered as needed pain medications in November and December 2015. Staff failed to document pain scores (assessment) prior to and after administration of the pain medications as required by the facility's Clinical Documentation Policy of September 2015. 28 Pa. Code 211.5 (f) Clinical records. 28 Pa. Code 211.12(d)(5) Nursing services.

Based on clinical record review, resident and staff interview, it was determined that the facility failed to offer bathing in accordance with the resident's choice for two of nine sampled residents. (Residents R23, R26) Findings include: During an interview on December 2, 2015, at 2:45 p.m., the Director of Nursing stated that showers were offered to residents daily unless medically contraindicated. On December 3, 2015, at 8:30 a.m., NA1 also stated that showers were offered daily and that if the resident refused that was documented. Clinical record review revealed that Resident R23 was admitted to the facility on [DATE]. In an interview on December 3, 2015, at 8:40 a.m., the resident stated that he would like a shower and that staff had only provided getting washed at the bathroom sink. Review of the bathing documentation revealed that of the 12 days of his stay he had not received a shower. There was a lack of evidence to support that staff offered this resident a shower or that a shower was medically contraindicated. Clinical record review revealed that Resident R26 was admitted to the facility on [DATE]. In an interview on December 1, 2015, at 12:30 p.m., the resident stated that she wanted a shower before she was discharged . She stated that at no time during her stay was she offered a shower. Review of the Minimum Data Set assessment dated [DATE], indicated that choice of bathing was very important to her. Review of the bathing documentation indicated that of the 19 days of her stay she had not received a shower. There was a lack of evidence to support that staff offered this resident a shower or that a shower was medically contraindicated. 28 Pa. Code 201.29(j) Resident rights.

Based on observation of the medication pass on both nursing units, it was determined that the facility had a 10.7 percent error rate from 28 observed medication opportunities. (Schaeffer Unit) Findings include: Observation of the medication pass on December 1, 2015, at 10:00 a.m., revealed that RN1 made the following errors when administering medication to Resident R11. RN1 crushed [MEDICATION NAME], Aspirin EC and [MEDICATION NAME] CD. All three of these medications were to be adminstered whole. 28 Pa. Code 211.12(d)(5) Nursing service.

Based on observation during the medication pass, it was determined that the facility failed to ensure that a medication was stored securely for one of three residents. (Resident R11) Findings include: During observation of the medication pass on December 1, 2015, at 10:00 a.m., RN1 prepared and took all medications into Resident R11's room. The nurse took a medication that was separately packaged, Carafate and placed it on the resident's bedside table. She adminstered all other medications and exited the room leaving the Carafate on the resident's bedside table and within the resident's reach. The packaged medication remained at resident's bedside at 10:35 a.m.,and 11:50 a.m. At 12:10 p.m., in the presence of the Director of Nursing, the medication remained at bedside. 28 Pa. Code 211.12(d)(1)(5) Nursing service.

Based on the environmental tour of the Food Service Department, observation and staff interview, it was determined that the facility failed to maintain sanitary conditions and acceptable practices for the storage of food. Findings include: Observation during the environmental tour of the Food Service Department on December 9, 2013, at 8:49 a.m., revealed a soiled interior and exterior of refrigerator number one. The exterior of flour and sugar bins were dirty. The holder for the scoop for the ingredient bin was dirty. The interior and cutting board of the mobile preparation cooler was dirty. The juice machine was dirty. There was a scoop including the handle stored within a container in contact with the rice. The floor behind the ice machine was soiled. The gaskets of both doors on refrigerator number seven and the walk-in freezer were torn, loose and soiled. There were several opened and undated foods, such as shredded cheese, undated bags of cheese sticks in the freezer, opened undated bag of salad , three containers of soup and a pan of lasagna. One container of soup was labeled to be used by December 7, another was labeled to be used by December 8, 2013. An opened bag of brown sugar and a container of wheat and cornmeal that had a label with an incomplete use by date. In an interview on December 9, 2013, at 8:49 a.m., the Operations Manager of the Food Service Department confirmed that once a food product was opened, a label was to be applied that identified an opened and use by date. Observation of the manufacturer's specifications on the dismachine revealed that the wash cycle was to be 160 degrees Fahrenheit. Review of the temperature logs revealed there was no temperature documented for the wash/final rinse cycle at breakfast on December 9, 2013. Interview with the Dishroom Worker 1 revealed that the dishmachine had been used prior to this observation however, he did not take the temperature. Observations of the dishmachine starting at 9:40 a.m., revealed that the wash cycle ranged from 136 degrees to 140 degrees Fahrenheit not meeting the manufacturer's specifications. The Operations Manager confirmed that dishmachine temperatures were to be taken prior to use each meal. Observation of the "S" wing medication room refrigerator on December 9, 2013 at 9:30 a.m., revealed seven outdated nutritional supplements. At 11:45 a.m., on the same day, a jar of applesauce, and a container of grape juice were in the refrigerator and not dated. Observation of the "T" wing dining room refrigerator on December 9, 2013, at 9:15 a.m. revealed nine containers of prune juice were that were not dated. Also in the same refrigerator were four cups of lemon flavored thickened water that were labeled "use by December 7, 2013." 28 Pa. Code 201.14(a) Responsibility of licensee.

