Health inspection·September 29, 2023

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure mechanically altered diets were the appropriate consistency for two (R1 and R3) of seven residents reviewed for mechanically altered diets in the sample of seven. Findings include: 1. R1's Face Sheet documented diagnoses including Parkinson's Disease, Hypertension, and Chronic Kidney Disease. R1's Physicians Orders documented a 9/12/23 order for a mechanical soft diet with thin liquids and fortified foods and (nutritional supplement) shakes at all meals. R1's Minimum Data Set, dated [DATE], documented R1 requires extensive assistance from one staff member for eating, R1 has moderate deficits in cognitive functioning, and R1 requires a mechanically altered diet. A 9/14/23 Speech Therapy Evaluation authored by V11 (Speech Therapist) documented, Patient demonstrated difficulty swallowing with reports of coughing during noon meal on 9/13/23. It is still recommended that patient remain on the current ordered diet. An Illinois Department of Public Health Initial and Final Report, dated 9/13/23, documented, On 9/13/23 at approximately 4:30pm, nursing staff was called to the dining room in response to a possible choking resident. Upon arrival, (R1) was noted to be coughing frequently and leaning forward in her wheelchair. Resident was encouraged to continue coughing by staff. Resident was unable to cough forcefully enough to clear her airway. Nursing staff then administered 3-5 back blows to resident without success. At that time, resident was noted to have stridor and then no air movement. At that time, Heimlich maneuver was initiated by nursing staff. After three Heimlich thrusts, the food was expelled and respiratory status returned to WNL (Within Normal Limits). Order was received for Speech Therapy to evaluate by next meal regarding the safety of current diet consistency which is mechanical soft with thin liquids. Resident had been previously treated by Speech Therapy and was discharged on 9/12/23 with no dysphasia indicators noted. Speech Therapist recommended that resident remain on the current ordered diet with the following swallowing guidelines: Constant supervision with meals and assist as needed. Verbal cues should be made to take one bite per swallow and alternate liquids and solids. Resident should remain upright 20 minutes after eating or drinking. Investigation: Residents current diet order is for a mechanical soft consistency. It was validated that she was served the correct consistency. The facility menu documented the following recipe instructions for the potato salad: Chopped soft potato salad-no raw veg (vegetable) lists the following ingredients: potato (peeled, cooked and diced), eggs, hard cooked, chopped, onion powder, pickle relish, sweet, mayonnaise, mustard, and salt. This recipe documents to peel potatoes and cut into a small to medium dice. Place potatoes in a large (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: 145376 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 145376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakview Nursing & Rehab 1320 West 9th Street Mount Carmel, IL 62863 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)