Prairie Oasis

resident will be placed in alternate room until repair is completed.

jeopardy to resident health or On February 7, 2026, Maintenance Director checked Resident's (R1) heating unit in addition to all floor safety heating units for coverings.

Heating units have proper protective cover in place and secure.

This was completed on February 12, 2026.

Maintenance Director and his assistant in addition to Weekend

On February 12, 2026, hourly rounding with recordings initiated on all units. (see attached) Surveyor verified that this was completed on 2/19/2026.

Administrator will be responsible for overall compliance to this removal plan in conjunction with Asst Administrator, Director of Nursing, Assist Director of Nursing and Maintenance Director by monitoring during routine rounds daily when on duty.

Each Charge Nurse and Facility Manager on Duty as well as Weekend Housekeepers as assigned will be responsible for monitoring overall compliance in absence of Admin, Asst Adm., DON, ADON and Maintenance Director.

The Quality Assurance Quality Improvement Team meets monthly.

This event will be brought again to the next monthly QAQI meeting for discussion and re-evaluation of interventions. If further interventions are needed at that time, they will be implemented accordingly.

Completion Date: February 19, 2026

• R5's face sheet documents in part the following diagnoses: unspecified dementia, severe with other

behavioral disturbance, traumatic subdural hemorrhage with loss of

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

11 PM-7 AM shift, on 2/7/2026 there were 7 nursing assistants that worked 11 PM - 7AM shift, on

worked the 11 PM-7 AM shift. V39 affirmed that no other staff members came in those days to cover

there were only 6 certified nursing assistants. V39 stated that the facility's staffing plan is 11 nursing assistants on day shift (7 AM-3 PM), 10 nursing assistants on PM shift (3PM -11 PM) and 9 nursing assistants on NOC (11 PM-7 AM) shift.

Record review of the facility's daily staffing assignment sheets (1/30/2026-2/13/2026) documents in part, on 1/30/2026, 3 call-ins (1 Nurse PM, 2 CNA NOC), on 1/31/2026 2 call-ins (1 CNA AM, 1 Nurse NOC), 2/1/2026 5 call-ins (2 CNA PM, 2 CNA NOC, 1 Nurse NOC), on 2/2/2026 2 call ins (1 Nurse PM, 1 CNA NOC), 2/5/2026 1 call-in (1 CNA PM), on 2/6/2026 4 call-ins (1 CNA AM, 3 CNA PM) , on 2/7/2026 2 no-call no shows (2 CNAs NOC), on 2/8/2026 3 call-ins (1 AM CNA, 2 PM CNA) and 1 no call no show (PM CNA), 2/9/2026 4 call ins (3 NOC CNA, 1 NOC Nurse), 1 removed from schedule (NOC CNA), 2/10/2026 1 call in (NOC CNA), 1 removed from schedule (NOC CNA), on 2/11/2026 1 call-ins (PM Nurse) 1 No Call-No Show (PM CNA), 2/12/2026 2 call-ins (PM CNA, NOC Nurse), 2/13/2026, 4 no call no shows (1 PM CNA, 3 PM NOC) and 1 call off (PM CNA). On 2/2/2026 there were 8 nursing assistants that worked 11-7 shift, on 2/7/2026 there were 7 nursing assistants that worked 11-7 shift, on 2/8/2026 6 certified nursing assistants worked the 11-7 shift, on 2/9/2026 there were 7 nursing assistants that worked 11-7 shift, and on 2/13/2026 6 certified nursing assistants worked the 11-7 shift.

Facility census for 2/2/2026 documents 113 residents were residing within the facility.

Facility census for 2/3/2026 documents 112 residents were residing within the facility.

Facility census for 2/7/2026 documents 112 residents were residing within the facility.

Facility census for 2/8/2026 documents 111 residents were residing within the facility.

Facility census for 2/9/2026 documents 109 residents were residing within the facility.

Facility census for 2/13/2026 documents 113 residents were residing within the facility.

Record review of the facility assessment (2/12/2026) documents in part for the facility's staffing plan that that approximately 4 licensed nurses are needed per shift on 1st shift, 4 on second shift, and 3 on third shift.

For certified nursing assistants, 11 are needed on first shift, 10 are needed on second shift, and 9 are needed on third shift to adequately meet the resident's care needs.

Additionally, the facility assessment identifies an average census of 103.

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

meet the dietary needs of all persons eating meals in the facility. On 2/18/2026 at 9:53 AM, V1 stated,

reviewed with V1 (Administrator).

When asked if the facility assessment identifies the dietary

dietary aides.

