Mascoutah Rehab And Nursing

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

working evening shift, and 3 CNAs working night shift. On 12/18/25, there were 4 CNAs working day shift, 2 CNAs working evening shift, and 3 CNAs working night shift. On 12/16/25 at 10:40 AM, V1, Administrator, stated the CNAs think they need 4 CNAs per shift, but with a census of 33, they only need 3 CNAs on day shift, 3 CNAs on evening shift and 2 CNAs on night shift. V1 stated they have had turnover with the CNA staff recently and are actively hiring and recruiting. The Facility Assessment, dated 11/1/25, documents

they require 15 full time employees to provide competent resident support and daily care. The Staffing Policy, with a revision date of 2/20/25, documents the following: The facility will provide sufficient staff with

the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity, and diagnoses of the facility's resident population in accordance with the facility assessment. The Centers for Medicare and Medicaid Services, Form 671, dated 12/16/25, documents there are 33 residents residing in the facility.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mascoutah Rehab and Nursing

201 South 10th Street Mascoutah, IL 62258

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

Resident R16's Physician Order dated 11/30/2025 at 1:57 PM documents Resident R16 is on a Low Concentrated Sweets Diet.

1. 7. On 12/16/25 at 11:06 AM, Resident R29 stated the food in the facility is horrible and herself and other residents

practically go hungry because the food is awful, cold, and there is not enough at times.

Residents Affected - Many Resident R29's Undated Face Sheet documents Resident R29 was admitted to the facility on [DATE REDACTED]. Resident R29's MDS dated [DATE REDACTED] documents Resident R29 is cognitively intact. Resident R29's Physician Order dated 11/12/2024 at 10:42 AM documents Resident R29 is on a Regular Diet.

2. 8. On 12/17/25 at 11:46 AM, V6, Dietary Cook, removed an industrial sized pan of scalloped potatoes out of

the oven and placed them on top of the stove underneath the hood vent. On 12/17/25 at 12:20 PM, V6 placed the industrial sized pan of scalloped potatoes on the steam table and served the residents without taking the temperature before serving.

3. 9. On 12/17/25 at 12:30 PM, after the last resident had been served, food temperatures were taken with a

calibrated thermometer on the steam table, and the following food temperature was not within the safety food code guidelines of 135 degrees Fahrenheit (F) or higher: pork loin 123.0 F.

4. 11. On 12/18/25 at 1:00 PM, during the resident council meeting, the following concerns with the food were

voiced: Resident R20 stated the food is gross, over the weekend they had some sort of fettucine, the noodles weren't cooked, and it wasn't fit to eat. Resident R20 stated another time she got to the dining room late for lunch because there wasn't enough staff. She asked for a grilled cheese and the cook, told her no they didn't have time. Resident R20 stated she is hungry a lot because the food isn't edible. Resident R1 stated the food [NAME] are small, not even child size portions. Resident R1 stated they started using smaller glasses too. Resident R20 stated he has snacks in his room

he can eat but not everyone does. Resident R1 stated it's all due to budget. Resident R30 stated on the weekends they are screwed, the food is bad, they have an alternate menu but it is just as bad. Resident R30 stated he was going to go out and buy some canned sardines and smoked ham so he will have something to eat.

On 12/17/2025 at 3:20 PM V17, Dietary Manager, stated all hot food temperatures should be between 170-190 degrees Fahrenheit and temperatures are taken before food is served to prevent food borne illness.

On 12/18/25 at 3:00 PM, V1, Administrator, stated they do not have a policy on food palatability/taste.

The Facility's Food Temperatures Policy Revised 12/30/2024 documents Food stored hot will be kept at 135 degrees F or above. Food will be cooked to the appropriate internal temperature per regulations.

The Facility's Food Storage Areas Policy Revised 12/30/2024 documents Hot foods or potentially hazardous food will leave the kitchen or steam table at 135 degrees F or above.

The Centers for Medicare and Medicaid Services, Form 671, dated 12/16/25, documents there are 33 residents residing in the facility.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet