Centerville Care And Rehab Center Inc

Observation on 5/18/25 at 11:30 a.m. of the kitchen revealed:

*The plate storage cabinet had dust on top of the cabinet where the plate covers were stored.

*The shelves where the dishes had been stored had food debris and stains on the shelves.

*The beverage serving cart with prepared residents' beverages on it had food debris and food stains on the shelves.

*The kitchen floor, under the stove, and storage racks were soiled with food debris and dirt.

*Drawers containing clean utensils had food stains and food debris in them.

*The recessed cabinet and drawer handles were soiled with food debris.

*The refrigerator door was soiled food debris.

2.

Interview on 5/18/25 at 11:50 a.m. with dietary aide M regarding the cleaning of the beverage storage cart revealed the cart should have been cleaned after every use.

3.

Interview on 5/18/25 at 1:00 p.m. with cook L regarding the cleaning of the plate storage cabinet revealed:

*The cooks had specific cleaning scheduled tasks for kitchen equipment and the dietary aides had specific cleaning scheduled tasks for the kitchen.

*She agreed the plate storage cabinet was not clean, and she was unsure of the last time it had been cleaned.

4.

Interview on 5/20/25 at 9:15 a.m. with cook N regarding the kitchen cleaning tasks schedule revealed:

*There was a task to clean the inside and outside of the cabinet doors by the cooks.

*She tried to keep up with the cleaning of the inside of utensil storage drawers.

*Everyone should have cleaned the drawers if they had noticed they were dirty.

435088

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 435088 B.

Wing 05/21/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Centerville Care and Rehab Center Inc 500 Vermillion St Centerville, SD 57014