Health inspection·April 1, 2025

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to provide diets as ordered and failed to follow pre-planned meals for 2 of 4 residents (R3, R4) in a sample of 7. Findings Include: 1. On 3/28/2025 at 9:10 AM, R3 stated he does not always get what he orders from the facility's menu, due to the facility running out of food or not having what is listed on the menu for that meal. R3's Minimum Data Set (MDS) dated [DATE] documents R3 is cognitively intact. R3's Physician Order dated 3/19/2025 documents R3 is on a Consistent Carbohydrate diet with regular texture and liquid consistency. 2. On 3/28/2025 at 11:52 AM, R4 stated she is on a mechanical soft diet and will receive 2 items on her tray but will not always receive 3 or 4 items. R4 stated the facility does not always have available what is listed on the menu. R4's MDS dated [DATE] documents R4 is mildly cogitatively impaired and needs supervision or touching assistance with eating. R4's Physician Order dated 3/4/2025 at 7:38 PM, documents R4 has a regular diet with mechanical soft texture, regular liquid consistency. R4's Care Plan dated 7/01/2024 documents diet to be followed as prescribed. Grievance dated 1/31/2025 documents description of incident: Not offering different choices in drinks only giving half sandwiches for a meal. Residents ordering food and never getting it. Grievance dated 1/31/2025 documents description of incident: Early dialysis patients not getting breakfast before dialysis. Grievance dated 1/31/2025 documents description of incident: Food quality-no protein in meals, burnt food, being out of milk, juice, lemonade etc. Serving the same soup 2-3 days in a row. Two people had this concern. Grievance dated 2/28/2025 documents description of incident: Food is cold, not getting what is on Page 1 of 2 146122 146122 04/01/2025 St Paul's Senior Community 1021 West E Street Belleville, IL 62220

F 0803 the menu, no protein offered on some meals. Level of Harm - Minimal harm or potential for actual harm Grievance dated 3/2/2025 documents description of incident: Lunch menu said shrimp but served grilled cheese and chips on paper plates. Grilled cheeses were burnt-dietary aide told nurse she didn't know how to work the stove top. Dietary aid didn't serve any soup. Nurse made all new sandwiches. Never any fruit with meals or on hall. Residents Affected - Few On 3/28/2025 at 8:15 AM V4, Interim Certified Dietary Manager stated he has been in his current position for about a month and when he started this position the facility was not making everything on the menu for the residents who have special diets such as pureed and mechanical soft. V4, Interim Certified Dietary Manager, stated residents were not receiving the proper number of items off the menu if they have a special diet. On 3/28/2025 at 8:34 AM V5 Licensed Practical Nurse (LPN) stated residents that are on a mechanical soft or pureed diet will receive 2 things off the facility menu made for their diet, but not always 3 or 4 items. On 3/28/2025 at 9:30 AM, V3, Assistant Director of Nursing (ADON), stated residents who have orders for special diets such as a mechanical soft or pureed diet are expected to receive the facility's full menu made to how the resident's diet is ordered, which should consist of at least 3 items. On 3/28/2025 at 11:47 AM V11, Activities Assistant, stated residents who are on special diets will not always receive 3 items from the menu made for them, but they will receive 2 items. On 3/28/2025 at 11:50 AM V12, Certified Nursing Assistant (CNA), stated residents with special diets will receive 2 items from the facility's menu made per their diet, however they will not always receive 3 items. On 3/28/2025 at 12:00 PM V14, LPN stated not everything on the facility's menu will be made for the residents with special diets such as mechanical soft or pureed. V14, LPN, stated she knows on the weekends, residents will only receive maybe 2 items from the menu, but not 3 or 4 items. The Facility's Menus and Special Diets Policy, Subject Menu Planning dated 9/7/2017 states The nutritional needs of residents will be met in accordance with the recommended dining allowances of the Food and Nutrition Board of the National Research Council, National Academy of Science (which are adjusted for age, gender, activity level, and disability). through nourishing well balanced diets, unless contraindicated by medical needs. Menus will also be prepared and presented in a hospitality charged environment. 146122 Page 2 of 2