Inspection·March 25, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to follow a resident's food preference by serving oatmeal instead of grits. This failure affected 1 resident (R10) out of 7 residents reviewed for dietary services, in a total sample of 20 residents. Residents Affected - Few Finding Include: R10's Face Sheet documents resident is a [AGE] year-old with diagnoses including but not limited to: Malignant neoplasm of supraglottis, moderate protein-calorie malnutrition, cerebral infarction, unspecified asthma, vitamin D deficiency. Minimum Data Set Section (MDS) section C (dated 02/13/2025) documents that R10 has a Brief Interview for Mental Status (BIMS) score of 15, indicating that R10's cognition is intact. Care plan (dated 05/28/2024) documents that R10 is at nutritional risk as disease progresses. Diagnoses are supraglottis cancer, moderate protein calorie malnutrition, lymphedema, schizo-affective disorder, nicotine dependence, dysphagia. The care plan documents that R10 has been identified to have some degree of risk to develop malnutrition with a body mass index (BMI) of 20.9. On 03/18/2025, surveyor was conducting a complaint investigation survey in regard to dietary services. At 9:20 AM, surveyor interviewed R10. R10 stated, They keep sending me oatmeal for breakfast. I have oatmeal and I breakout when I eat it. I keep on telling them not to send me oatmeal, but they keep sending it anyway. I told the nurses and the certified nursing assistants (C.N.A.s) that I don't want oatmeal. Yesterday, I spoke to a dietary aide that works in the kitchen and I told her that I hate oatmeal and that I breakout when I eat it. I told the aide not to send me oatmeal, and they still continue to send it. Surveyor assured R10 that surveyor would come and inspect R10's breakfast tray the following day in order to determine if the facility is following R10's dietary preference. The following morning, on March 19, surveyor went to R10's room to inspect R10's breakfast tray. At 9:13 AM, R10's breakfast tray arrived. Surveyor inspected R10's breakfast tray and noted that R10 received oatmeal, which is a type of hot cereal that R10 strongly dislikes. Surveyor inspected R10's meal ticket which was located on R10's tray. The meal ticket read, Dislikes: Oatmeal. R10 was upset when she saw that she was served oatmeal again. R10 stated, See they keep sending me oatmeal, I hate oatmeal. I am allergic to oatmeal and I breakout from it. On 03/19/2025, at 9:40 AM, V7 (registered dietitian) stated,R10 is on a general diet with thin liquids. As far as preferences, oatmeal is listed as a dislike. This is one of the meals that the resident does not like and does not wish to have oatmeal for breakfast. R10 had a 6-month weight loss, and interventions were put into place to prevent R10 from losing weight. R10 has nutritional drink (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 3 Event ID: 145661 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 145661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze West 5130 West Jackson Boulevard Chicago, IL 60644 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)