Inspection·February 26, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to adequately assess, administer medications, and notify the physician for a resident who had not had a bowel movement in over 3 days on several occasions. This failure contributed to (R1) developing a fecal impaction, pain and inflammation in her colon. This applies to 1 of 3 residents (R1) reviewed for quality of care in the sample of 7. Residents Affected - Few The findings include: R1's face sheet shows she was admitted to the facility on [DATE] with diagnoses including: Unspecified Dementia, Parkinsonism and Constipation. R1's active Care Plan shows she has a cognitive impairment due to dementia, is incontinent of bowel and bladder, and is at risk for constipation due to impaired mobility. R1's constipation Care Plan initiated on 10/5/22 and revised on 1/5/25 shows that R1 will have one soft formed stool every 2-3 days. Interventions listed in the care plan include assess residents past bowel elimination pattern and document every shift, report negative findings to the physician, assess abdomen for distention, guarding, and bowel sounds at least every shift and administer laxatives/stool softeners and enemas as ordered by the physician. R1's Electronic Treatment Administration Record (ETAR) Electronic Medication Administration Record (EMAR), and Physician Order Summary (POS) show an active order from 6/9/23 that states, Monitor bowel movements (BM's) every shift if no BM in 3 days notify MD. On 2/26/25 at 10:25 AM, R1's bowel elimination tracking for January 2025 was reviewed with V7 (Licensed Practical Nurse). R1 had documented BM's on 1/3/25 and not again until 1/8/25 (5 days in between), 1/13/25 and not again until 1/18/25 (5 days again in between) and next on 1/22/25 (4 days in between). R1's EMAR shows she had PRN (as needed) medication orders for Milk of Magnesia (laxative) to be given daily as needed for constipation, and Miralax Powder (laxative) 17 grams every 12 hours as needed. The EMAR and paper copies of the Medication Administration Summary shows neither of these medications were administered in January 2025 to R1. R1's January 2025 Nursing Progress notes and assessment have no documented abdominal assessment or phone calls to R1's physician to notify and obtain orders for lack of bowel movements longer than 3 days. A change in condition note for R1 dated 1/24/25 shows that R1 was sent to a local community (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 2 Event ID: 145029 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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)