Inspection·June 23, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to follow wound treatment orders for 1 of 3 residents (R1) reviewed for wounds in the sample of 3. This failure resulted in R1's wound deteriorating and requiring R1 to be hospitalized and recieve a surgical intervention. Residents Affected - Few The findings include: On 6/17/25 at 9:00 AM, R1 was in bed with an intravenous antibiotic infusing to a peripherally inserted central catheter in his left arm. R1's left leg was amputated below the knee and was wrapped in a dressing with a wound vacuum attached. R1 said he originally had surgery on his knee back around the Superbowl of this year. R1 said the wound had been infected and he has had pills and shots and surgery and now this. R1 said the wound became infected and he was sent to the hospital and the surgeon did a procedure a couple weeks ago. R1 said he was in the hospital for 6 days where they jabbed him with more needles. R1 said now they have him hooked up to the antibiotics and the wound vac machine. On 6/17/25 at 9:07 AM, V3 Wound Nurse Practitioner said she has been following R1 since 4/29/25. R1's surgical incision started off as covered eschar. V3 said one side of the eschar had tunneling underneath with some slough. V3 said at first there were no signs or symptoms of infection, but then the wound had some drainage. V3 said R1 was started on oral antibiotics which seemed to improve but then the tunneling appeared worse and she did an x-ray to rule out osteomyelitis. V3 said the x-ray came back suspicious for osteomyelitis so she gave orders to send R1 to the hospital. On 6/17/25 at 10:15 AM, V4 Wound Licensed Practical Nurse said R1's wound had an area that was open and had tunneling. V4 said V3's wound treatment orders were packing the wound with iodoform packing on Monday, Wednesday, and Fridays. V4 said the wound had increased drainage and the packing would be soaked. V4 said V3 ordered an X-ray to check for osteomyelitis and the x-ray came back suspected osteomyelitis. V4 said V3 had R1 sent to the hospital. V4 said at the hospital, R1 had testing which showed an abscess. V4 said R1 had an incision and drainage procedure with the surgeon to wash out the wound. V4 said R1 returned to the facility with a wound vac and on intravenous antibiotics. On 6/17/25 at 1:12 PM, V3 said R1's treatment orders for the tunneling in his wound was iodoform packing to be done daily. V3 said wound packing is almost always done daily in order to be effective. V3 said she never orders packing a wound only Monday, Wednesday, and Fridays. V3 said wound packing helps the wound heal from the inside out and packing [NAME] the wound drainage out of the wound. V3 said daily packing changes prevents a bacterial bio film from forming in the wound cavity. V3 said the bacterial bio film increases the risk for infection especially someone already colonized with Methicillin-resistant Staphylococcus aureus (MRSA) like R1. V3 said her expectation is for treatment (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 3 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 06/23/2025 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)