Inspection·August 23, 2023

F 0804 On 8/22/23 at 9:12 AM, R5 stated, I always eat in my room, and the food is usually cold by the time I get it. Level of Harm - Minimal harm or potential for actual harm 3. R8's Face sheet, undated, documents, R8 was admitted to the facility on [DATE]. Residents Affected - Few R8's Electronic Medical Record, documents, R8's diagnosis include: Osteoarthritis, Spondylopathy-Lumbar, Dementia, Alzheimer's Disease, COPD, Anxiety Disorder, Major Depressive Disorder, Cirrhosis of Liver, Schizoaffective Disorder, Gastroesophageal Reflux Disease, (GERD), HTN, and Psoriasis. R8's Care Plan, dated 11/22/22, documents, R8 is at an increased risk for nutritional issues. Interventions: Offer supplements/snacks, obtain/update food preferences, provide diet as ordered, monitor nutritional status, obtain weights as ordered, observe signs/symptoms of dehydration. On 8/22/23 at 10:53, R8 stated, I'm the president of the Resident Council Meeting and one of the general complaints is about the food here. It is not very good tasting and is almost always cold. I eat in my room, and I am at the end of a hall, and by the time I get my food, it is cold. On 8/22/23 at 12:55 PM, R8, stated, I was happy for lunch today, I actually got a warm plate of food. That metal pan under the plate does wonders. On 8/22/23 at 10:38 AM, V13, Dietary Manager, stated, We serve breakfast at 7:30 AM, Lunch at 12:00 PM, and Dinner at 5:00 PM. It seems like majority of the residents are now eating in their rooms. The kitchen will plate the food and will place the trays in a metal cart that is not heated. That cart is taken to the halls where the CNAs are responsible for delivering the trays to each resident. We used to use hot plates, but when COVID hit, we didn't have enough of them to go around so for some reason, we quit using them. We need to get some more and start using them again. There is really no way to keep the food warm once we plate it. We count on the CNAs to deliver it to the resident quickly. On 8/22/23 at 11:45 AM, Dietary Department was getting ready to serve lunch. The food was already placed in the warmer/serving line and temperatures were checked. The Pasta dish was 169 degrees, the Peas 202 degrees, the Ham (substitute item) 192 degrees, Scalloped Potatoes, (substitute item), 196 degrees, Greens (substitute item) 199 degrees, and the dinner rolls were sitting in a large metal bowl on top of the serving line and not warmed up. There were two unheated metal carts for delivering trays to resident rooms (100 hall and 200 hall). There were already trays with the resident's meal ticket, a drink, and a bowl of oranges on each tray in the metal cart. V13 has the plate warmers and is now using them for today's meal. On 8/22/23 at 11:55 AM, the first plate of food was placed on the 100-hall cart. All plates are covered with plastic plate cover. On 8/22/23 at 12:05 PM, Surveyor's Sample Plate was placed on a tray on the 100-hall cart. On 8/22/23 at 12:07 PM, the 100-hall food cart was taken out of the kitchen to the 100-hall with 21 food trays on this cart. V1, Administrator, made sure that all available staff, including office personnel, were passing out trays to the residents in their rooms. On 8/22/23 at 12:15 PM, the 200-hall food cart was filled and taken to the floor and passed out to residents with 20 food trays in the cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146075 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 146075 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare of Granite City 3500 Century Drive Granite City, IL 62040 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 8/23/23 at 12:20 PM, the last food tray was delivered to the 100-hall residents, and the sample plate was delivered to the conference room for testing. The food temps on the sample plate were, the Peas were at 96 degrees, and the Pasta was at 110 degrees. The Food palatability was a little bland, needed more seasoning for taste, the roll was soft but not warm, the bowl of oranges was at room temperature, and the grape juice drink was warm, and no longer cold. The oranges and drink were sitting on the tray with the other hot food items from the kitchen. On 8/23/23 at 12:47 PM, V13, Dietary Manager, stated, No one has ever told me there was complaints about cold food. I knew nothing about it. On 8/23/23 at 12:53 PM, V14, Activity Director, stated, We actually have a Food Committee, that is basically part of the Resident Council meeting, and we meet after the Resident Council and pretty much consists of the same residents, we just call it the Food Committee. If there are concerns brought up about Dietary, they are given to (V13) for her to take care of. I know that (V13) has attended some of these meetings and she has heard these issues for herself. On 8/23/23 at 12:55 PM, R8, Resident Council President, stated, (V13) has attended some of the Food Committee Meetings, and she would ask me why I keep reporting all of these Dietary issues, because it doesn't matter, nothing is going to change around here. On 8/23/23 at 2:02 PM, V1, Administrator, stated, I am responsible for the cold food because, I'm over the entire facility. I would have thought the Dietary Manager, would have taken care of these problems, once she was made aware, and apparently, she just didn't do anything about it. It will be fixed going forward. I guarantee that. The Facility's Monitoring Food Temperatures for Meal Service Policy/Guideline, dated 2016, documents, Food temperatures will be monitored daily to prevent food borne illness and ensure foods are served at palatable temperatures. 1. Prior to serving a meal, food temperatures will be taken and documented, for cold and hot foods to ensure proper serving temperatures. Any food item not found at the correct holding/serving temperature will not be served but will undergo the appropriate corrective action listed below. 2. If the serving/holding temperature of a hot food item is not at 135 degrees F, (Fahrenheit), or higher when checked, they will be reheated to at least 165 degrees F for a minimum of 15 seconds, only once and discarded or consumed within two hours. Cold food item or beverage is not at 41 degrees F or below, (for less than four hours in duration), will be chilled on ice or in the freezer until it reaches 41 degrees F, (or less), before service. 3. All hot foods will be kept in steam table pans on the steam table for not more than four hours. However, to assure the nutritive value and palatability of foods that are served, it is recommended to hold hot foods no more than two hours on a steam table. Cold foods and beverages will be held on ice or in the cooling unit during meal service. 4. Meals that are served on room trays may be periodically checked at the point of service for palatable food temperatures. Note: per Serv-Safe guidelines food held out of temperature control for less than four hours are safe to consume. No food is held for longer than two hours on the steam table to ensure food quality. Therefore, foods for room trays are not at risk for food borne illness. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146075 If continuation sheet Page 3 of 3