Inspection·May 7, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to implement effective fall interventions in three (R1, R2, and R3) of three residents reviewed for falls. These failures resulted in R1 sustaining a head laceration with an arterial bleed, requiring nine sutures and R2 sustaining bilateral fractured wrists resulting in decreased independence, both as the result of falls. Findings include: The Facility Accidents and Incidents Policy dated 11/2023 documents, The Charge Nurse must conduct an immediate investigation of the accident/incident and implement immediate appropriate intervention to affected parties. 1.) R1's undated diagnosis sheet documents the following diagnoses including: dementia, encephalopathy, neutropenia, history of falls, chronic kidney disease, diabetes mellitus, type 2, congestive heart failure, chronic kidney disease, history of a kidney transplant, hypertension, hyponatremia, and a history of a coronary artery bypass graft. R1's progress note documents admission to the facility on 4/15/24 and that R1 is forgetful, uses a walker, has an unsteady gait and needs therapy services for strength and stability training. R1's fall assessment dated [DATE] documents R1 as a high fall risk. R1's Minimum Data Set, dated [DATE] documents R1 as moderately cognitively impaired. R1's fall investigation dated 4/18/24 documents that R1 fell at 6:45AM while sitting at the nurse's station while repeatedly attempting to stand up. The intervention used was to redirect R1. R1 stood up after being reminded that it was unsafe, fell and hit her head. R1 was then sent to the hospital. R1's emergency room notes dated 4/18/24 document that R1 sustained a forehead contusion from the fall and has a history of hyponatremia. R1 was returned to the facility on the same day. R1's care plan dated 4/18/24 documents the intervention to prevent further falls is to check R1's basic metabolic panel weekly. R1's progress notes dated 4/26/24 document R1 as restless and attempting to stand unassisted. R1 was again placed in a chair next to the nurse's station, R1 stood up and fell. A laceration was (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 4 Event ID: 145243 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 145243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accolade Healthcare Danville 801 North Logan 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)