Inspection·February 18, 2025

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 ensure food was served at a temperature to meet resident satisfaction for 4 of 4 residents (R1, R2, R3, and R13) reviewed for food temperatures in the sample of 13. Residents Affected - Some The findings include: R1's face sheet showed he was admitted to the facility on [DATE]. R1's facility assessment dated [DATE] showed he has no cognitive impairment. On 2/18/25 at 12:10 PM, R1 said the food is always cold. R1 said he was told by V8 (Dietary Manger) that the temperature meets state requirements but that by the time it is served its cold. R2's face sheet showed he was admitted to the facility on [DATE]. R2's facility assessment showed he has no cognitive impairment. On 2/18/25 at 12:27 PM, R2 said, The food is not hot most of the time. I have to go heat it up in the microwave a lot. R3's face sheet showed he was admitted to the facility on [DATE]. R3's facility assessment dated [DATE] showed he has no cognitive impairment. On 2/18/25 at 12:30 PM, R3 said the food is usually cold. R3 said, I just eat it anyway but I would like it better warm. R13's face sheet showed he was admitted to the facility on [DATE]. R13's facility assessment dated [DATE] showed he has moderate cognitive impairment. On 2/18/25 at 12:32 PM, R13 said, Usually by the time we get the food it is cold . there is a microwave we can take it to but if everyone has to warm it up the line would be a mile long. On 2/18/25 at 11:46 AM, there was regular texture shredded chicken, regular texture rice, regular texture corn, creamed corn, and two divided plates that had already been served with pureed chicken, pureed rice, and pureed corn on the second floor steam table. V5 (Dietary Aide) said they check temperatures on the steam table prior to serving on the second floor but she had forgotten the thermometer. V5 retrieved the thermometer and proceeded to check temperatures. The regular texture chicken was 117 degrees, the regular rice was 129 degrees, the mechanical soft chicken was 125 degrees, the pureed chicken was 106 degrees, the pureed rice was 118 degrees, and the pureed corn was 104 degrees. The facility's policy and procedure with revision date of 9/18/23 showed, Food Safety and Sanitation . Hot food prepped for serving will maintain a minimum temperature of greater than or equal to 135 degrees Fahrenheit when on the steam table and prior to being served to the residents. 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: 145937 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 145937 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Forest City Rehab & Nrsg Ctr 321 Arnold Avenue Rockford, IL 61108 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)