Health inspection·July 29, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to follow physician's orders for administration of eye drops for one of three residents (R3) reviewed for hygiene in the sample list of 15 residents.On 7/24/25 at 9:18 AM R3 was sitting in a wheelchair. R3's eyes were red with a small amount of yellow/white matter on the lower lids. R3 rubbed his eyes with his hands. At 1:03 PM R3's eyes had a small amount of matter on the lower lids.R3's Minimum Data Set, dated [DATE] documents R3 has severe cognitive impairment. R3's active diagnoses list includes ectropion of right and left lower eyelids (drooping of eyelids).R3's Progress Note, recorded by V12 Nurse Practitioner, dated 4/10/25 documents R3 continues to have ectropion and chronic blepharitis (inflammation) to bilateral eyelids, Systane Complete ophthalmic solution ordered, continue current management.R3's active Physician's Orders include an order dated 4/1/25 for Systane Complete Ophthalmic Solution apply one drop to each eye twice daily. There are no other orders for eye drops.On 7/24/25 at 11:08 AM V3 Licensed Practical Nurse stated staff apply a warm washcloth a couple times per day and R3 receives scheduled eye drops. V3 removed a box of Ketotifen Fumarate 0.035% eye drops labeled with R3's name. V3 stated R3 has a chronic problem with his eyes that cause pain and irritation, and R3 rubs his eyes a lot. At 12:32 PM V3 stated Ketotifen eye drops are used in place of the Systane, as they are the same. The medication cart was viewed with V3 who confirmed Ketotifen were the only eye drops for R3 in the medication cart, and there were no bottles of Systane eye drops labeled with R3's name. On 7/24/25 at 2:16 PM V7 Pharmacist stated Systane eye drops are for dry eyes, and Ketotifen eye drops are for allergies/allergic conjunctivitis, these are not the same. V7 stated if they were interchangeable there would be a physician's order and the pharmacy would have notified the facility. V7 stated V7 does not see Ketotifen on R3's order profile.On 7/24/25 at 2:38 PM V2 Director of Nursing stated nurses should follow physician's orders, and today V3 told V2 about R3's eye drops not matching the physician order. The Facility Physician/Practitioner Orders Policy Dated 2/10/2025 documents the Facility will verify that the order and original, valid prescription match. The facility will forward the original, valid prescription with the verification order to the pharmacy per protocol. The policy also documents if the orders (i.e. dose or frequency) do not match, or in the absence of an original, valid prescription, obtain an original, valid prescription and forward it along with the written order to the pharmacy per protocol. 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: 145031 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 145031 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loft Rehab & Nursing of Normal 510 Broadway Normal, IL 61761 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)