Health inspection·June 15, 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. Based on observation, interview, and record review the facility failed to ensure the residents received the correct portion size of fried potatoes, mixed vegetable, and pureed Italian sausage during the lunch meal for all residents receiving meals in the facility. The findings include: The facility data sheet dated 6/15/24 shows 126 residents reside in the facility. On 6/15/24 at 12:06PM, V5 (Dietary Aide) was plating the lunch meal. There were three large pans on the steam table: one with Italian sausage, one with mixed vegetable, one with shredded potatoes. There were four smaller pans, one with chopped/ground Italian sausage, pureed Italian sausage and bun, mashed potatoes, and pureed vegetables. The large pan of mixed vegetables had a spoodle with a white handle resting in it. V5 verified this spoodle was a 3 ounce serving size (not the recommended 4 ounce). V5 used the spoodle to scoop up a level serving size of the mixed vegetables and put it on the plates. V5 used his gloved hand to measure a handful of shredded potatoes and put the handful of potatoes on the plate. V5 filled several plates with an Italian sausage and bun, spoodle of vegetables, and a handful of potatoes. V5 was asked how much the serving size of potatoes should be and said, I just give them a handful. I give them a little more than I'm supposed to. The pureed mixed vegetable, mashed potatoes, and chopped Italian sausage had a blue ice cream like scoop in it that V5 used to plate the servings. The pureed bread and Italian sausage had a green handled ice cream like scoop that V5 used to serve this item. V5 said all the residents received the shredded potatoes, except the pureed diets who got mashed potatoes. All the residents got the mixed vegetable except those on pureed diet, who received the pureed mixed vegetable. On 6/15/24 at 12:22PM, V3 (Certified Dietary Manager) looked at the food items on the steam table and the utensils being used to measure the items. V3 verified the pureed vegetables had a blue scoop, measuring 2 ounce (1/4 cup)of vegetable, the meat had a green scoop measuring 2 2/3 ounce of meat/bread, and the spoodle in the regular vegetables measured 3 ounces. V3 said they should be following the recommended serving size listed in the book provided, which also included the menu and recipes for the food items. V3 looked in the book and said the serving size should have been 4 ounces, or 1/2 cup, for the mixed vegetables (not 3 ounces). The pureed mixed vegetables should have been 4 ounces (not the 2 ounces served). V3 said the pureed Italian sausage serving size should be two ounces. V3 said the pureed italian sausage also had the bun pureed with it. V3 was asked if the 2 ounce portion included adding the bun to the meat and serving them together? V3 said no, I'm not sure what the serving size would be then. On 6/15/24 at 12:35PM, V3 said [V5] should not have been measuring the shredded potatoes with his Page 1 of 3 145908 145908 06/15/2024 Amberwood Care Centre 2313 North Rockton Avenue Rockford, IL 61103

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many hand. He should be using the recommended scoop. V3 said yes the 2 ounce scoop would be the wrong size for the pureed sausage and bun because the bread was added to the meat and pureed together. The total volume of food changed. On 6/15/24 at 12:40PM, V5 said he should have followed the book to determine how much the serving size of each lunch item should have been. V5 said there is also a sheet hanging on the the wall that tells the serving sizes of utensils. V5 verified he pureed the bun and meat together, and verified he used the 2 ounce scoop (green handle) to dish the pureed meat and bread. V3 (Dietary Manager) was present and looked at the meat and bun pureed mixture. V3 looked at the scoop used for meal service and said it was 2 and 3/4 ounce. V3 said the correct serving size of the pureed Italian sausage and bun should have been 5 and 2/3 ounce or 3/4 cup. On 6/15/24 at 1:40PM, V4 (Registered Dietician) said the menus provided to the facility are created by a dietician. The menu and serving size is designed to ensure the recommended nutrients are given. The serving size is listed for each menu item and is contained in a book in the kitchen. The facility is expected to follow the menu, and the expected serving size. The facility is also supposed to serve food with the appropriate utensil. Utensils are consistent for portion control, hands would not be. V4 said if the facility pureed the Italian sausage and bun together, they would add the serving sizes for each item together, and this would tell them how much of the combined food item should be served. In this case, they would add the recommended portion size of the protein (Italian sausage), with the recommended serving size of the starch (bun) to determine how many ounces to give. V4 said, no 2 ounces would not be an appropriate serving size for the pureed Italian sausage and bun. The goal of the recommended serving size is to meet the nutritional needs, including the recommended vitamins, mineral, and protein needs of the resident. On 6/15/24 at 3:12PM, V2 (Director of Nursing) said yes, they should be following the recommenced serving sizes for the food items based off the menu recommendations. The menu dated 6/15/24 shows the lunch meal consisted of Italian sausage, fried potatoes with onions, seasoned zucchini, chilled pears, hot dog bun, ketchup/mustard, coffee/tea, condiments. The pureed bread serving recommendation in the dietary book shows pureed bread- serving size, 2 slices = # 8 scoop. The pureed Italian sausage serving recommendation in the dietary book shows serving size #12 scoop. This also includes directions to add liquid and thickener when pureeing. It does not include directions to add bread. The fried potatoes and onions serving recommendation in the dietary book shows serving size #8 scoop = 1/2 cup. The seasoned zucchini serving recommendation in the dietary book shows serving size: #8 scoop = 1/2 cup. The pureed seasoned zucchini serving recommendation in the dietary book shows serving size: #8 scoop (1/2 cup). The facility provided a dietary list printed 6/15/24, that showed all residents received regular, ground, or pureed lunch except R20 who is NPO. 145908 Page 2 of 3 145908 06/15/2024 Amberwood Care Centre 2313 North Rockton Avenue Rockford, IL 61103

F 0803 The facility policy dated 9/26/23 Menu & Nutritional Adequacy pureed Food Preparation shows Level of Harm - Minimal harm or potential for actual harm 2. Standardized recipes will be sued to produce pureed food to maintain nutrient content. 6. Proper scoop sizes will be used. Residents Affected - Many The facility policy dated 9/26/23 Portion Control shows: 1. Dietary staff will serve portions to residents based on planned menus that list the portion size for each food item. 3. Proper serving utensils (ie, scoops, ladles, or spoons) are used to assure accurate portions are served. The facility policy dated 9/25/23 Menu Requirements shows: Menus are developed to meet the Daily Recommended Intake national guidelines, regional food preferences, resident input, and regulatory parameters. 145908 Page 3 of 3