Based on observation, facility policy review and staff interview, it was determined that the facility failed to ensure that staff implemented measures to prevent the spread of infection for two of five residents on "contact precautions." (Residents R1, R19) Findings include: Review of the "Isolation Precautions to Prevent Transmission of Infectious Agents" policy (dated July 3, 2013) revealed that staff was to use "contact precautions" when caring for residents with drug resistant infections such as MRSA (methicillin resistant staphylococcus aureus). "Contact precautions" included the use of gowns by staff "whenever anticipating that clothing will have direct contact with the (resident) or potentially contaminated environmental surfaces or equipment in close proximity to the (resident)." The policy also indicated that "when possible (staff was to) keep supplies in clean drawers or carts or on a surface away from (the) potential for contamination." Clinical record review revealed that Resident R19 was admitted to the facility on [DATE], and had [DIAGNOSES REDACTED]. According to the Minimum Data Set assessment, dated December 2, 2013, the resident was occasionally incontinent of urine and required extensive assistance of two staff members for bed mobility. On the day of admission, the physician ordered that staff use "contact precautions" due to "MRSA (in the) urine." On December 11, 2013, at 9:30 a.m., RN2 and RN3 were observed providing incontinence care. During this procedure, the resident was positioned on either side while he was being cleaned. RN2 and RN3 were not wearing gowns while coming in direct contact with the resident and his bed sheets. Also, at that time a urinal was on an overbed table with a spoon and other personal items belonging to the resident. Observation of medication pass on December 10, 2013, at 9:15 a.m., revealed that RN4 administered medications to Resident R1 and took the medication cart inside the resident's room, in close proximity to the resident's bed. Resident R1 had a [DIAGNOSES REDACTED]. In an interview on December 11, 2013, a 12:25 p.m., the Infection Control Preventionist stated that the medication cart should be kept outside the rooms of residents on contact precautions. 28 Pa. Code 211.10(d) Resident care policies. 28 Pa. Code 211.12(d)(5) Nursing services.

Based on policy review, clinical record review and observation it was determined that the facility failed to assess a resident for safe self-administration of a medication for one of six residents observed during the medication pass. (Resident R32) The findings include: Review of the facility's "Medication Self Administration" policy (dated July 3, 2013) revealed that alert and oriented residents were permitted to administer their own medications after they received instructions from the interdisciplinary team. Clinical record review revealed that Resident R32 had a physician's orders [REDACTED]. During observation of the medication pass on December 10, 2013, at 9:30 a.m., Resident R32 self administered the eye drops. The nurse did not give the resident any instructions at that time. There was no documentation in the clinical record that the facility assessed the resident to determine if medications could be safely self administered. There was no documentation that the facility provided the resident with education on how to properly administer eye drops. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review and staff interview, it was determined that the facility failed to implement a physician's order for one of twelve sampled residents. (Residents R14) Findings include: Clinical record review revealed that Resident R14 was admitted to the facility on [DATE], with [DIAGNOSES REDACTED]. On November 28, 2013, the physician's order identified the resident at moderate risk for a venous/thrombus/embolism (VTE). On November 29, 2013, the physician ordered that nursing staff apply compression boots at night. There was no documentation to support that the compression boots had been applied in accordance with the physician's order. In an interview on December 11, 2013, at 12:11 p.m., the Administrator confirmed that there was no documentation to support the application of the compression boots. 28 Pa. Code 211.12(d)(1)(5) Nursing services.

Based on clinical record review it was determined that the facility failed to ensure that there was medical justification for the use of an antipsychotic for one of two residents that received this type of medication. (Resident R37) Findings include: Clinical record review revealed that Resident R37 was admitted to the facility on [DATE], and had [DIAGNOSES REDACTED]. At the time of admission, the physician ordered that staff administer an antipsychotic medication ([MEDICATION NAME]) every six hours as needed. There was no documentation in the clinical record at the time the [MEDICATION NAME] was ordered to indicate the specific symptom for the mediation. Review of the December Medication Administration Record [MEDICATION ADMINISTRATION RECORD DETAILS REDACTED]. Prior to receiving this mediation, a nurse noted that the resident had some confusion about her medications, but was otherwise "comfortable" and had "no complaints." There was no documented evidence that the resident was experiencing any symptoms to justify the use of the antipsychotic medication. 28 Pa. Code 211.12(d)(5) Nursing services.

Based on observation, clinical record review, staff and resident interview, it was determined that the facility failed to ensure that a physician's order was implemented for one of two residents observed with a wound. (Resident R29) Findings include: Clinical record review revealed that Resident R29 was admitted to the facility on [DATE], with a skin tear on her leg. On December 16, 2011, the wound nurse consultant recommended a change in treatment. A physician's order was obtained on the same day for staff to apply hydrogel to the wound daily. Observation on December 20, 2011, at 8:30 a.m., and 9:45 a.m., revealed the resident in bed with a dressing on her leg that was dated December 18, 2011. The resident stated that staff had not changed her dressing on December 19, 2011. Review of the treatment record revealed that staff had not documented the reason why the treatment was not done. In an interview on December 21, 2011, at 12:42 p.m., the Director of Nursing confirmed that staff had failed to provide the physician ordered treatment to the resident's wound on December 19, 2011. 28 Pa. Code 211.12(d)(5) Nursing services.

Based on observation, it was determined that the facility failed to ensure that a nutritional supplement was stored in accordance with manufacturer's standards on one of two nursing units. (T unit) Findings include: Observation of the T unit refrigerator on December 19, 2011, at 9:15 a.m., revealed two thawed "Health Shakes" with no use by date on the product. Instructions on each individual container noted that the product was to be used within 14 days of being thawed. One of the Health Shakes was identified with a date of November 22, 2011.