Every finding on record at Rockmart Health

Based on observation, record review, resident and staff interviews, the facility failed to ensure they offered an appealing option of similar nutritive value to residents during lunch service. This failure had the potential to affect all 47 residents that received an oral diet. Findings include: 1. Record review for R K revealed a Quarterly Minimum Data Set (MDS) assessment dated [DATE] which documented a Brief Interview for Mental Status (BIMS) summary score of 15, indicative no cognitive impairment. During interview R K on 12/3/18 at 3:00 p.m., she they have the same food over and over with no variety. She stated they will offer an alternate that is worse than the main meal or it is what they served the day before. Also by the time you get your dinner around 6, they already closed the kitchen at 5:30 p.m. and you can't ask for a bowl of soup and grilled cheese or something else if you don't like the food. R K further stated they provide sandwiches but not at night for snacks and they are not consistently available. The dietician promises this or that and the next day it's the same thing. Review of the (YEAR)-2019 Fall and Winter Menus- Week 3 revealed lunch on 12/4/18 (Wednesday) as follows: Chicken and Dumplings, Tossed Salad w/Dressing, Chilled Fruit Cup, Coffee, Margarine, Pepper, Parsley Sprig. Alternate: Beef Stroganoff, California Vegetable Blend, Soup of the Day, Select Sandwich. Steam Table and Food Line observation on 12/5/18 at 11:47 p.m. revealed regular texture chicken and dumplings, mechanical chopped chicken and dumplings, puree chicken and dumplings, spring mix salad, mandarin oranges, green beans and puree spring mix salad. There was no alternate meal prepared on the steam table and no soup of the day. Once all meals were served, there was no chicken and dumplings left in regular and chopped texture and a very small amount of puree left. The Dietary Manager arrived at 11:50 a.m. Interview on 12/16/18 at 12:55 p.m. with the Dietary Cook AA revealed he did not make an alternate meal today because some residents were asked this morning if they wanted the alternative and they said no so he didn't make any. When asked if he asked every resident in the facility about the alternative, he could not confirm that 100% of residents were asked about the alternate meal. Interview on 12/15/18 at 1:00 p.m. with the Dietary Manager (DM) confirmed there was no alternate meal prepared today and there should always be an alternate meal prepared and ready to serve, but once she came in and saw the food line, there was nothing she could do. She stated she was not in the kitchen when the meal was being prepared and she would need to provide staff training. The DM stated that they usually have an alternate meal prepared. She stated they also provide grilled cheese, turkey and ham sandwiches if a resident does not like the meal. Observation of the reach in cooler with the DM at 1:03 p.m. revealed cheese slices but no sandwich turkey and no sandwich ham. The DM stated they usually have it in the reach-in cooler but no-one must have thawed the sandwich meats today. Observation of the walk-in freezer at 1:06 p.m. with the DM revealed one large package of sliced ham. The DM stated there was only one package and maybe that's why no one thawed the sandwich meat. When asked, the DM stated that she is typically in the kitchen with staff during meal preparations but she was in her office today. The DM stated they have a company that provides the menu and portion sizes and they can tweak the menu some. She stated she had not heard about very many complaints about the food variety. She stated they are currently working on an Anytime Menu instead of an alternate meal such as chicken fingers, hamburgers, hot dogs etc. because that is the kind of foods a lot of the resident's in this facility like. She stated this will be implemented soon.

