Health inspection·August 22, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 apply the correct treatment to a wound for one (R6) of three residents reviewed for wounds in a sample list of seven. Residents Affected - Few Findings include: R6's Care Plan initiated 5/6/2024 includes the following diagnoses: Wedge Compression Fracture of Unspecified Lumbar Vertebra, Alzheimer's Disease, Difficulty In Walking, Symptoms And Signs Involving The Musculoskeletal System, and Protein-Calorie Malnutrition. R6's Pressure Ulcer Risk assessment dated [DATE] documents R6 is at moderate risk for skin breakdown. R6's Wound assessment dated [DATE] documents R6 has a facility acquired stage 4 pressure ulcer to the left buttock. R6's physician's order dated 8/12/24 written by V13 (R6's Physician) documents to cleanse the wound to the left buttock, pat dry, apply calcium alginate, and cover with an abdominal (ABD) pad every day and as needed. The Facility's Medication Administration Policy effective 03/2024 states in section II bullet one: Medications must be administered in accordance with the physician's order. On 8/20/24 at 8:18 AM, there was a hydrocolloid dressing on R6's left buttock. V5 (LPN) removed the hydrocolloid dressing from R6's left buttock. V5 then cleansed the wound, applied calcium alginate to the wound bed and covered with an ABD pad. On 8/20/24 at 8:52 AM, V5 confirmed R6's treatment order for the wound on the left buttocks is to cleanse the wound to the left buttock, pat dry, apply calcium alginate, and cover with an ABD pad every day and as needed. V5 stated that sometimes the ABD pad becomes soiled, and the other nurses often use the hydrocolloid to cover the wound. On 8/21/24 at 12:28 PM, V2 Director of Nursing stated all nurses are expected to follow the physician's orders. Page 1 of 2 145058 145058 08/22/2024 Arc at Chillicothe 1028 Hillcrest Drive Chillicothe, IL 61523

F 0690 Level of Harm - Minimal harm or potential for actual harm Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on interview and record review the facility failed to obtain a urinalysis in a timely manner for one of three residents (R1) reviewed for urinary tract infections in the sample of seven. Residents Affected - Few Findings Include: R1's Medical Diagnoses list dated 6/18/2024 documents Acute Kidney Failure, Type 2 Diabetes Mellitus with Hyperglycemia, Difficulty in Walking, and Lack of Coordination. R1's Physician Order written by V13 (R1's physician) dated 6/28/24 documents an order for a urinalysis. R1's Lab Services Urine Microbiology Results dated 7/5/24 document R1's urine was collected on 7/2/23 at 6:45 PM and was sent to the lab on 7/3/24 at 11:24 AM. R1's urine's microbiology results detected Escherichia coli Extended Spectrum Beta-Lactamase (ESBL) 50-100,000 colonies per milliliter. On 8/21/24 at 2:00 PM, V2 Director of Nursing confirmed R1 had received a physician order for a urinalysis. V2 stated V13 ordered a urinalysis to be completed on 6/28/24 at 7:24 AM and staff should have collected and sent the urine sample to the lab the same day or next day at the latest. V2 stated staff should not have waited more than 24 hours to collect the urine sample and if they were unable to collect the urine sample V13 should have been notified. V2 stated this delay subsequently delayed the urinalysis results and treatment for R1's urinary tract infection. 145058 Page 2 of 2