Cherrydale Health & Rehabilitation Center

The facility failed to date, label, and/or cover bread products stored in the kitchen, which had the potential to create an environment for food-borne illnesses. (Refer to

Review of all 12 residents' meal slips showed that milk should have been included with their meals. A review of the lunch menu noted that milk was to be served for all diets.

Upon interview on 04/22/25 at 12:40PM, Resident (R) 89, R66, and R86, all stated that milk had not been provided or offered to them. R89, R66 and R86 stated that meals had been served in the past that did not include milk.

Review of the meal slips for R89, R66 and R86 showed that six ounces of milk should have been provided.

During the lunch observation on Unit 2 on 04/23/25 about 12:30PM, it was again observed that there were 12 residents who were served their lunch meal without milk, which was confirmed by a corporate registered dietician (OS4), who also was present. OS4 directed the Head Cook, who was serving food, to make sure that the 12 residents received their milk, as noted on their meal slips. OS4 also directed that the residents who were eating in their rooms be served milk with their lunch meal.

During an interview on O4/23/2025 at 1:30PM, OS4 stated that she did not realize that 12 residents on Unit 2 were not receiving milk with their meals, along with residents who were served their meals in their rooms. OS4 stated that there was no reason the residents were not served their milk, as it was available, and listed on both the lunch menu and the residents' meal slips.

No additional information was provided prior to survey exit.

28106

Based on observation, resident interview, and staff interview, the facility staff failed to provide drink preferences for one of 46 residents.

Resident # 80 (R80) was not provided milk as indicated on the meal ticket.

The findings include:

According to the clinical record, diagnoses for R80 included difficulty walking, dialysis, diabetes, chronic kidney failure, and peripheral vascular disease.

The most current MDS (minimum data set) was a quarterly assessment with an ARD (assessment reference date) of 01/29/2025, which assessed R80 with a cognitive score of 15 out of 15, indicating cognitively intact.

495121

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 495121 B.

Wing 04/24/2025

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

Cherrydale Health & Rehabilitation Center 3710 Lee Highway Arlington, VA 22207

The survey team reviewed the form that had been developed for monitoring the disinfecting procedure for glucometers in coming weeks, as listed in removal plan. No concerns were noted.

After consulting with the SA, the survey team determined that the removal plan was fully implemented and that the likelihood of serious injury, serious harm, serious impairment, or death no longer existed, the facility was notified that the Immediate Jeopardy had been removed on 04/23/25 at 11:20 AM.

495121

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 495121 B.

Wing 04/24/2025

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

Cherrydale Health & Rehabilitation Center 3710 Lee Highway Arlington, VA 22207