Based on observations, record review, review of Centers for Disease Control and Prevention (CDC) guidelines on Shingles and Gastrointestinal Disease Outbreak, the facility policy Recommendations for the Control of [MEDICAL CONDITION] Gastroenteritis Outbreaks in Long-Term Care Facilities and staff interviews, the facility failed to use personal protective equipment (gloves), and hand washing with soap and water, when caring for residents with gastrointestinal disease outbreak symptoms such as diarrhea and vomiting for resident (R) R#250, and R#26 with Shingles. The sample size was 20 residents. Findings include: Observation on 12/4/18 at 12:40 p.m., of Certified Nursing Assistants (CNA) EE, FF, GG and HH as they passed meal trays revealed that they entered resident (R) R#250 room, who had symptoms of diarrhea with blood, seven times on that day. The CNAs touched the resident and the resident's roommate's food; they started passing the food trays without washing their hands or wearing gloves. After they have finished passing the meal trays, they only sanitized their hands. Observation on 12/4/18 at 2:10 p.m. with the Director of Nursing (DON) revealed CNA II entered the room of R#26 to care for a resident on contact isolation precautions. CNA II wore a gown and gloves although upon exit from the resident's room, the CNA did not wash her hand with soap and water. She went straight to the opposite hall, touched the equipment in another resident's room. A telephone interview on 12/3/18 at 1:20 p.m., with Public Health JJ, revealed that the facility reported the gastrointestinal disease outbreak on Thursday 11/29/18; she then came to the facility on Friday 11/30/18 as a follow up providing the facility with the Environmental Protection Agency guidelines to use, such as cleaning with bleach, isolating residents with symptoms, and staff must wash their hands with soap and water before entering and after exiting a resident's room, to prevent transmission of gastrointestinal disease outbreak. An interview on 12/4/18 at 12:40 p.m., with CNAs EE, FF, GG, and HH revealed that they entered R#250 room and were aware the resident had symptoms of diarrhea with blood, seven times on that day. The CNA's further revealed that they did touch resident and touched the resident's roommate's food without washing their hands. They further revealed that they used sanitized on their hands. An interview on 12/4/18 at 2:05 p.m. with the Housekeeper revealed that she was scheduled to work 9:00 a.m. to 5:00 p.m., Monday thru Friday; the housekeepers clean the residents' rooms and toilets once daily. The housekeeper further revealed that in the event of emergency, staff would call Housekeeping to come and clean the area. She further revealed that all staff were in-serviced on how to use the cleaning chemical products. An interview on 12/4/18 at 2:10 p.m. CNA II revealed that she had sanitized her hands on 12/4/18 at 2:10 p.m. after care for R#26 although she forgot to wash her hands with soap and water. An interview on 12/4/18 at 2:00 p.m. with Licensed Practical Nurse (LPN) DD revealed that staff were supposed to wash their hands with soap and water upon entering the rooms of residents with gastrointestinal outbreak and repeat the same hand washing procedure when they exit. An interview on 12/5/18 at 12:47 p.m. with the DON revealed that the facility had obtained three stool specimens today and sent them to the laboratory through the Public Health Department (PHD). She further revealed that DPH had recommended facility to limit group activities, and that staff should wear a gown and gloves when they do residents care, and to follow the rule on proper hand washing with soap and water upon entering and exiting. The DON confirmed that the facility was serving meals in the resident's rooms and limiting activities to one on one, in room, activities. The DON further revealed that she didn't know if the housekeeping staff should be cleaning toilets more than once a day, and she is not aware that the staff were not performing hand washing with soap and water before and after the procedures. The nurses and CNAS are to clean after Housekeeping closed at 5:00 p.m. All staff were in-serviced on how to use chemical products to clean after housekeeping closed at 5:00 p.m. An interview on 12/5/18 at 1:30 p.m. with the Administrator and Housekeeping Supervisor stated they were not aware of staff were not cleaning the toilets or not washing their hands before and after care. A telephone interview on 12/6/18 at 9:09 a.m. the Epidemiologist KK revealed that they recommended isolation precautions, non-essential activities to be curtailed. Contact isolation are recommended but are not required. It is up to the facility's policy. It is recommended hand washing with soap and water, not sanitizer, before entering and after exiting a room with symptomatic resident. A telephone interview on 12/6/18 at 9:31 a.m., with the Physician's Nurse Practitioner (NP) revealed that they were aware of gastrointestinal disease outbreak and recommended isolating residents in their room, and hand washing with soap and water, before entry and after exit. Review of the GI Outbreak Surveillance Form for residents (line listing) revealed that the first GI symptoms began on 11/27/18 with one resident and two staff members, 11/28/18 with two additional residents, 11/29/18 with five residents and two staff members, 11/30/18 with five additional residents and one staff member, and on 12/4/18 with two additional residents. A post survey telephone interview with the Administrator on 12/20/18 at 1:22 p.m. revealed that the quarantine was lifted on 12/8/18. She revealed that the stool