Health inspection·January 31, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to notify the POA (POA/Power of Attorney) of changes in condition. This applies to 1 of 3 residents (R1) reviewed for policy and procedures. The findings include: On 01/30/24 at 1:53 PM, V4 (CNA/Certified Nursing Assistant) said she takes care of R1 all the time. V4 said she was taking care of R1 on 01/11/24 during the 6:30 AM-2:30 PM shift when she saw bulging to R1's right hip. V4 said she did not see any bruising on 01/11/24. V4 said she first saw the bruising a few days later after seeing the hip bulging. V4 said the bulging of the right hip had never looked that big before. V4 said she asked R1 if she was in pain and R1 said no. V4 said she told the nurse, V5 (LPN/Licensed Practical Nurse). V4 said V5 came in the shower room and assessed R1. V4 said she assumed V5 told the family about the bulging right hip. V4 said when I see bruising or anything abnormal, I report it to the nurse, the supervisor, and the abuse coordinator. On 01/30/24 at 2:07 PM, V5 (Licensed Practical Nurse) said she was called to the shower room on 01/11/24 by V4 (CNA) taking care of R1. V5 said V4 reported a bulging spot on R1's back of right hip. V5 said she never saw any bruising. V5 said the spot was not new, but it appeared to be a little more swollen than normal. V5 said she assessed the area and R1 was not in any pain or distress. V5 said at the end of her shift, she endorsed the incident in report about the bulging. V5 said she did not document that she notified R1's POA (POA/Power of Attorney) of the bulging spot. V5 said she started the incident report but did not complete it. V5 said she was not aware that she did not complete the incident report or the documentation. V5 said she did not notify the POA of the bulging spot. V5 said the normal processes when there is an accident or injury is to do the incident report, notify the doctor and the family. V5 said when incidents occur, the facility normally documents for 72 hours after the incident is found. V5 said she does not know if any documentation was done after 01/11/24 because she was not on that unit during the time it would have been documented. On 01/20/24 at 1:25 PM, V3 (Licensed Practical Nurse) said on 01/12/24 she was told in report from another nurse that R1 had a bruise to her right hip. V3 said the nurse told her that R1 might have hit her right hip on the edge of the bed or the bedside table. V3 said when she assessed R1 there were no changes in the size or color of the bruise. V3 said R1 told her she was not in pain. V3 said she never notified anyone that R1 had a bruise. V3 said she called R1's daughter (POA) on 01/15/24 or 01/16/24 to give her the results of the x-ray. V3 said she told R1's daughter there was no fracture or dislocation to the right hip. V3 said she told the daughter R1 had arthritis in the right hip and the bruise probably came from R1 bumping her hip on something. V3 said the normal process for finding a bruise is to do a risk management. It is like an incident report. We notify the family and the (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: 145043 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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)