Inspection·February 13, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to provide daily sanitation of the facility and resident rooms during outbreaks of respiratory and gastrointestinal viruses. This failure has the potential to affect all 76 residents in the facility. Residents Affected - Many Findings include: Resident Room Roster dated 2/11/25 indicates there were 76 residents in the facility on that date. On 2/11/25 a tracking document presented by V3, ICP (Infection Control Preventionist) indicated between 1/25/25 and 2/3/25 23 residents were identified as having symptoms of nausea/vomiting/diarrhea and two residents (R4 and R8) diagnosed with Norovirus; nine residents identified as having respiratory symptoms including shortness of breath/cough with six residents identified positive for Influenza A and five residents positive for RSV (Respiratory Syncytial Virus). On 2/11/25 at 12:15pm V8, Housekeeping Manager was assisting R6 to change rooms by packing up R6's belongings. V8 stated, I'm the only housekeeper here right now, there are no other housekeepers in the building. One housekeeper would be coming in at 4pm and stay until 9pm. On 2/11/25 at 1:30pm V8 was still in the same room (R6's room), moving another resident into the room. V8 stated she has been Tied up making these room changes and hasn't been able to do any of the room cleaning or general facility cleaning. V8 stated the other dayshift housekeeper called in (non-illness related) and said, If someone calls in, we don't have anyone to replace them. They only allow me two staff per day, so I have one in the am and one in the pm. They each do one side of the building. I could help but not when I'm tied up like today. V8 stated it's difficult for the housekeepers to get an entire side of the building done even when the three of them are there. V8 stated, We should be doing enhanced sanitizing during an outbreak, but we can't even get the regular daily cleaning done. On 2/11/25 R3 and R7 (both reside on Southwest Wing) stated housekeeping does not clean their rooms every day. R7 stated she wipes down her tables and in the bathroom herself With whatever I can find to clean with. R7 stated she shares a bathroom with R3 who sometimes has bathroom problems and worries she might get sick because the bathroom isn't cleaned enough. On 2/13/25 R4 and R8 (roommates who reside on Northwest wing) stated that housekeeping sweeps the floor most days, But that's about it. On 2/11/25 at 3pm V2, DON (Director of Nursing) stated, We have addressed the housekeeping issue for weeks. We talk about the general lack of cleanliness in morning meetings. The Administrator is in (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 3 Event ID: 145000 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 145000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Washington Senior Living 1201 Newcastle Washington, IL 61571 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)