That's not a requirement. We follow the federal regulation, which is: if you have enough staff to create the food and serve the food then you are meeting the needs of the facility.

Review of facility working dietary staff schedules for 2/2026, documents in part that the facility usually staffs between 2-3 dietary aides between 6:00 AM - 8:00 PM with one cook working 6 AM-2 PM and a second cook working 12 PM-8 PM. On 2/1/2026, 2/3/2026, 2/13/2026, and 2/14/2026, there was only 1 dietary aide working the 4:00-8:00 PM shift. On 2/12/2026, only 1 dietary aide worked the 6:30 AM-2:30 PM shift. On 2/9/2026, only one cook worked from 12:00 PM-8:00 PM.

The facility assessment (2/12/2026) does not indicate a dietary department staffing plan or how many/which type of staff members are required to meet the needs of the facility's dietary department.

The Dietary aides and cooks are not identified within the dietary department staffing plan.

Facility document titled, MEAL CART AND TRAY TIMES (Undated), documents in part that breakfast is served at 8:00 AM, 8:15 AM and 8:30 AM, lunch is served at 12:00 PM, 12:15 PM, and 12:30 PM, and supper (dinner) is served at 5:00 PM, 5:15 PM, and 5:30 PM in the 300-dining room, 200-dining room and main dining room, respectively.

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

powder, salt, black pepper, tomato sauce, condensed cream of tomato soup and shredded cheddar

spice peach parfait indicates the following ingredients: diced peaches, juice pack, brown sugar,

according to package instructions, add honey, and whisk to incorporate the honey into the whipped topping.

Record review of the recipe for the whipped topping instructs the staff to mix whipped topping mix packages and ice-cold water into a mixing bowl and whip for approximately 5-10 until peaks form.

There is no recipe to use spray-style whipped cream in place of this whipped topping mix.

Record review of the current facility menu cycle indicates the following days where a sandwich (meat or other food item between bread/bun) is being served for dinner: Week 1: Tuesday (Grilled Cheese Sandwich), Thursday (Barbequed Chicken Sandwich), Friday (Chicken Salad Sandwich); Week 2 : Sunday (Grilled Ham and Cheese Sandwich), Monday (Alpine Burger with Bun), Tuesday (Turkey and Swiss Cheese Sandwich), Thursday (Bratwurst on bun), Week 3: Sunday (Turkey and Swiss Cheese Sandwich), Monday (Hot Dog with Bun), Saturday (BBQ Rib Patty on Submarine Roll), Week 4: Sunday (Sloppy [NAME] Sandwich), Monday (Tuna Salad Sandwich), Thursday (Cheeseburger with Bun), Friday (Bratwurst Sausage with Bun), Saturday (Breaded Fish Sandwich with Cheese on Bun).

This indicates that a sandwich style entree was served for dinner on 3 days in Week 1, 4 days in Week 2, 3 days in week 3, and 5 days in week 5.

Facility policy titled, Menu Changes (2017) documents, Menu Items will be served as planned whenever possible.

Due to unavoidable circumstances, temporary changes may be made to the menu.

Procedure: Changes will be indicated on the posted menu prior to the meal service.

The menu change will be noted in a file kept for that purpose.

The reason for change will be noted.

Changes will be of similar nutritional value.

Permanent changes must be approved by the dietician.Facility policy titled CYCLE MENU (2018) documents in part, .Procedure: Cycle Menus are planned by a dietician at least two weeks in advance. A variety of nourishing food is served three meals a day and an evening snack.

Menus are different for the same day of consecutive weeks and seasonal foods are used.

Menus reflect the religious, cultural and ethnic needs of the clients as well as the clients' food preferences .

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

flavor and palatability of the food from the residents and has implemented a food committee to try and

they get documented in the resident council meeting minutes. R8's Face Sheet documents in part the

osteoarthritis. R8's Minimum Data Set (12/24/2025) documents in part a BIMS summary score of 13, indicating R8 is cognitively intact. On 2/17/2026 at 10:16 AM, R8 make a gagging noise and motion like R8 was throwing up.

That's what I think of the food: nasty.On 2/18/2026 at 5:08 PM, V40 (Licensed Practical Nurse) affirmed that V40 no longer works at the facility but when V40 did work at the facility, V40 would often have residents complain about the food. V40 recalled, It was pretty much every day that residents would complain about it (food).

They would say like, oh I don't want that, it looks gross or it doesn't have any taste or seasoning.

Food being too bland was probably the most frequent complaint.

Resident council meeting minutes 11/2025-present documents in part on 12/30/2025, the resident council had concerns related to grits needing to be cooked longer and putting veggies on sandwiches.

