Based on observation, interview, and record review, the facility failed to ensure dietary staff were supervised and trained by a qualified dietary manager resulting in R6, R53, R21, and R65 receiving incorrect physician prescribed diets and resulted in R6 choking, requiring the Heimlich maneuver. R6 required hospitalization for aspiration pneumonia and remains at risk for further episodes of choking and aspiration due to continuing receiving the incorrect diet. This failure applies to 4 of 4 residents (R6, R53, R21, and R65) reviewed for mechanical soft diets in the sample of 20. This failure resulted in an Immediate Jeopardy. The Immediate Jeopardy began on [DATE], when the facility failed to ensure residents were served a mechanically soft diet as prescribed by their physician. …
F801 citations in Illinois
Qualified dietary staff · Nutrition and Dietary Deficiencies
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.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Illinois cites F801 more often than its own record predicts
1.28 times the share F801 takes of citations nationally.
Of every deficiency written in Illinois in 2025, this is the portion that was F801.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Illinois surveyors wrote
F801 findings written in Illinois, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview, and record review, the facility failed to employ a clinically qualified Director of Food and Nutrition Services. This failure has the potential to affect all 67 residents in the facility. Findings include:On 8/5/2026 at 10:30AM, V10 (Dietary Manager) was actively supervising dietary operations in the facility kitchen. V10 reported being the full-time manager of the facility food service (person in charge) and reported not being a clinically qualified Certified Dietary Manager (also known as Certified Food Protection Professional) or having equivalent training. …
Based on observation, interview, and record review, the facility failed to provide the services of a qualified director of food and nutrition services. This failure affects all 44 residents residing in the facility. Findings Include: On 12/15/24 at 9:15 AM V1 (Administrator) stated the facility has not had a qualified Dietary Manager since the last one quit. The facility hired V17 (Dietary Manager) who is starting work on 12/16/24 and would work on getting V17 trained and qualified. On 12/16/24 at 11:45 AM V17 was actively supervising and directing the meal service for lunch. The facility's Centers for Medicare and Medicaid Services Long Term Care Facility Application for Medicare and Medicaid dated 12/16/24 documents 44 residents reside in the facility.
The short window
Recent years
| Year | Share of Illinois citations | vs expected |
|---|---|---|
| 2023 | 0.47% | 1.33× |
| 2024 | 0.41% | 1.22× |
| 2025 | 0.33% | 1.28× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Illinois surveyors cite →
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