cultures were negative, and that Norovirus was not detected. Review of the facility's policy titled Recommendations for the Control of [MEDICAL CONDITION] Gastroenteritis (GI) Outbreaks in Long-Term Care Facilities without a date, includes the following: Contact the local health department immediately when there is an onset of vomiting and/or diarrhea among residents and staff who all develop symptoms within a short time of each other. Isolate residents with GI symptoms in their rooms to reduce the risk of spread to other residents. Residents movements for non-essential activities should be canceled or postponed. Meals should be served in resident's rooms. Caution visitors that they may be exposed to infections and emphasize hand hygiene. All persons, including staff, should wash their hands upon entering or leaving the resident's room. Recommendations for Patient Care: Were gloves and disposable/washable apron or gown for contact with symptomatic residents or contaminated environments. Wash hands with soap and water after contact with affected persons or objects; before handling food, drink or medications; upon leaving an affected environment; and when entering or leaving all residents' rooms. Clean and disinfect vomit and fecal spills promptly. Review of the facility's Infection Control and Contact Precautions Policies and Procedures with a release date of (MONTH) 2, (YEAR) states: Revealed MOST IMPORTANT PIECES OF QUARANTINE HAND WASHING PRACTICED AT ALL TIMES. Observation, during hall dinning, conducted on 12/3/18 at 12:18 p.m. revealed room [ROOM NUMBER] was in contact isolation for [MEDICAL CONDITION], not GI symptoms. The Certified Nursing Assistant (CNA) LL put a gown on and another CNA tied the gown behind her back. CNA LL went into room [ROOM NUMBER] but did not put on gloves. CNA LL moved the rolling walker in front of the resident in bed B, then delivered her lunch in a Styrofoam container. CNA LL then removed her gown, sanitized her hands and walked out of the room and went to the food delivery cart. The Licensed Practical Nurse (LPN) DD whispered to CNA LL to wash her hands. CNA LL walked back into room [ROOM NUMBER] directly to the bathroom and the sink could be heard running as well as removal of paper towels. Interview with CNA LL as she exited the room at 12:20 p.m. confirmed that she went into the bathroom to wash her hands. CNA LL then donned another gown but did not put on gloves to deliver the lunch meal to the resident in bed A. She shook the resident's arm to wake her up to eat. CNA LL then took her gown off, threw it in the isolation trash bin, sanitized her hands and exited the room at 12:22 p.m. without washing her hands. An interview on 12/6/18 at 3:48 p.m. with LPN DD confirmed that during lunch service on 12/3/18, CNA LL entered room [ROOM NUMBER] with a gown but no gloves although gloves should have been utilized. LPN DD confirmed that he had to prompt her to wash her hands after exiting the room and confirmed that she entered the room a second time to serve lunch with no gloves on. LPN DD stated he had to educate her on washing hands before entering and before exiting a room that is in contact isolation. LPN DD confirmed that room [ROOM NUMBER] was in Contact Isolation on 12/3/18.

Based on observations, record review, resident interviews, staff interviews, and sampled test tray, the facility failed ensure that food served was palatable, attractive and at an appetizing temperature for five of 20 sampled residents (R) (K, L, M, N, and P). Findings include: Dining observation on 12/3/18 at 12:18 p.m. revealed general observations of resident lunch trays. The mixed vegetables appeared over cooked with a mushy appearance. The dessert was a small, rectangle, single layer slice of white cake with white frosting that was 1.25 inches x 1.75 inches. 1. Record review for R K revealed a Quarterly Minimum Data Set (MDS) assessment dated [DATE] which documented a Brief Interview for Mental Status (BIMS) summary score of 15, indicative no cognitive impairment. During interview R K on 12/3/18 at 3:00 p.m., she stated the food is always cold when served to the hall and in the dining room. R K stated they have the same food over and over with no variety. They always serve rice, noodles or instant potatoes. R K stated the food is just horrible! Last night they had a chicken wrap with a wheat tortilla that was so tough, we couldn't even eat! R K stated they will offer an alternate that is worse than the main meal or it is what they served the day before. Also by the time you get your dinner around 6:00 p.m., they have already closed the kitchen at 5:30 p.m. and you can't ask for a bowl of soup and grilled cheese or something else if you don't like the food. The dietician promises this or that and the next day it's the same thing. R K stated I wouldn't feed it to a dog and they shouldn't be feeding old people this stuff. Observation on 12/5/18 at 8:26 a.m. revealed R K in her room in her bed. Observation of the resident's breakfast revealed a Styrofoam container with scrambled eggs, oatmeal and a muffin, milk, juice and coffee. R K stated she didn't like the breakfast and was not going to eat it. She stated she gave her muffin to her roommate. Observation of the eggs revealed they were stiff and cut in a square, were not loose like scrambles eggs and had numerous air bubble holes in them with the appearance of swiss cheese. The oatmeal was solid, thick and dark brown in color. 