Health inspection·May 6, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review the facility failed to document complete accurate assessments for one resident (R7) of three residents reviewed for documentation in a sample list of eight residents. Residents Affected - Few Findings Include: R7's current diagnoses list includes the following diagnoses: Repeated Falls, Malignant Neoplasm of Prostate, COVID-19, Pain in Unspecified Joint, Abnormalities of Gait and Mobility, Type 2 Diabetes without Complications, Chronic Atrial Fibrillation, Lack of Coordination, Colostomy, Hyperlipidemia, and Vitamin C Deficiency. R7's progress note dated 4/11/25 at 7:30 PM documents R7 was admitted from the hospital emergency room following a fall at the assisted living facility where he lived on 4/11/25. R7's Nursing assessments on 4/11/25 and 4/12/25 do not indicate R7 was having any respiratory symptoms and documents R7 as negative for respiratory signs and symptoms. There are no head-to-toe assessments or respiratory assessments documented on 4/13/25, 4/14/25, or 4/15/25. R7's Electronic Medical record census report documents R7 left for the hospital 4/15/25. R7's progress note dated 4/14/2025 at 11:16 AM documents (R7) Tested positive for Covid; Power of Attorney here and was notified. Stated family member had tested positive and helped resident move in facility. R7's progress note dated 4/14/2025 at 11:33 AM documents Fax sent to (APN) to report covid positive results; chest congestion, cough. R7's progress note dated 4/14/2025 at 11:37 AM Documents Covid isolation precautions initiated. There are no subsequent assessments or notes to indicate where R7 was transferred to or rationale for transfer. There is also no documentation to indicate if the physician or family were made aware of the transfer. On 5/7/25 at 2:00 PM V2, DON (Director of Nursing) stated I am aware our documentation for R7 is lacking and it would be my expectation when a resident becomes symptomatic and tests positive for Covid at very least respiratory assessments should be documented and when a resident is sent to the hospital the reason and an assessment should be documented. Page 1 of 3 145031 145031 05/06/2025 Loft Rehab & Nursing of Normal 510 Broadway Normal, IL 61761

F 0842 The facility's policy Notification of Changes reviewed 2/10/25 states Circumstances requiring notification (of Physician) include A transfer or discharge of a resident from the facility. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 145031 Page 2 of 3 145031 05/06/2025 Loft Rehab & Nursing of Normal 510 Broadway Normal, IL 61761

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to follow their infection prevention, response, and reporting policy following a newly identified Covid positive resident. This failure has the potential to affect all residents who reside in the facility. Residents Affected - Many Findings Include: The 5/6/25 facility Census document 108 residents reside at the facility. R7's current diagnoses list includes the following diagnoses: Repeated Falls, Malignant Neoplasm of Prostate, COVID-19, Pain in Unspecified Joint, Abnormalities of Gait and Mobility, Type 2 Diabetes Without Complications, Chronic Atrial Fibrillation, Lack of Coordination, Colostomy, Hyperlipidemia, Vitamin C Deficiency. R7's progress note dated 4/14/2025 at 11:16 AM documents (R7) Tested positive for Covid; Power of Attorney here and was notified. Stated family member had tested positive and helped resident move in facility (4/11/25). R7's progress note dated 4/14/2025 at 11:33 AM documents Fax sent to (APN/Advanced Practice Nurse) to report Covid positive results; chest congestion, cough. R7's progress note dated 4/14/2025 at 11:37 AM Documents Covid isolation precautions initiated. On 5/5/25 at 2:00 PM V5, RN (Registered Nurse) Infection Preventionist stated she wasn't aware there needed to be contact tracing and testing following a resident testing positive for Covid. V5 further stated I didn't do any of that. If I was aware I would have. On 5/5/25 at 2:15 PM V2, DON verified contact tracing and testing should have been initiated immediately following a newly Covid positive resident. V2 also verified direct care staff at the facility have the potential to work anywhere in the facility according to staffing needs. The facility's policy Covid 19 Prevention, Response, and Reporting reviewed 10/1/24 states Responding to a newly identified SARS CoV-2 infected Health Care Provider or resident: a. The facility should defer to the recommendations of the jurisdiction's public health authority when performing an outbreak response to a known case. b. A single new case of SARS CoV-2 infection in any Health Care Provider or resident should be evaluated to determine if others in the facility could have been exposed. c. The approach of an outbreak investigation could involve either contact tracing or a broad-based approach; however, a broad-based approach (e.g. Unit, floor, or other specific areas of the facility) is preferred if all potential contact cannot be identified or managed with contact tracing or if contact tracing fails to halt transmission. d. Perform testing for all residents and Health Care Providers identified as close contacts or on the affected unit(s) if using a broad-based approach, regardless of vaccination status. 145031 Page 3 of 3