Inspection·May 5, 2025

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on observation, interview and record review the facility failed to employee a qualified dietary staff member to oversee the operations of the kitchen. The facility failed to ensure residents' nutritional assessments were completed, in-person, by a qualified dietary staff member. These failures have the potential to affect all 51 residents in the facility. The findings include: The Facility Data Sheet dated 5/5/25 showed 51 residents resided in the facility. A facility list dated 5/5/25 showed V3 Dietary Manager was hired as the facility's dietary manager on 7/1/23. On 5/5/25 at 7:47 AM, V3 Dietary Manager and V4 Dietary Aide were the only kitchen staff, in the building, preparing and plating breakfast trays for the residents. On 5/5/25 at 8:26 AM, V3 Dietary Manager stated she had never received her certification in dietary management or food service. V3 stated she had taken the online dietary management course three times but was unsuccessful at passing the certification test. V3 stated she had never enrolled in any college courses. V3 stated no staff member in the facility was currently a certified dietary manager or certified food service manager. V3 stated she was responsible for completing quarterly nutritional assessments on residents. On 5/5/25 at 12:15 PM, V10 Registered Dietician (RD) stated she was hired as the RD at the facility on 2/25/25. V10 stated she did not know V3 Dietary Manager had never been certified in the role. V10 RD stated, I am 100% remote. I am only consulting for them (facility) and don't go into the facility. They call me when they need me. V10 RD stated she had never been in the facility's kitchen, was unaware of the day-to-day operations of the kitchen, and had never provided the kitchen staff with any education. V10 stated she is responsible for completing admission and significant change nutritional assessments on residents however she never does these assessments in-person. V10 stated, I do these assessments remotely. I don't assess residents in-person. I don't interview the residents when doing these assessments. I talk to staff and get their input when doing the assessments. On 5/5/25 at 2:00 PM, V11 Consultant and V2 Director of Nursing (DON) each stated they were aware V3 Dietary Manager had never become certified in her role. V11 Consultant stated he was unaware V10 Registered Dietician worked only remotely for the facility and had never been in the facility. (continued on next page) 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 4 Event ID: 146152 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 146152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Rochelle 1021 Caron Road Rochelle, IL 61068 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)