Inspection·October 4, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to follow the plan of care to provide mechanically altered diet and nutritional supplements as ordered by physician for 1 (R1) of 4 residents reviewed for improper nursing care. Residents Affected - Few The findings include: R1's admission record documented admit date on 1/28/2021 with diagnoses not limited to Dysphagia, Chronic obstructive pulmonary disease, Gastro-esophageal reflux disease, Essential (primary) hypertension, Hyperlipidemia, Vitamin d deficiency, Atherosclerotic heart disease of native coronary artery, Anxiety disorder, Cocaine abuse, Alcohol abuse, Schizophrenia, Adult failure to thrive. On 10/1/24 at 12:12pm Observed R1 resting on bed, head of bed elevated, appears comfortable, alert and verbally responsive. Lunch tray was served with ham sandwich, potato salad, juice, cookie. R1's meal ticket showed Mechanical Altered/Ground, whole milk, Frozen nutritional treat. Ham/meat was not ground. Whole milk and frozen nutritional treat were not available on the tray. R1 was assisted by V4 (Certified Nursing Assistant) at mealtime. R1 ate 100% of the food. Whole milk and frozen nutritional treat were not provided to R1. On 10/1/24 at 12:41pm V14 (Dietary Manager) stated he has been working in the facility for 6 months. V14 stated his responsibilities include ensuring residents are getting the right diet and correct portion of food, and making sure dietary staff follow the meal ticket. Every resident has meal ticket. R1's meal ticket reviewed with V14 and said R1 is getting regular mechanical ground. He said meat should be ground. He said R1 has a swallowing problem, easy to swallow if grounded. R1 could possibly choke if it is not grounded. Everything on the ticket should be on the meal tray. He said today for lunch, kitchen is serving cold cut sandwiches due to oven replacement. He said notification were sent to the units and residents were made aware. V14 stated at lunch time, R1 received ham sandwich and the ham should have been ground. He said if not ground it could be a choking hazard. R1's meal ticket reflected Whole milk and dietary aide should provide whole milk on the meal tray from the kitchen. Whole milk helps with weight maintenance. He said R1 should have nutritional frozen/ice cream twice a day (lunch and dinner) and should be included in the meal tray. Nutritional frozen treat has high calorie and that helps with weight gain or maintenance. On 10/1/24 at 1:17pm V15 (Registered Dietician) stated she has been working in the facility for almost 3 weeks. She said R1 was evaluated on 9/27/24 upon readmission. R1 needed 1:1 assistance at mealtime. R1 had been eating 100% since readmission. R1's diet is mechanical soft. All meat should be ground- soft bread should be okay. If R1 was served with ham sandwich, the meat should be ground. She said the potential risk if not ground could have a problem chewing and possibly choking. For safety (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: 145235 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 145235 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakefront Nursing & Rehab Ctr 7618 North Sheridan Road Chicago, IL 60626 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)