Health inspection·May 8, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on interview, observation and record review, the facility failed to provide nutritional supplements as ordered for 2 (R56, R58) of 12 residents reviewed for nutrition in a sample of 40. Residents Affected - Few Findings include: 1. R45's face sheet documents an admission date of 11/11/20 and diagnoses including: Cerebral ischemia, Dementia, Polyarthritis, Repeated falls, scoliosis, lumbar region, Essential hypertension, Spinal stenosis, lumbar region without neurogenic claudication, Other specified disorders of bone density and structure, multiple sites, Osteophyte, left hip, Diaphragmatic hernia without obstruction or gangrene, Type 2 diabetes mellitus without complications, Trochanteric bursitis, right hip, Unsteadiness on feet, Gastro-esophageal reflux disease without esophagitis, Chronic kidney disease, stage 3, iron deficiency anemias, History of falling, Anxiety disorders, Insomnia, Pain in unspecified joint, Vitamin D deficiency, Hypothyroidism, Restless legs syndrome, and Dysuria. R45's Physician order sheet documents a diet order of mechanical diet with double desserts and nutritional shakes with meals with a start date of 03/10/24 and an end date documented as: open ended. On 05/07/24 at 11:45 AM, R45 was served the lunch meal and did not receive her nutritional shake, nor any substitute for the nutritional shake. On 05/07/24 at 1:30 PM, V10 (Dietary Manager) stated, the facility did run out of nutritional shakes today. V10 stated they should have provided nutritional ice creams as a substitute. V10 stated he has been trying to educate his staff on situations like this. The facility policy dated 02/2024 titled, Weight Management Program documents in part: Policy: It is the policy of (this facility) to manage resident weight through prevention, assessment, and implementation and evaluation of interventions. 12. The charge nurse will notify the attending physician of the current resident's condition and of the RD's (Registered Dietician) recommendations and document the physician's order on the physician's order sheet and the 24 hour report sheet. 2. R56's Face Sheet dated 05/08/24, documents an admission date of 07/08/23 with diagnoses in part, of unspecified severe protein-calorie malnutrition, hypertension, dysphagia, oropharyngeal phase, hypo-osmolality and hyponatremia, hyperlipidemia, and abnormal weight loss. R56's Minimum Data Set (MDS) Section GG dated 03/04/24, under eating documents that R56 requires supervision or touching assistance. R56'S Current Care Plan documents a Category of Nutritional Status, noting a problem of Resident (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 5 Event ID: 145388 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 145388 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Helia Healthcare of Olney 410 East Mack Olney, IL 62450 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)