Health inspection·February 1, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to properly monitor personal food storage for four of four residents (R25, R63, R65, and R17) reviewed for environment in the sample 35. 1. R25's face sheet, dated 1/31/24, documented that R25 was admitted to the facility on [DATE] with diagnosis of hypertensive heart disease with heart failure, Osteomyelitis, chronic obstructive pulmonary disease, neuromuscular dysfunction of bladder, paroxysmal atrial fibrillation, cardiomyopathy, anxiety disorder, osteoarthritis, and chronic gout. R25's MDS (Minimum Data Set), dated 1/16/24, documented that R25 is severely cognitively impaired. On 1/29/24 at 9:15 AM, R25 was observed resting in bed. R25 had a small refrigerator sitting on his nightstand. The nightstand was within reach of R25. The refrigerator had a thermometer that read 78 degrees. The contents in the refrigerator included a gallon of chocolate milk that was half full and warm to touch, individually wrapped homemade caramels, a jar of pickles that had been partially consumed, condiments, and cans of V8. There was food debris and water on the bottom shelf. The refrigerator had a foul sour odor coming from it and multiple gnats were observed flying around the refrigerator and throughout the room. On 1/30/24 at 9:40 AM, the refrigerator thermometer read 80 degrees and the same ingredients were observed within the refrigerator. There was a foul odor coming from the refrigerator and multiple gnats were observed flying around the refrigerator and throughout the room. On 1/30/24 at 9:50 AM, V1 Administrator presented a refrigerator temperature log for R25's refrigerator dated January 2024. V1 stated that the housekeeping department was responsible for checking the refrigerators everyday and for monitoring the temperatures. The January 2024 temp log documented that R25's refrigerator temperature was 40 degrees on 1/29/24 and 40 degrees on 1/30/24. 2. R63's face sheet, dated 1/31/24, documented that resident was admitted to the facility on [DATE] with diagnosis of osteoarthritis, type 2 diabetes, bipolar disorder, anxiety disorder, hyperlipidemia, gastro-esophageal reflux disease, and restless leg syndrome. R63's MDS, dated [DATE], documented that resident is cognitively intact. On 1/30/24 at 9:22 AM, R63 was sitting in his recliner in his room. R63 stated that he uses his refrigerator every day, and he could not recall the last time it had been cleaned or inspected. The refrigerator had a large amount of food debris on the bottom shelf. There was no thermometer in the Page 1 of 2 146048 146048 02/01/2024 Taylorville Skld Nur & Rehab 800 McAdam Dr Taylorville, IL 62568

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some refrigerator. The refrigerator contained an open package of lunch meat that did not have a date of when it was opened. The refrigerator also contained cheese, applesauce, and condiments. On 1/30/24 at 9:50 AM, V1 Administrator presented a refrigerator temperature log for R63's refrigerator dated January 2024. The January 2024 temperature log documented that R63's refrigerator temperature was 40 degrees on 1/29/24 and 40 degrees on 1/30/24. 3. R65's face sheet, dated 1/31/24, documented that R65 was admitted to the facility on [DATE] with diagnosis of metabolic encephalopathy, chronic obstructive pulmonary disease, type 2 diabetes, Parkinson's disease, dementia, hypertension, and peripheral vascular disease. R65's MDS, dated [DATE], documented that R65 is moderately cognitively impaired. On 1/30/24 at 9:28 AM, R65 was observed resting in bed. There was a small refrigerator next to his bed within his reach. The refrigerator did not have a thermometer in it. There was a jar of salad dressing that was half full. The refrigerator contained a package of opened ham with no opened date. The refrigerator also contained nutritional shakes and soda. On 1/30/24 at 9:50 AM, V1 Administrator presented a refrigerator temperature log for R65's refrigerator dated January 2024. The January 2024 temperature log documented that R65's refrigerator temperature was 40 degrees on 1/29/24 and 40 degrees on 1/30/24. 4. R17's face sheet, dated 1/31/24, documented that R17 was admitted to the facility on [DATE] with diagnosis of emphysema, chronic kidney disease, major depressive disorder, anxiety disorder, hypertension, and dementia. R17's MDS, dated [DATE], documented that R17 is cognitively intact. On 1/30/24 at 9:35 AM, R17's room had a small refrigerator sitting on the floor. The refrigerator had soda spilled on the bottom shelf. There was an undated and unlabeled disposable cup containing a liquid substance with a straw in the refrigerator. R17 stated that he did not know what was in the cup. There was no thermometer in the refrigerator. On 1/30/24 at 9:50 AM, V1 Administrator presented a refrigerator temperature log for R17's refrigerator dated January 2024. The January 2024 temperature log documented that R17's refrigerator temperature was 40 degrees on 1/29/24 and 40 degrees on 1/30/24. Facility Food and Nutrition policy dated 9-1-21 documents in part, The use and storage of food brought to residents by family and other visitors must be monitored to ensure safe and sanitary storage, handling, and consumption. Guidelines. 1. Temperature records or each cold storage unit maintained to ensure temperatures remain at or below 40 degrees for refrigerator . 2. Daily temperatures will be recorded. 3. An accurate thermometer will be kept in each refrigerator and freezer . 146048 Page 2 of 2