Comments (12/30/2025) were made by V35 (Dietary Manager) that indicated that the cook was in-serviced on making grits.

There are no comments related to corrective action for the residents' wanting vegetables on their sandwiches and no further information was provided prior to the exit of the survey.

Facility policy titled, FOOD PALATABILITY- HOT FOOD TEMPERATURES (2018) documents in part, POLICY: The healthcare community prepares and serves food and beverages that are palatable, attractive, and at safe and appetizing temperature .

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

then they just give you a salad. A salad ain't enough.On 2/17/2026 at 10:27 AM, V35 (Dietary

thawing.

Same with the cornbread, there was more cornbread that (V29) could have made. I don't

11:45 AM, V37 (Registered Dietician) affirmed V37 is the consultant dietician for the facility and was not aware of any ingredient substitutions or menu changes for 2/14/2026. V37 denied V37 gave any approvals to change any parts of the menu on 2/14/2026. V37 explained that the facility should be procuring enough ingredients and making enough food so that all residents can be served from the menu with some leftovers for seconds, if needed. V37 stated that the facility should be following the recipes and menus that are approved.

The facility's policy for food ordering/procurement was requested on 2/17/2025.On 2/17/2026 at 12:51 PM, V1 (Administrator) stated, There is no policy for food procurement/ordering.Facility policy titled, Menu Changes (2017) documents, Menu Items will be served as planned whenever possible.

Due to unavoidable circumstances, temporary changes may be made to the menu.

Procedure: Changes will be indicated on the posted menu prior to the meal service.

The menu change will be noted in a file kept for that purpose.

The reason for change will be noted.

Changes will be of similar nutritional value.

Permanent changes must be approved by the dietician.

145927 02/20/2026

Prairie Oasis 16000 South Wabash South Holland, IL 60473

V1 replied, we (staff) ask about that stuff in resident council and the residents get to choose a meal

dietary aides.

That's not a requirement. We follow the federal regulation, which is if you have enough

assessment dated (2/12/2026) documents in part, .

Ethnic, cultural, or religious factors Describe ethnic, cultural, or religious factors or personal resident preferences that may potentially affect the care provided to residents by your facility.

Examples may include activities, food and nutrition services, languages, clothing preferences, access to religious services, or religious-based advanced directives.Residents and/or resident representative will be interviewed to determine preferences with regards to daily schedules, waking/bedtime, special food preferences or restrictions, religious/spiritual needs, special communication needs, language barriers, etc. to meet the needs of the residentList any specific or unique Ethnic/ Cultural/ Religious factors affecting care provided, if any:Activity to discuss in resident council meetingPrairie Oasis has a population with an average age of 74 that should be considered when providing services .Staffing plan Based on your resident population and their needs for care and support, describe your general approach to staffing to ensure that you have sufficient staff to meet the needs of the residents at any given time .Other (department heads, quality assurance nurse, ancillary staff in maintenance, housekeeping, dietary, laundry, etc.) Customize to the staffing of your facility: 1 Director of Nursing 1 Assistant Director of Nursing MDS/Careplan Coordinators 1 Restorative Nurse 1 Treatment Nurse 1 Infectious Disease Nurse 1 Maintenance/Housekeeping Director 1 Dietary Director 1 Activity Director 1 Scheduler/Medical records 1 Social Service Director 1 PRSC 1 Admissions Director/Marketer 1 Assistant Administrator.

The requisite number of cooks and dietary aides is not identified within the facility assessment. No ethnic, cultural or religious needs were identified within the facility assessment.

Facility Assessment Tool Instructions (Undated) document in part, Requirement Nursing facilities will conduct, document, and annually review a facility-wide assessment, which includes both their resident population and the resources the facility needs to care for their residents (S483.70(e)).

Purpose The purpose of the assessment is to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies.

Use this assessment to make decisions about your direct care staff needs, as well as your capabilities to provide services to the residents in your facility.

Using a competency-based approach focuses on ensuring that each resident is provided care that allows the resident to maintain or attain their highest practicable physical, mental, and psychosocial well-being.

Overview of the assessment tool The tool is organized in three parts:Resident profile including numbers, diseases/conditions, physical and cognitive disabilities, acuity, and ethnic/cultural/religious factors that impact careServices and care offered based on resident needs (includes types of care your resident population requires; the focus is not to include individual level care plans in the facility assessment)Facility resources needed to provide competent care for residents, including staff, staffing plan, staff training/education and competencies, education and training, physical environment and building needs, and other resources, including agreements with third parties, health information technology resources and systems, a facility-based and community-based risk assessment .