Inspection·June 12, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to follow proper sanitation and food handling practices, including not wearing a beard net to protect hair from getting into the food, and not covering food items during transportation. This failure has the potential to affect all 38 residents in the facility. Findings include: On 6/12/25 at 8:10 AM, V4, Cook, was seen working in the kitchen, preparing residents breakfast meal with no beard net on while having a full beard and mustache. On 6/12/25 at 9:25 AM, V5, Cook, was seen in the kitchen with a hat on, has a full beard with no beard net on. After V5 was interviewed, he went and got a hairnet and a beard net and put them on. On 6/12/25 at 9:30 AM, R5 stated she mainly eats in the dining room, the food always has a lid on the plate only, but in her room, there is no lid on her drinks or side dishes. R5 stated she does not see the male cooks wearing anything over their beards. On 6/12/25 at 9:35 AM, R2 stated he eats both in his room and in dining room and the main plate of food has a lid on it when delivered to his room, but nothing else is covered. R2 stated he doesn't remember seeing anyone with a beard net or something covering their beard. On 6/12/25 at 10:10 AM, R3 stated that he eats in his room for dinners and in the dining room for breakfast and lunch. R3 stated that the food delivered to his room is always covered, but not the side dishes or drinks. R3 stated that he does occasionally see the men in the kitchen with beards wear a beard net and usually a hat, but he estimates only about 60% of the time. R3 stated he was an inspector for the United States Department of Agriculture (USDA), and he is well aware of what kitchen requirements are and the expectations of the kitchen staff and he watches for things like that, and this facility needs some improvements. On 6/12/25 at 10:35 AM, R1 stated he is the President of the Resident Council. R1 stated whether he eats in his room or the dining room, the main food always come covered, but the side dishes and drinks are not. R1 stated the kitchen staff don't wear hairnets at all unless the State walks in. R1 stated the guys with the beards (V4, V5) never wear a beard net like they are supposed to. On 6/12/25 at 11:20 AM, V6, Certified Nursing Assistant (CNA)/Shower Aide, stated that she sees the kitchen staff wear hair nets, but not beard nets. V6 stated only the main plate of food has a lid on it, the sides and drinks never do. (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: 145518 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 145518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mascoutah Rehab and Nursing 201 South 10th Street Mascoutah, IL 62258 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)