Health inspection·February 6, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on interview, observation, and record review, the facility failed to ensure Dietary Staff wear appropriate hair and beard nets, failed to perform proper hand hygiene and/or wear gloves, and failed to check temperatures of food, including all diets (regular diets, special diets, and pureed foods) prior to serving to residents, to prevent contamination and foodborne illness. This failure has the potential to affect all 52 residents living in the facility. The findings include: On 2/1/24 at 2:20 PM, R1, stated, The food is horrible, I wouldn't feed it to my dog. It's usually between warm and cold. The outside may be warm, but the inside is cold. It comes from the hospital, and by the time we get it, it has cooled down. On 2/5/24 at 8:00 AM, V6, Food Service Director, stated All of the food at the facility is produced at the hospital and transported in hot boxes via hospital van, to the facility, it is unloaded, and is placed in a plug-in warmer. The facility's dietary department will prep the food, such as pureed, etc., as needed for special meals, and the cart is brought up to the floor's dining room steamtable/food line. The food is then plated for residents in the dining room first, and then to the residents in their rooms. The food is plated and placed on a non-warming cart and transported to the resident rooms. We try to follow the dietary menu as best we can unless there is a special diet a resident needs. There is a list of alternatives available 24-hours a day, with some exceptions. We are not going to cook chicken strips and fries in the middle of the night. On 2/5/24 at 8:17 AM, Breakfast was being served to residents sitting in the dining room, and then to the resident rooms. There were four breakfast trays on a non-warming plastic cart being delivered to residents by V7, Certified Nursing Assistant (CNA), including R3's and R4's. The breakfast plates on cart were partially covered by a plastic cover. On 2/5/24 at 8:18 AM, V7, stated, We only do four trays at a time and deliver the trays to their rooms. On 2/5/24 at 8:19 AM, R4, was eating her food as soon as the tray was delivered. R4, stated, No the food is not warm anymore. It comes from the hospital, and it is never warm. The food is usually not cold, but definitely not warm. On 2/5/24 at 8:33 AM, R3's breakfast tray was seen delivered (from 8:17 Cart), which took 16-minutes to get to R3 after the tray was placed on cart. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 145121 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145121 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alton Memorial Rehab & Therapy 1251 College Avenue Alton, IL 62002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)