Health inspection·September 14, 2024

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to serve an portion of food that meets the needs and preferences of the residents. This failure applies to all 238 residents receiving meals from the facility. Findings include: R1 is a [AGE] year-old female, with a diagnoses history of Psychosis, Auditory Hallucinations, Bipolar Disorder, Post Traumatic Stress Disorder, Schizoaffective Disorder, Recurrent Major Depressive Disorder, Non-Toxic Multi Nodular Goiter, and Abnormal Results of Thyroid Function, who was admitted to the facility 3/22/2023. R3 is a [AGE] year-old female, with a diagnoses history of Dementia, Schizophrenia, COPD, Dysphagia, Extrapyramidal Movement Disorder, and Hypothyroid Disorder, who was admitted to the facility 01/27/2021. On 09/13/2024 at 9:50 AM, V6 (Certified Nursing Assistant) stated, (R1) and (R3) could eat all day. The food portions are too small. (R1) eats pureed meals and they provide a scoop of pureed foods which doesn't seem adequate. The meal portions served are too small. R5 is a [AGE] year-old female with a diagnoses history of Type 2 Diabetes Mellitus, Mild Protein Calorie Malnutrition, and Chronic Kidney Disease, who was admitted to the facility 03/17/2024. On 09/13/2024 at 9:50AM, R5 stated, The food is okay sometimes, but not really enough. R5 opened his breakfast tray that was sitting at the bedside table and said, This is what I get for breakfast. There was one hard-boiled egg, one slice of bread, a half cup of grits, and a small cup of juice in resident's tray. R6 is an [AGE] year-old female, with a diagnoses history of COPD, Heart Failure, Weakness, and Anemia, who was admitted to the facility 03/17/2024. On 9/13/2024 at 10:00AM, R6 was asked about food, and stated, It is okay sometimes, but they don't give you enough. R6 was asked if they can get seconds if the portion was not sufficient, and she stated, No, you can ask, but they never give it to you. Food Committee Meeting Report, dated 07/29/2024, documents residents would like to see more meat for breakfast. (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: 145735 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 145735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of River Oaks 14500 South Manistee Burnham, IL 60633 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)