Health inspection·September 14, 2023

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 ensure resident menus and appropriate serving sizes were followed for 4 of 8 (R3, R5, R6, R7) reviewed for therapeutic diets in the sample of 8. Findings include: 1.R5's Order Summary Report dated 9/13/23 documents R5 is on a regular diet with pureed texture and thin liquid consistency starting on 5/4/22. R5's Diet Card for Lunch on 9/12/23 documents pureed texture with pureed beef tips and mushroom entrée. The Facility's Diet Spreadsheet for Day 17 Pureed documents use of #6 Dip (Scoop=6 ounces) for the Pureed Beef Tips and Mushrooms. On 9/12/23 at 12:12 PM, V6, Interim Dietary Manager, stated, We don't have an extra number six scoop for these, so we are using the two-ounce scoop and giving them three scoops each. V9, Dietary Aide, placed two scoops of pureed meat on R5's plate. 2.R3's Order Summary Report dated 9/13/23 documents R3 is on a No Added Salt (NAS) diet, easy to chew (Mech) (EC7) (Easy to Chew 7) texture, thin consistency. R3's Diet Card for Lunch on 9/12/23 documents regular, easy to chew, NAS diet with beef tips and mushrooms entrée. The Facility's Diet Spreadsheet for Day 17 Regular Easy to Chew (EC7) documents #6 Dip for the Easy to Chew Beef Tips and Mushrooms (EC7). On 9/12/23 at 12:23 PM, V6, Interim Dietary Manager, stated, That scoop (for the mechanically altered meat) is only four ounces, so you (V9, Dietary Aide) will do one of those scoops and one two-ounce scoop. On 9/12/23 at 12:46 PM. V9, Dietary Aide, plated one scoop of mechanically altered meat for R3. V9 stated, We are just running low. I didn't do (make) enough of it. It's my fault. 3.R6's Order Summary Report dated 9/13/23 documents R6 is on a regular diet, regular texture and thin liquid consistency starting 3/3/23. Page 1 of 3 145267 145267 09/14/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0803 R6's Diet Card for Lunch on 9/12/23 documents regular diet with ice cream. Level of Harm - Minimal harm or potential for actual harm On 9/12/23 at 12:25, V8, Dishwasher, prepared R6's tray. There was no ice cream placed on the tray prior to placing on the meal cart for delivery to resident. Residents Affected - Some 4.R7's Order Summary Report dated 9/13/23 documents R7 is on a regular diet with regular texture and mildly thick (nectar) consistency. R7's Diet Card for Lunch on 9/12/23 documents regular diet with mildly thick liquids and two whole slices of wheat bread at all three meals. On 9/12/23 at 12:44 PM, V8, Dishwasher, prepared R7's tray. There was only one slice of bread on the tray before it was placed in the meal cart for delivery to resident. On 9/12/23 at 3:14 PM, R7 was sitting in his wheelchair outside his room with a sling on his right arm. R7 stated a few words, but primarily used a dry erase board for communication. R7 communicated the Facility is always running out of wheat bread, salami, Swiss cheese, mayonnaise, and strawberry yogurt. On 9/12/23 at 10:34 AM, V3, Certified Nursing Assistant (CNA) stated sometimes the kitchen makes mistakes, but they usually try to correct them. On 9/13/23 at 9:42 AM, V10, Unit Assistant (UA), stated the kitchen often runs out of food. On 9/13/23 at 9:58 AM, V9, Dietary Aide, stated the Facility does get complaints about running out of food items and the dietary manager is aware. On 9/13/23 at 10:02 AM, V13, Dietary Manager, stated the Facility ran out of items before she worked here, but it is no longer a problem. She would expect staff to follow the menus and look at portion sizes when they are making the resident trays. On 9/13/23 at 2:22 PM, V16, Registered Dietitian (RD), stated different scoops are used to ensure residents get the appropriate amount of calories and protein. If a smaller scoop is used, residents will not get enough protein. If this is happening all the time it could lead to weight loss and different things like medications not working the same. She stated it is important for mechanically altered diets to have the correct scoop sizes. On 9/13/23 at 2:55 PM, V2, Director of Nursing (DON), stated she expects dietary staff to follow meal cards. The Facility's Resident Council Meeting Minutes dated 8/7/23 documents, Menu's not being taken at times & not being given what ordered. The Facility's Therapeutic Diets Policy issued 9/1/21 documents, All residents have a diet order, including regular, therapeutic, and texture modification, that is prescribed by the attending physician, physician extender, or credentialed practitioner in accordance with applicable regulatory guidelines. Therapeutic diet is defined as a diet ordered by a physician, or delegated registered or licensed dietitian, as part of the treatment for a disease or clinical condition. The purpose of a therapeutic diet is to eliminate or decrease specific nutrients in the diet (e.g., sodium), or to increase 145267 Page 2 of 3 145267 09/14/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0803 Level of Harm - Minimal harm or potential for actual harm specific nutrients in the diet (e.g., potassium), or to provide food that a resident is able to eat (e.g., mechanically altered diet). Mechanically altered diet means one in which the texture of the diet is altered. Diets are prepared in accordance with the guidelines in the approved Diet Manual and the individualized plan of care. Residents Affected - Some 145267 Page 3 of 3