Health inspection·May 22, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow its policy to provide incontinent care to dependent residents. Residents Affected - Few This applies to 3 of 3 residents (R1, R4, and R5) reviewed for activities of daily living (ADL) in a sample of 5. Findings include: 1. R1 is a [AGE] year-old female with cognition intact as per Minimum Data Set (MDS) assessment dated [DATE]. Record review on MDS indicates that R1 requires extensive two-person assistance for toilet use. On 5/20/23 at 9:10 AM, R1 was observed on her bed with a urine smell. R1 stated, They changed me at six o'clock in the morning, and nobody changed me after that. On 5/20/23 at 9:13 AM, V3 (Certified Nursing Assistant - CNA / Restorative Aide) checked on R1 and R1was observed with a urine-soaked incontinent brief. On 5/20/23 at 9:13 AM, V3 stated, I am not the assigned CNA for R1. We are supposed to provide incontinent care every two hours and as needed. On 5/21/23 at 11:50 AM, R1 stated, They changed me today at around 9:00 AM. I can't tell now if I am wet or not. On 5/21/23 at 11:55 AM, V7 (CNA) checked on R1 per the surveyor's request and observed her incontinent brief soaked in urine. On 5/21/23 at 11:55 AM, V7 stated, I changed R1 at 9:30 AM. I am going to change her now. 2. R4 is a [AGE] year-old female admitted on [DATE] with severely impaired cognition per MDS dated [DATE]. Record review on MDS indicates that R4 requires extensive one-person assistance for toilet use. On 5/20/23 at 9:17 AM, observed R4 on her bed with speech difficulty. R4 stated, I am wet now. They changed me around 8:00 PM last night. On 5/20/23 at 9:20 AM, V4 (Licensed Practical Nurse - LPN) checked R4 for incontinence, and R4 was observed with a double diaper with the inner one soaked in urine. On 5/20/23 at 9:20 AM, V4 stated, R4 should have been changed earlier. Incontinent care is supposed to be every 2 hours and as needed. 3. R5 is a [AGE] year-old female, morbid obese with a body mass index (BMI) of 65.6, with cognition Page 1 of 2 145011 145011 05/22/2023 Alpine Care of Evanston 500 Asbury Street Evanston, IL 60202

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few intact as per MDS dated [DATE]. Record review of the MDS assessment indicates that R5 depends on two-person physical assistance for toilet use. On 5/20/23 at 9:35 AM, R5 stated, I am wet; they don't like to be called. I was changed at 6:00 AM by night shift staff. On 5/20/23 at 9:35 AM, V5 (Licensed Practical Nurse - LPN) checked R5 for incontinence, and R5 was observed with a urine-soaked incontinent brief. On 5/20/23 at 11:30 AM, V2 (Director of Nursing - DON) stated, As per our incontinent care policy, the staff are supposed to give incontinent care every two hours and as needed. Noncompliance with the incontinent care policy can cause UTI. I will tell my staff to check R1 more frequently as she urinates frequently and has a history of UTI. The facility presented incontinence and perineal care policy revised on 7/28/22 documents: Do rounds at least every 2 hours to check for incontinence during shift. 145011 Page 2 of 2