Inspection·November 16, 2022

F 0806 Level of Harm - Minimal harm or potential for actual harm Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observation, interview and record review, the facility failed to assess the individual food preferences for 2 (R13 and R74) of two residents reviewed for food preferences in the sample of 42. Residents Affected - Few Findings include: 1. R13's Face Sheet documented an admission date of 09/27/22. R13's November 2022 Physician Order Sheet documented an order for regular diet with regular consistency and thin liquids. R13's Dietician Progress Notes for 09/29/22, 11/03/22, and 11/10/22 documented weight loss with interventions to address weight loss, however contained no documentation as to R13's food preferences. There was no documentation in any of R13's dietary notes about R13's food preferences. On 11/14/22 at 12:16pm, R13 was alert and oriented to person and place. R13 got the month and year right but the date wrong. R13 stated R13 hates the food the facility serves R13. R13 stated R13 eats the same thing, a grilled cheese sandwich and/or chicken noodle soup, every day for lunch and dinner. R13 stated R13 always eats in R13's room. There was an untouched dish of beets on R13's tray. R13 stated, I don't know why they keep sending me this crap I don't like. R13 stated staff have never asked R13 what kinds of foods R13 likes. R13 stated staff has not explained to R13 what foods are always available. On 11/14/22 at 12:45pm, V4 (Certified Nursing Assistant/CNA) stated R13 is a picky eater who will only eat grilled cheese and chicken noodle soup. On 11/15/22 at 9:30am, V3 (Dietary Manager) stated it is her responsibility to interview residents about their food preferences and to document them within the Dietary Progress Notes. V3 stated she has not yet had an opportunity to assess or discuss food preferences with R13. V3 stated she does know R13 requests chicken noodle soup and grilled cheese daily. On 11/15/22 at 12:08pm, R13 was eating lunch in R13's room. R13 was eating two bowls of chicken noodle soup, without a grilled cheese. R13 stated R13 was not in the mood for grilled cheese today. R13 stated R13 always orders biscuits and gravy for breakfast. R13 stated R13 likes bacon and would eat it if served to R13, but it is not served very often and R13 is not sure if R13 can request it. R13 stated R13 likes fried eggs but the facility only serves poached or scrambled eggs. R13 stated nobody has ever asked R13 how R13 prefers R13's eggs. 2. R74's Face Sheet documented an admission date of 09/18/22. R74's November 2022 Physicians Order (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: 145841 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 145841 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Manor 3116 Williamson County Parkway Marion, IL 62959 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)