F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
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 sanitation and food handling
practices while preparing resident meals. Failed to record temperatures of food before serving residents.
Failed to maintain temperatures of food before serving food to residents. This failure affected 20 residents
reviewed for food safety.Findings include:On 02/20/26 at 12:00pm observed V21 (Dietary Aide) and V22
(Cook) preparing meal trays and meals for resident dining. V21 and V22 were observed with full facial
beards with no beard coverings.On 02/20/26 at 12:03pm V15 (Dietary Manager) stated that V21 (Dietary
Aide) and V22 (Cook) should both have beard coverings on while preparing resident meals. V15 stated that
hair can fall in the resident's food and that not covering their beards is unsanitary.On 02/20/26 at 12:05pm
V22 (Cook) stated that he didn't know that the facility had hair nets for beards. V22 stated that he should
have a hair net over his beard so that hair doesn't fall in the food.On 02/20/26 at 12:08pm V21 (Dietary
Aide) observed with ungloved hands, lick his hand and pick up menu ticket and place it on the resident
meal tray. Observed V21 prepare multiple trays which V15 (Dietary Manager) counted as 20 trays before
V21 sanitized his hands and placed gloves on.On 02/20/26 at 12:08pm V21 (Dietary Aide) stated that he
should not have licked his fingers and continued to prepare the meal trays. V21 stated that licking his
fingers is unsanitary.On 02/20/26 at 12:14pm V21 (Dietary Aide) observed with gloved hands, place mask
over V21's face, adjusting mask at ear and nose placement. V21 then observed to continue preparing meal
trays without removing gloves and sanitizing hands.On 02/20/26 at 12:14pm V15 (Dietary Manager) stated
that V21 (Dietary Aide) should have sanitized his hands and replaced his gloves before continuing the tray
line.On 02/20/26 at 12:27pm surveyor observed delivery of the 3 south meal carts delivered to the 3 south
dining room. V15 (Dietary Manager) pulled random tray from meal cart. V15 checked temperature of food
on the meal tray. Ham on the meal tray tempted at 87.8 degrees Fahrenheit. V15 stated that the ham should
be at least 110 degrees Fahrenheit. V15 stated serving food at the right temperature makes it safe for
residents to eat and makes it palatable.On 02/20/26 at 12:34pm surveyor requested to view temperature
log of temperature checks before lunch was served. V22 (Cook) stated that he checked the temperatures
before he served the lunch to residents, but he did not write them down anywhere. V22 stated that he is
unable to provide me with a temperature log.On 02/20/26 at 12:34pm V15 (Dietary Manager) stated that
V22 (Cook) should have taken the food temperatures before serving the food to the residents. V15 stated
that the food temperatures should be taken to make sure that food is safe to serve to the residents. V15
stated that food temperature checks should be kept on a log.Facility policy titled Employee Health and
Personal Hygiene) revised 09/17/23 documents in part, Policy: Food service employees shall maintain good
personal hygiene and be free from communicable illnesses and infections while working in the facility.
Procedure:. Hair restraints will be worn at all times. Beards should be well-trimmed and covered with an
appropriate hair restraint. Personnel that are serving food on trays or for activities must wear gloves
(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:
145764
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
145764
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Morgan Park Healthcare
10935 South Halsted Street
Chicago, IL 60628
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
while handling ready to eat food but do not have to hairnets.Facility's policy titled General Preparation and
Cooking Practices revised 09/18/23 documents in part, Policy: The facility will follow sanitary practices in
food preparation and cooking to keep food safe. Identification of potential hazards in the food preparation
process and adhering to critical control points can reduce the risk of food contamination and thereby
prevent foodborne illness. Procedure: Hands are washed thoroughly before touching food or equipment.
Hairnets or caps and beard guards are used in the preparation of food. Foods that have become unsafe
must be discarded. The following situations may render foods to be unsafe. when it is contaminated by
hands or bodily fluids. When it has exceeded the time and temperature requirement. Hot food prepped for
serving will maintain a minimum temperature of greater than or equal to 135F (degrees Fahrenheit) when
on the table and prior to being served to the residents. If the food is below 135F, the staff must reheat the
food to 165F to assure time and temperature control. Internal temperatures for cooking meals must meet:
145 degrees for fish, veal, lamb, pork, and other red meats.Facility's policy titled Tray Service dated
10/25/23 documents in part, Policy: Employees will use measures to ensure the sanitation and safety of
food provision on the tray line, transportation of meals, and tray delivery. Procedure:. 3. Temperatures are
taken prior to service to ensure hot foods and cold foods are maintained at the appropriate temperatures.
