Health inspection·January 30, 2024

F 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a resident's personal funds were refunded upon discharge. This applies to 1 of 4 residents (R1) reviewed for personal funds in the sample of 4. Residents Affected - Few The findings include: R1's face sheet shows she is a [AGE] year-old female admitted to the facility on [DATE] and discharged on 12/12/23. Medicaid is listed as the payor source. Her diagnoses include Wernicke's Encephalopathy, depression, alcohol dependence, and COPD. On 1/30/24 at 10:33 AM, V7 (R1's family) said R1 was discharged from the facility on 12/12/23. She called the facility to follow up on R1's social security check, it was being directly deposited to the facility when she was there. V3 (Business Office) told her they received R1's Social Security check for January 2024, R1 has not received a refund for her January personal funds. V7 said the facility did not report to Social Security she was discharged and that's why her personal funds were deposited with the facility's management account. On 1/30/24 at 11:00 AM, V3 (Business Office) said she got a call from V7 regarding R1's Social Security check. V7 said, This was my first time experiencing a resident being discharged to the community with her personal funds being deposited with the facility. I did not notify Social Security of (R1's) discharge from the facility. (R1's) January check was deposited to the facility, we switched management systems and the previous company would report to Social Security when a resident was discharged . Someone must report to Social Security when a resident is discharged so the resident can receive their funds. (V7) was a little upset and I told her we were working on it. V3 said she requested a refund from the management company yesterday. R1's Resident Fund Management Service Authorization and Agreement to Handle Resident Funds form dated 8/9/23 shows a signed signature by R1 and elected direct deposit of her social security funds with the facility's management service. R1's Resident Statement Fund provided on 1/29/24 shows a deposit on 1/10/24 (29 days after discharge) from Social Security for $1215.00. On 1/10/24 an auto withdrawal for care cost of $1185.00 (R1 was discharged on 12/12/23). A Check Request form dated 1/29/24 (48 days after R1's discharge) shows a refund was requested due to her discharge. The form shows an area For Office Use Only including account number, check amount approved by and date approved are all blank. Page 1 of 2 145200 145200 01/30/2024 Franklin Grove Living and Rehab 502 North State Street Franklin Grove, IL 61031

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 interview and record review the facility failed to provide a resident's medications upon discharge. This applies to 1 of 3 residents (R1) reviewed for discharge in the sample of 4. The findings include: R1's face sheet shows she is a [AGE] year-old female admitted to the facility on [DATE] and discharged on 12/12/23. Medicaid is listed as the payor source. Her diagnoses include Wernicke's Encephalopathy, depression, alcohol dependence, and COPD. R1's Physician Order Sheets dated December 2023 shows orders to discharge to home with current medications (order date 12/8/23) including buspirone (anti-anxiety) 10 mg (milligram) twice a day for Wernicke's encephalopathy and Zoloft 100 mg one tablet for depression. On 1/30/24 at 10:33 AM, V7 (R1's family) said when R1 was discharged , she was not sent home with her psych medications. V7 said, I called and spoke with the head nurse, and she told me (R1's) medications got sent back to pharmacy. (R1's) payor source is Medicaid and her medications for the month were already paid for when she was in the facility. (R1) was having increased behaviors without her medications and she paid for her medications out of pocket. On 1/30/24 at 1:05 PM, V6 (Licensed Practical Nurse/LPN) said she discharged R1. Medications should be sent home with the resident based on the payor source. She remembers sending R1's inhaler home but does recall if she sent home her psych medications. R1 was alert and had some behaviors and paranoia issues. On 1/30/24 at 10:04 AM, V5 (LPN) said she is not sure if medications are sent home with residents. On 1/30/24 at 1:27 PM, V2 (Director of Nursing) said residents should receive their medications on discharge if they have Medicaid, because they have been charged for those medications for the month. V7 contacted her and reported R1 did not receive her medications on discharge. She was asking about R1's psych medications. V2 said R1's medications were sent back to the pharmacy. R1's Discharge Summary form dated 12/12/23 does not show her medications were sent home upon discharge. The facility did not provide a policy regarding medications upon discharge. 145200 Page 2 of 2