Inspection·February 19, 2025

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review the facility failed to follow their menu. This has the potential to affect all residents receiving a regular diet at the lunch meal. Residents Affected - Many The findings include: The Facility Data Sheet dated 2/19/2025 shows a total in-house census of 68 residents. The facility provided Diet Type Report dated 2/19/2025 lists 58 of 68 or 83.8% of residents within the facility diet texture as Regular. On 2/19/2025 at 12:04PM, the burgers were observed sitting on the steam table ready for plating. The burgers appeared small and shrunken. On 2/19/2025 at 12:02PM, V5 (Registered Dietition) said the hamburgers looked a little small to me when I walked by a minute ago. V5 said lunch should include 2oz of protein. On 2/19/2025 at 12:05PM, V4 Certified Dietary Manager (CDM) said the burgers should be 2oz. V4 said the burgers should be measured on a scale to make sure they are the correct size/portion. V4 said [V6-Cook] made the burgers today for lunch. On 2/19/2025 at 12:07PM, V6 said he patted out the burgers for lunch today. V6 said he estimated the size of the burgers. On 2/19/2025 at 12:07PM, test patty was placed on the scale and reading was less than 2 ounces for the patty, weighing approximately 1-1.5 ounces. V5 was present to verify the burger patties were less than 2 ounces. On 2/19/2025 at 12:38PM, R4 was observed sitting at a table in the dining room. R4 said his burger was small. On 2/19/2025 at 12:38PM, R3 was observed sitting at a table in the dining room. R3 said look at this big burger (said in a sarcastic tone). The resident's burger appeared small and covered less than 75% of the bun's circumference. On 2/19/2025 at 12:38PM, R5 said all the burgers are small. On 2/19/2025 at 12:44PM, V5 said everyone is asking for more food. (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: 145234 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 145234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl Pointe Nursing Rehab & Care 900 South Kiwanis Drive Freeport, IL 61032 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)