Taylorville Care Center

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 employ a Director of Food and Nutrition. This has the potential to affect all 67 residents living in the Facility. Findings include: On 8/12/25 at 9:00 AM, during the initial kitchen inspection, there was no dietary manager in the Facility.On 8/12/25 at 9:08 AM, V7, Cook, stated she was unsure whether the Facility has a dietary manager and suggested checking with V1, Administrator.On 8/12/25 at 9:16 AM, V1 stated the previous dietary manager recently quit without notice, and they do not currently have a dietary manager.On 8/12/25 at 2:20 PM, V6, Dietary Aid, and V7 were working alone in the kitchen. They stated they have not had any supervision by management today.On 8/15/25 at 8:50 AM, V25, Registered Dietitian (RD), stated he visits the Facility three times a month and has not been asked to perform any additional duties since they have been without a dietary manager.From 8/12/25-8/15/25, no certified dietary manager was observed in the Facility.On 8/15/25 at 9:16 AM, V1 stated she expects the facility to follow its food service policies.The Facility's Undated Structure and Organization Policy documents, A qualified food service manager supervises the daily functions of the Food and Nutrition Services Department. The food service manager is a full-time person, qualified by training and experience. This person is responsible for the daily planning; food procurement, storage, preparation, distribution and service of food under safety and sanitation conditions; as well as the supervision, training, and scheduling of the kitchen staff.The Facility's Long-Term Care Facility Application for Medicare and Medicaid (CMS 671) dated 8/12/25 documents there are 67 residents living in the Facility.

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

Event ID:

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Taylorville Care Center

600 South Houston Taylorville, IL 62568

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

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or potential for actual harm

Based on interview, observation, and record review, the Facility failed to provide residents with palatable and safe temperature meals for 8 of 8 residents (Resident R4, Resident R20, Resident R24, Resident R27, Resident R28, Resident R43, Resident R45, Resident R46) reviewed for food and nutrition services in the sample of 33.Findings include: On 8/12/25 at 10:20 AM, Resident R20 stated the food lacks flavor and is never at the right temperature.On 8/12/25 at 10:24 AM, Resident R28 stated the Facility's food is just not good. It is always cold, and the toast is hard.On 8/12/25 at 10:40 AM, Resident R43 stated the food quality could be better. On 8/12/25 at 10:50 AM, Resident R27 stated the food is cold and tastes bad.On 8/13/25 at 9:00 AM, during the Resident Council group meeting, Resident R4, Resident R24, Resident R45, and Resident R46 all stated the kitchen and food quality have really gone downhill.On 8/12/25 at 1:12 PM, food temperatures were obtained with a metal calibrated thermometer after the last resident tray was served. The ham salad measured 55 Fahrenheit (F). The pureed ham salad measured 68 F. The pureed deviled eggs measured 71 F.On 8/15/25 at 8:50 AM, V25, Registered Dietitian (RD), stated the temperatures of the ham salad and deviled eggs were not good.On 8/15/25 at 9:16 AM, V1, Administrator, stated she expects dietary staff to follow food service policies.The Facility's Menus and Food Preparation Policy revised December 2016 documents, Food shall be prepared by methods that conserve nutritive value, flavor and appearance and in a form designed to meet individual needs. Food and drinks served shall be palatable, attractive and at a safe and appetizing temperature.

Residents Affected - Some

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

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

08/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Taylorville Care Center

600 South Houston Taylorville, IL 62568

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation, interview and record review, the Facility failed to ensure foods were stored and prepared in a manner that prevents foodborne illness. This has the potential to affect all 67 residents living

in the Facility.Findings include:On 8/12/25 at 9:00 AM, V6, Dietary Aid, was unloading clean dishes that had just run through the dish machine and putting them away on shelves. V6 dropped a plastic cup on the floor, picked it up, and put it back in the crate containing clean dishes. V6 continued to unload dishes until all glassware was placed on shelves. V6 stated he did not know what happened to the cup that fell on the floor.

V6 stated dietary staff do not have to check sanitizer levels or temperatures on the dish machine. On 8/12/25 at 9:05 AM, in the dry storage room, there was a dented can of beef ravioli on a shelf with several other cans. V7, Cook, stated there is no separate place where dented cans are stored. On 8/12/25 at 9:08 AM, next to the three-compartment sink, there was a clear container with a white powdery substance inside. The container was not covered, labeled or dated, leaving the contents open to air. V6 stated the white powder is thickener.On 8/12/25 at 9:10 AM, in the standing freezer, there was a box of uncooked chicken tender fritters stored directly above boxes of cauliflower and roasted turkey breast. There was a box of bacon stored on the shelf directly above boxes of waffles and pancakes. V6 stated there is no specific location for storing uncooked meat, she just tries to separate it by breakfast, lunch and dinner.On 8/12/25 at 9:12 AM, in the walk-in refrigerator, there was a box of pasteurized shell eggs stored on a shelf directly above a box of 2% milk. There was a container labeled applesauce and 5/8. There was a pitcher half full of orange liquid with no label or date. On 8/12/25 at 1:12 PM, food temperatures were obtained from the steam table after the last resident tray was served using a metal calibrated thermometer. The ham salad measured 55 Fahrenheit (F). The pureed ham salad measured 68 F. The pureed deviled eggs measured 71 F.On 8/15/25 at 8:50 AM, V25, Registered Dietitian (RD), stated he is unsure if dietary staff have been checking the temperatures of food before serving, but the temperatures of the ham salad and eggs were not good due to potential for foodborne illness. He stated uncooked animal proteins should be stored on the lower level to reduce risk of contamination.On 8/15/25 at 9:16 AM, V1, Administrator, stated she expects dietary staff to follow dietary policies.The Facility's Undated Food Safety Requirements Policy documents, It is the policy of this facility to provide safe and sanitary storage, handling, and consumption of all food.The Facility's Food and Supply Storage Policy revised January 2012 documents, Food and supply storage areas shall be maintained in a clean, safe, and sanitary manner. Plastic containers with tight-fitting lids will be used for storing flour, sugar, bulk cereal, dried vegetables, etc. Prepared foods stored in the refrigerator until service will be covered, labeled, and dated with an expiration date. All foods will be covered, labeled, and dated.The Facility's Cleaning and Sanitation - General Policy revised January 2012 documents, Any utensil or dishware that falls on the floor before use will be washed, rinsed, and sanitized before it is used.

Food will be maintained at proper internal temperatures. The Facility's Long-Term Care Facility Application for Medicare and Medicaid (CMS 671) dated 8/12/25 documents there are 67 residents living in the Facility.

Event ID:

Facility ID:

If continuation sheet