Health inspection·August 5, 2024

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service. Based on observation, interview and record review the facility failed to provide a sufficient number of dietay staff to ensure meals are served at the facility designated meal times. This failure has the potential to affect all 29 residents living in the facility. Findings include: The facility policy revised 6/06 for mealtimes documents breakfast is to be served at 7:00am, Lunch 11:30am, and Supper at 5:00pm. On 08/01/24 the breakfast service was observed. Service began at 7:25am, there were two dietary workers, including the V3, Dietary Manager in kitchen. At 07:35am, there were still several residents without trays. Three residents were served on Styrofoam plates, all residents had Styrofoam bowls. On 08/01/24 the lunch service was observed. Service began at 11:50am, and the first lunch trays were served. At that time there were two dietary workers in the kitchen. At 12:30pm, trays were still coming out a few at a time and people were finished with their meals while other people were still waiting. On 08/05/2024 the first lunch trays were served at 11:42am, there were three dietary workers in the kitchen including the V3, Dietary Manager. On 08/01/2024 at 10:36am, R3 who was alert to person and place stated in the morning breakfast runs a little late sometimes. On 08/01/2024 at 10:42am, R5 who was alert to person, place and time stated supper is the only meal that is on time. On 08/01/2024 at 10:46am, R6 who was alert to person, place and time stated breakfast is always late, but the other meals aren't usually on time either. On 08/01/2024 at 10:57am, V3, Dietary Manager stated she cannot keep staff, they hire people and then they usually do not pass background check. V3 stated that she interviews like crazy and then cannot get anyone to call her back. V3 stated that she uses the Styrofoam bowls because when it is just one or two staff in the kitchen it is the only way that it gets done. On 08/01/2024 at 01:35pm, V6 (Certified Nurse Assistant/CNA) stated meals are late often due to not having adequate kitchen staff. Page 1 of 4 145517 145517 08/05/2024 Axiom Healthcare of Mount Vernon 1700 White Street Mount Vernon, IL 62864

F 0802 Level of Harm - Minimal harm or potential for actual harm On 08/05/2024 at 12:45pm, V8 (CNA) stated meals can be late sometimes, usually due to lack of kitchen staff. On 08/05/2024 at 02:40pm, V7 (CNA) stated that meals are almost never served on time. V7 stated they are usually waiting on meals to be ready to serve them. Residents Affected - Many On 08/05/2024 at 03:02pm, V2 (Director of Nursing) stated meals are not served on time and they have been cited for it before. V2 stated part of their plan of correction was for her to start coming in at early to assist with passing breakfast, but honestly, the kitchen usually is not even ready when she gets there. A review of the dietary schedule for the month of July, documents four employees total, including the dietary manager that work in the kitchen. The facility's Resident Roster dated 07/31/2024 documents there are 29 residents residing in the facility. 145517 Page 2 of 4 145517 08/05/2024 Axiom Healthcare of Mount Vernon 1700 White Street Mount Vernon, IL 62864

F 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on observation, interview and record review the facility failed to serve meals at the facility's designated meal times. This failure has the potential to affect all 29 residents living in the facility. Findings include: The facility policy revised 6/06 for mealtimes documents breakfast is to be served at 7:00am, Lunch 11:30am, and Supper at 5:00pm. On 08/01/24 the breakfast service was observed. Service began at 7:25am, there were two dietary workers, including the V3, Dietary Manager in kitchen. At 07:35am, there were still several residents without trays. Three residents were served on Styrofoam plates, all residents had Styrofoam bowls. On 08/01/24 the lunch service began at 11:50am, and the first lunch trays were served. At that time there were two dietary workers in the kitchen. At 12:30pm, trays were still coming out a few at a time and people were finished with their meals while other people were still waiting. On 08/05/2024 the first lunch trays were served at 11:42am, there were three dietary workers in the kitchen including the V3, Dietary Manager. On 08/01/2024 at 10:36am, R3 who was alert to person and place stated in the morning breakfast runs a little late sometimes. On 08/01/2024 at 10:42am, R5 who was alert to person, place and time stated supper is the only meal that is on time. On 08/01/2024 at 10:46am, R6 who was alert to person, place and time stated breakfast is always late, but the other meals aren't usually on time either. On 08/01/2024 at 10:57am, V3, Dietary Manager stated that she uses the Styrofoam bowls because when it is just one or two staff in the kitchen it is the only way that it gets done. On 08/01/2024 at 11:35am, R14 who was alert to person, place and time stated meals come late often. On 08/01/2024 at 01:35pm, V6 (Certified Nurse Assistant/CNA) stated meals are late often due to not having adequate kitchen staff. On 08/05/2024 at 12:45pm, V8 (CNA) stated meals can be late sometimes, usually due to lack of kitchen staff. On 08/05/2024 at 01:35pm, R11 who was alert to person, place and time stated she eats in her room and her meals are never timely. On 08/05/2024 at 02:40pm, V7 (CNA) stated that meals are almost never served on time. V7 stated they are usually waiting on meals to be ready to serve them. 145517 Page 3 of 4 145517 08/05/2024 Axiom Healthcare of Mount Vernon 1700 White Street Mount Vernon, IL 62864

F 0809 Level of Harm - Minimal harm or potential for actual harm On 08/05/2024 at 03:02pm, V2 (Director of Nursing) stated meals are not served on time and they have been cited for it before. V2 stated part of their plan of correction was for her to start coming in at early to assist with passing breakfast, but honestly, the kitchen usually is not even ready when she gets there. The facility's Resident Roster dated 07/31/2024 documents there are 29 residents residing in the facility. Residents Affected - Many 145517 Page 4 of 4