2. Record review for R L revealed a Quarterly MDS assessment dated [DATE] which documented a BIMS summary score of 13, indicating no cognitive impairment. Interview on 12/4/18 at 10:12 a.m. with R L revealed sometimes the food is good and sometimes it is not good. R L stated if they had meat one, the next day they will just throw BBQ sauce on it and serve it again. She stated the food is sometimes overcooked, especially the vegetables. R L further stated she eats in her room and often the food is cold. 3. Record review for R M revealed a Quarterly MDS assessment dated [DATE] which documented a BIMS summary score of 15, indicating no cognitive impairment. Interview on 12/4/18 at 9:05 a.m. with R M revealed she had no complaints about the facility other than the food. R M stated the food is horrible! She stated the vegetables are either overcooked or undercooked and the meat is usually overcooked and hard to eat. R M stated she hears other residents complain about it. R M stated the recipes just are not good and she stated there is nothing we can do about it. R M stated she has her own refrigerator and her family keeps her with bread and stuff to make sandwiches. R M stated they will bring soup or something else if you ask for it. Interview on 12/4/18 at 10:16 a.m. with the Social Service Director/Activities Director revealed that she attends the Resident Council meetings and she has heard complaints related to food. She stated the complaints are related to cold food, poor tasting food and food variety. She stated she reports the complaints to the Dietary Manager. The Social Service Director/Activities Director further stated several residents have their own refrigerators in their room and the families bring them snacks/food because they do not like the food. Steam Table and Food Line observation on 12/5/18 at 11:47 p.m. revealed the dietary staff just finished plating one of three tall food carts. Observation of the steam table revealed regular texture chicken and dumplings, mechanical chopped chicken and dumplings, puree chicken and dumplings, spring mix salad, mandarin oranges, green beans and green puree (unable to identify). Test of the food temperatures beginning at 11:48 a.m. revealed the following: Regular Diet Chicken Dumplings= 170 degrees Fahrenheit (F) Chopped Chicken Dumplings= 168 F Green Beans= 163 F Puree Chicken and Dumplings= 170 F Interview on 12/5/18 at 11:51 a.m. with the Dietary Cook AA revealed the green puree was pureed Spring Mix Salad and not green beans. When asked why the green beans were not pureed, he stated because the Spring Mix Salad was the main vegetable on the menu for the day so that is what he pureed. Observation and interview on 12/5/18 at 11:52 a.m., food cart #2 was filled and set alongside food cart #1. An interview with the Dietary Manager (DM) at this time revealed they do not take the food carts to the floor until all three carts have been plated. At 12:01 p.m. the dietary staff began plating food cart #3. At 12:03 p.m., the DM pushed food carts #1 and #2 outside the kitchen door into the hall. At 12:05 p.m., there was no more mechanical chopped chicken and dumplings and the Dietary cook and Dietary Aide had to stop plating food to make more mechanical chopped texture for five more residents. Observed at this time, above the food preparation table revealed a hand-written note on the wall that documented 24- regular, 16- mechanical soft and 4- puree. At 12:06 p.m. a staff member in the hall came to take the cart and the DM was heard telling the staff no, no, no, not yet. At 12:10 p.m. they ran out of mandarin oranges and the Dietary Aide had to stop and get diced pears from the reach-in cooler for the remaining lunch trays. At 12:12 p.m., the DM stated she went ahead and sent food cart #1 and #2 down the hall. At 12:19 p.m. the last meal was place on food cart #3 and test food tray was requested. At 12:21 p.m. the food cart #3 left the kitchen and arrived to the North Hall at 12:12 p.m. Staff began passing the meals at 12:22 p.m. and the last resident meal was served at 12:37 p.m. Test tray sampling began at 12:38 p.m. with Licensed Practical Nurse (LPN) CC. LPN CC sampled the regular texture chicken and dumplings and stated there was mostly chicken gravy with small diced cubes of chicken. LPN CC stated there was and only one whole, small dumplings and one broken off piece of dumpling in the serving. LPN CC stated the temperature was good, the texture was okay and stated it was very salty and tasted like Salty broth. Surveyor observed warm temperature, overpowering salty taste and one quarter sized rounded dumpling and a broken piece of dumpling with mostly chicken gravy. LPN CC sampled the mechanical chopped chicken and dumplings and stated it does not look appetizing and in not recognizable. LPN CC further stated the texture was weird, the temperature was lukewarm and had the same salty broth taste. The surveyor observed the texture to be lumpy, gooey, cool temperature and overpowering saltiness. LPN CC sampled the puree chicken and dumplings and stated it was cold, the texture okay but still had the salty broth flavor. The surveyor observed the puree chicken and dumplings was cold, good puree texture, but overpowering saltiness. LPN CC sampled the green beans and stated they were lukewarm with a mushy/soft texture. LPN CC further stated the green beans had no flavor such as butter or spices. Surveyor sampled the green beans and observed them to be, lukewarm in temperature, overcooked/soft/mushy and bland in flavor. LPN CC sampled the pureed spring mix salad and when placed in her mouth, she made a disapproving facial expression and stated This is not green beans! LPN CC further stated It almost tastes like dirt. LPN CC stated she thought it was going to be puree green beans and did not know it was puree spring mix. Surveyor sampled the puree spring mix and observed