Health inspection·February 20, 2025

F 0760 Ensure that residents are free from significant medication errors. 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 provide pain medication and antifungal medication to one resident (R1) of three residents reviewed for significant medication errors in the sample list of eight. These failures resulted in R1 experiencing pain and continued symptoms of infection. Residents Affected - Few Findings include: R1's undated diagnoses sheet, documents R1's diagnoses as: aftercare following Joint Replacement surgery, presence of Left Artificial Hip Joint, Candidiasis, unspecified, and unilateral Primary Osteoarthritis, left hip. R1's Physician Order Sheet (POS) dated January 2025, documents Hydrocodone/Acetaminophen Oral Tablet 5-325 milligrams (mg), give 5 mg by mouth one time only for pain related to following Joint Replacement surgery, for 1 day, give 2 tablets Hydrocodone/Acetaminophen 5/325 mg one time only dose; start date 1/30/2025, discontinue date 1/31/2025. R1's January 2025, Medication Administration Record (MAR) has no documentation that Hydrocodone/Acetaminophen Oral Tablet 5-325 milligrams (mg), medication was given on 1/30/25. R1's MAR dated January 2025, documents an order for Clotrimazole Vaginal Cream 2%, insert one applicator vaginally at bedtime for yeast infection, start date 1/30/2025. R1's Treatment Administration Record (TAR) dated January 30, 2025, has no documentation of Clotrimazole Vaginal Cream 2% being administered on 1/30/25 at bedtime. R1's TAR dated February 2025, has no documentation of Clotrimazole Vaginal Cream 2% being administered on 2/4/25, 2/7/25, 2/8/25, and 2/13/25. R1's Orthopedic Discharge summary dated [DATE]-[DATE], documents an order for Lidocaine 4% one patch transdermal on 12 hours, off 12 hours. R1's MAR dated January 2025, documents Lidocaine External Patch 4% apply to left hip topically every morning and at bedtime for pain apply in AM, remove at night, start date 1/30/2025. R1's TAR dated February 2025, has no documentation of a Lidocaine patch being put on R1's left hip on 2/1/25. On 2/14/25 at 10:26 AM, R1 stated when she first got here, they did not have her medications so she did not get her pain medications and she was in a lot of pain. R1 stated they have forgotten her (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: 145183 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 145183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Danville 620 Warrington Avenue Danville, IL 61832 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)