Health inspection·January 10, 2025

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to adequately staff the dietary department to ensure meals were served in a timely manner for 1 of 5 residents (R9) reviewed for food and nutrition services in the sample of 9. Findings include: R9's Physician Orders document R9 was admitted to the facility on [DATE]. R9's Face Sheet documents R9 has diagnoses including heart disease, peripheral vascular disease, and protein calorie malnutrition. R9's Minimum Data Set (MDS) dated [DATE] documented R9 was cognitively intact, independent with eating, and ambulated with wheelchair and walker. R9's Care Plan documents goal to improve nutritional status. R9's Physician Orders document 12/16/24 order for carbohydrate controlled diet. On 1/9/25 at 12:47 PM, R9 stated dinner is never on time and has recently received dinner as late as 6:30 PM and 6:35 PM. On 1/9/25 at 12:57 PM, V10, Certified Nursing Assistant (CNA) stated meal service tends to run slower in the evenings. On 1/9/25 at 2:40 PM, V16, Dietary Aid, stated he occasionally has to work by himself during meals and services the entire facility. On 1/9/25 at 2:50 PM, V15, Dietary Manager, stated sometimes meal trays are late, and it is more of a problem for residents who eat in their rooms because the dining room is served first. On 1/9/25 at 3:00 PM, V14, Activities Director, stated meal timing was previously discussed as a problem in the Resident Council Meeting. He was unsure if the issue has been resolved but was told the kitchen has been sending food a little later in effort to keep it hot. On 1/9/25 at 11:35 AM, V7, Licensed Practical Nurse (LPN), stated meals run late if there is only one person running the kitchen. (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 2 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 01/10/2025 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)