it to be distasteful and had an earthy/dirt flavor. LPN CC stated she would not have served this meal to anyone. LPN CC stated that sometimes the food looks really good and sometimes it does not look good. LPN CC stated that she does hear complaints from some of the residents that they do not like the food and some residents have their own refrigerators in their rooms. She stated the families bring them food to keep if they don't like the food. LPN CC stated the menu list an alternative and the kitchen will make them a sandwich if they don't like the food. Interview on 12/5/18 at 12:55 p.m. with the Dietary Cook AA revealed he has heard resident complaints about the food related to taste. Interview on 12/5/18 at 12:57 p.m. with the Dietary Aide BB revealed on Monday 12/3/18, there was a new dietary aide that cut the cake and she noticed that she cut the pieces too small and they had to educate her. Interview on 12/5/18 at 1:00 p.m. with the Dietary Manager (DM) revealed the green beans should have been pureed and not the spring mix salad and stated that once she came in and saw the food line, there was nothing she could do. The DM stated she was not in the kitchen when the meal was being prepared and she would need to provide staff training. When asked, the DM stated that she is typically in the kitchen with staff during meal preparations but she was in her office today. The DM stated they have a company that provides the menu and portion sizes and they can tweak the menu some. She stated she had not heard about very many complaints about the food quality, mostly about the food being cold. Further she stated they are in the process of replacing the plating system. The DM stated she was not aware of residents complaining about food variety but confirmed todays alternate meal on the menu was Beef Stroganoff that was just served for lunch on Monday. The DM stated they use real eggs in a carton, and the resident thinks they are using powdered eggs. She showed the cartons of whole eggs in the reach-in cooler. When surveyor observation described of the eggs on the resident's trays, she stated they were overcooked. She stated that they do not have a flat top stove so they have to cook the scrambled eggs in the oven. She stated if they are cooked correctly, they are stirred up and still have scrambled egg texture and appearance. The DM stated she stated she has seen them over cooked when they a are solid with air bubble holes. She stated she was going to have to in-service the cook. DM confirmed they on the Week 3- Fall/Winter menu. Review of the daily posted menus from the Week 3 Fall/Winter schedule revealed the following: Sunday Daily Menu lunch- Pork Roast (Pork Roast is also listed as the Tuesday Lunch alternate). Supper- Chicken Ranch Wrap. (Chicken Ranch wrap is also listed as the Tuesday Supper alternate). Monday Daily Menu lunch- Beef Stroganoff (Beef Stroganoff is also listed as the Wednesday Lunch alternate). Supper- Chicken Baked. (Chicken Baked is also listed as the Wednesday Supper alternate). Tuesday Daily Menu lunch- Ham Glazed Homestyle (Ham Glazed Homestyle is also listed as the Thursday Lunch alternate). Supper- Tuna Stuffed Tomato. (Tuna Stuffed Tomato is also listed as the Thursday Supper alternate). Wednesday Daily Menu lunch- Chicken and Dumplings (Chicken and Dumplings is also listed as the Friday Lunch alternate). Supper- Beef BBQ Sandwich. (Beef BBQ Sandwich is also listed as the Friday Supper alternate). Thursday Daily Menu lunch - Meatloaf Homestyle (Meatloaf Homestyle is also listed as the Saturday Lunch alternate). Supper- Club Sandwich (Club Sandwich is also listed as the Saturday Supper alternate). Friday Daily Menu lunch- Fish Crunchy Fried. (Fish Crumb Topped Zucchini and Tomatoes is listed as the Sunday Lunch alternate). Supper- Turkey Sliced w/Gravy. Saturday Daily Menu lunch- Pepper Steak. (Philly Steak on Bun Steamed Peppers/Onions is the Sunday Supper alternate). Supper- Meatloaf Homestyle. Interview on 12/6/18 at 9:58 a.m. with the Administrator revealed the facility talks to the residents all the time and some like the food and some do not. She stated because of resident surveys conducted in (MONTH) (YEAR) with low satisfaction for food, the corporate VP of finances and operations came to the facility and conducted a test tray and found that they need new plating system to keep foods warm. She stated the VP also attended a resident council meeting to discuss the food and the complaints were mostly about food being cold. The Administrator stated the Dietary Manager is currently getting a quote from the food supplier for a whole new plating system. The Administrator stated she personally, had not received many complaints related to the alternate meals or lack of food variety, however, they are working on implementing an anytime menu soon. DONE An interview on 12/03/18 at 1:05 p.m. with R N revealed that her food is never warm when it is served to her and she stated that her biggest complaint is that the mixed vegetables are never fully cooked and they are too hard to bite into. She stated that she doesn't get desert very often and the portions are small. The resident further revealed that they do offer an alternate but it is always what was given to them the day before. When asked if she had snacks available to here she stated that last night she ask for soup but she was told there was nothing in the pantry so she stated she did without and stated that this is not uncommon. An interview on 12/05/18 at 1:05 p.m. with R P revealed that the food is just not good. She stated that they just don't add salt, butter, or season anything and they don't put condiments on the tray.

