Health inspection·January 8, 2025

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. Based on interview and record review the facility failed to notify the physician of an ongoing change in condition in a timely manner. This applies to 1 of 3 residents (R1) reviewed for notification of changes in the sample of 5. The findings include: R1's eINTERACT change in condition evaluation dated December 18, 2024, shows, she had a change in condition of weakness that started the morning of December 18, 2024. The same evaluation continues to show, V5 Nurse Practitioner (NP) was notified of the changes, and nothing was ordered or done. On January 8, 2024, at 12:48 PM, V5 NP stated she did not recall if she was notified of R1's change in condition or not. There was nothing documented in R1's chart that showed she was. I get so many messages; I can't remember them all. R1's progress notes continue to show, her condition stays the same with no changes. R1's electronic medical records did not show any other documentation that R1's primary care physician or Nurse Practitioner were notified of any changes in condition from December 18th - December 22, 2024. On January 8, 2024, at 11:42 AM, V6 Registered Nurse (RN) stated, she worked with R1 on December 18th and 21st. R1 was having some weakness. She reported the original change in condition on December 18, 2024, to V5 NP however when she saw R1 again, she was the same as she was on the 18th. There was no improvement. She did not call the doctor on that day to update them on R1's condition. On January 8, 2024, at 12:13 PM, V9 RN stated, he worked with R1 on December 19th and 20th. He did not contact the doctor or let anyone know of her condition. As far as I know, my colleague did. The facility's physician-family notification-change in condition policy dated November 13, 2018, shows, Purpose: To ensure that medical care problems are communicated to the attending physician or authorized designee and family/responsible party in a timely, efficient, and effective manner. Guidelines: The facility will inform the resident; consult with the resident's physician or authorized designee such as Nurse Practitioner; and if known, notify the resident's legal representative or an interested family member when there is: (B) A significant change in the resident's physical, mental, or psychosocial status (i.e., a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications); Life-threatening conditions are such things as heart attack or stroke. Clinical complications are such things as development of a stage II pressure (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: 145261 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 145261 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Dekalb 1212 South Second Street Dekalb, IL 60115 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)