Temperatures will also be recorded 30 minutes into the meal service to ensure temperatures are
maintained. 4. If items are not at the correct temperatures, action will be taken so that temperatures are
restored to the correct temperatures. 5. Temperatures are recorded on the Tray Line Temperature Log and
kept on file for 1 year. 8. Food will be delivered to the residents in a sanitary way to prevent food-borne
illness. Protocol: 11. All food that is transported from the kitchen to other areas for service will be handled in
a safe manner, covered to prevent contamination, and in closed food carts. Hot foods will be at least
120-135 degrees, and cold food will be at 40-45 degrees at the time of service for palatability.Facility's job
description titled Dietary Aide documents in part, Summary: The Dietary Aide is responsible for aiding all
food functions as directed/instructed and in accordance with established food policies and procedures.
Essential Duties and Responsibilities: Ensure that the department is maintained in a clean and safe manner
by assuring that necessary equipment and supplies are maintained. Dietary Aide must also ensure the
facility's standards on Infection Control Precautions are being followed when performing daily
tasks.Facility's job description titled Cook documents in part, Summary: The [NAME] is responsible for food
preparation in accordance with current applicable federal, state, and local standard, guideline and
regulation with our established policies and procedures, and as may be directed by the Dietitian and/or
Director of Food Services, to assure that quality food service is provided at all times. Essential Duties and
Responsibilities:. Ensure that all food service procedures are followed in accordance with established
policies.
Event ID:
Facility ID:
145764
If continuation sheet
Page 2 of 3
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
145764
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/21/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Morgan Park Healthcare
10935 South Halsted Street
Chicago, IL 60628
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)
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
Based on observation, interview and record review the facility failed to provide a safe, functional, clean and
comfortable environment. This failure affects all residents residing in the facility.Findings include:On
2/20/2026 at 11:15am surveyor observed a picture with a bath blanket covering it on the 3rd floor at the end
of the North Hall. The glass in the picture frame had been broken out at the top and in the middle but there
was broken glass shards at the bottom of the picture frame. On 2/20/2026 at 11:21am V9 (Housekeeper)
stated the picture frame is broken with glass shards and if someone bumps into the picture frame it could
be dangerous.On 2/20/2026 at 11:22am V26 (Certified Nursing Assistant) stated it's a broken picture frame
with glass shards protruding from the bottom of the frame and it is a hazard to residents and can be used
as a weapon.On 2/20/2026 at 11:28am surveyor observed, on the second floor, the wall, in the shower
room, behind the toilet with a brown substance splattered on the wall and a yellowish gray and black debris
on the bottom of the toilet and floor.On 2/20/2026 at 11:30am V16 (Housekeeper) stated the brown
substance looks like feces on the wall and the yellowish gray substances looks like urine and the bathroom
should be cleaned twice a day and this mess should have been cleaned up.On 2/20/2026 at 2:08pm V25
(Maintenance Director) stated he was made aware that there was a picture frame on 3 North about 5
minutes after the surveyor saw it and that the frame had been taken down. V25 stated that it was not
documented in the work order binder.On 2/21/2026 at 8:48am V28 (Housekeeping Director) stated yes, the
entire toilet and the wall behind it should be cleaned daily and as needed and the purpose is to disinfect the
bathroom and allow it to appear homelike. No, I was not aware that there was a broken picture frame with
glass shards still in the frame on 3 North. V28 stated he will make sure those two items (bathroom cleaned
and picture frame removed) are taken care of. Preventative Maintenance Program with a reviewed date of
11/2023 documents, in part, all facility areas are kept clean and in safe condition.Undated Performance
Evaluation Housekeeping Assistant documents, in part, Main duties: G. remove dirt, dust, grease, film etc.
from surfaces using proper cleaning /disinfecting solutions.
Event ID:
Facility ID:
145764
If continuation sheet
Page 3 of 3