Based on observation, staff interview, and review of the facility policy Diarrhea and Fecal Incontinence the facility failed to provide Activity of Daily Living (ADL) care related to incontinent care for one resident (R) (R#100). The sample size was 20 residents. Findings Include: Minimum Data Set (MDS) Discharge assessment dated [DATE] Section C revealed R#100 has a memory problem. Section G Functional Status revealed extensive 2 person physical assistance with all ADL's. Section H Bowel and Bladder revealed R#100 is always incontinent of bowel and frequently incontinent of bladder. Section I revealed [DIAGNOSES REDACTED]. Observation and interview on 12/05/18 at 8:36 a.m. R#100 was heard by the surveyor calling out from her room saying, Help, help! No staff were observed in the hall. R#100's call light was observed to be on. During this time this surveyor asked the R#100 what she needed. She stated, It's too late now I've had diarrhea in my pants. At this time, this surveyor went to the room next door to R#100 where Certified Nursing Assistant (CNA) MM was observed picking up trash and advised her that R#100 was calling for assistance. CNA MM stated she would be right there. During an observation on 12/05/18 at 8:40 a.m. CNA MM enter R#100's room and ask her what she needed. R#100 stated that she had diarrhea and needed cleaned up. CNA MM turned the call light off and explained to R#100 that she would have to wait until after breakfast was done, and cleaned up, before she could clean her up and stated to R#100 that she couldn't clean her up now because of infection control reasons. During this time this surveyor asked CNA MM why R#100 must wait to be cleaned up. CNA MM stated that she was told any time during breakfast a resident needed cleaned up it had to wait until after breakfast was completed to prevent infection control problems. During this time CNA NN entered the room and this surveyor advised that R#100 had diarrhea and needed to be cleaned up and the longer she sits in a dirty brief the more likely it was for R#100 to get skin break down and a urinary tract infection. CNA NN stated that she and CNA MM would get R#100 cleaned up right away. During an interview on 12/05/18 at 8:50 a.m. with the Director of Nursing (DON) she stated that she told staff if a resident needed, or asked, to be cleaned up during passing trays they were to finish passing trays before cleaning up the resident to prevent any cross contamination. When asked if there was not enough staff available to clean a resident up while trays were passed, she stated that her expectation is that they let either the charge nurse, DON, or the Resident Care Coordinator (RCC) know a resident need changing so it can be done without interfering with passing trays and causing possible cross contamination. During an interview on 12/05/18 at 9:59 a.m. with the RCC he stated that during a quarantine, such as the facility is having with the norovirus breakout, the DON instructed the staff not to do incontinent care during passing meals but stated that he is always available. He stated that the staff has been instructed to come and get him, the charge nurse, or the DON and they will take care of the resident's needs. During an interview on 12/05/18 at 10:16 a.m. with CNA HH she stated if she is passing trays and a resident tells her they need to be changed she will let the charge nurse know. She stated that when the residents must be quarantined there is always an extra person on the hall that takes care of any personal needs of the resident while residents are being fed. CNA HH stated she has never been told not to stop and change someone when passing trays. Review of the policy Diarrhea and Fecal Incontinence revealed residents must be cleaned after each episode of incontinence.