Health inspection·March 23, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to perform hand hygiene to prevent cross contamination and the spread of infection for 3 of 9 residents (R21, R45, R35) reviewed for infection control in the sample of 34. Residents Affected - Few Findings include: 1. On 03/21/2023 at 12:30 PM, V11, Registered Nurse (RN), and V9, Certified Nurse Assistant (CNA), performed incontinent care for R21. Both V9 CNA and V11, RN, donned and doffed gloves without the benefit of hand hygiene, several times, during the procedure. 2. On 03/21/2023 at 12:45 PM, V8, CNA, and V10, CNA, transferred R45 to the toilet using a gait belt. After R45 was finish using the toilet, V8, with the same gloved hands, took a soapy washcloth and cleansed R45's peri rectal area and buttocks. V8 and V10 then transferred R45 back to her wheelchair with the same gloves they used to cleanse R45 touching the arm rest of R45's wheelchair and gait belt on the resident and then fastened R45 chair alarm seat belt. 3. On 03/21/2023 at 10:55 AM, R35 was sitting on the toilet with call light on, with the sit to stand lift connected to the belt around her. V10, CNA, performed hand hygiene and donned gloves. V10 operated the sit to stand lift and took R35 out of bathroom and to her bedside. V10, with the same gloved hands, took a soap and water washcloth from the sink, cleansed front to back of peri rectal area. While wearing the same soiled gloves, V10 got another washcloth from the sink, cleansed the peri rectal area again, front to back and then back to front with same cloth several times, all without glove changes and benefit of hand hygiene. On 03/22/2023 at 02:25 PM, V2, Director of Nurses (DON), stated that she would expect the staff to perform hand hygiene after they remove their gloves. The facility's policy, Hand Hygiene Protocol, dated 07/26/2021, documented, Use an alcohol based hand sanitizer: Before resident contact. It continues, Before moving from work on a soiled body site to a clean body site on same resident. It continues, Immediately after glove removal. Page 1 of 5 145267 145267 03/23/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to perform complete incontinent care for 2 of 6 residents (R45, R35) reviewed for incontinent care in the sample of 34. Findings include: 1. On 03/21/2023 at 12:45 PM, V8, Certified Nurse Assistant (CNA), and V10, CNA, transferred R45 to the toilet using a sit to stand mechanical lift. After R45 was finish using the toilet, V8 used a soapy wash cloth and cleansed R45's peri rectal area using back and forth strokes and not turning the wash cloth to the clean area. V8 continued to cleanse the buttocks, but did not cleanse the labia, groin area or abdominal folds. V8 and V10 then transferred R45 to her wheelchair. R45's Minimum Data Set (MDS), dated [DATE], documented that R45 requires extensive assist of 2 staff members to use the toilet and was frequently incontinent of urine. R45's Care plan, dated 01/30/2023, documented, TOILET USE: Assist me to the toilet every 2 hours and as needed. I am frequently incontinent and need assistance with hygiene care as needed. 2. On 03/21/2023 at 10:55 am, R35 was sitting on the toilet with call light on, with the sit to stand l mechanical lift connected to the belt around her. V10, CNA, had wash cloths in the sink with warm water and soap. V10 operated the sit to stand lift and took R35 out of bathroom to her bedside. V10 used a soap and water wash cloth to cleanse front to back of peri rectal area but did not cleanse R35's abdominal folds and bilateral groins. V10 used another wash cloth, cleansed the peri rectal area again, front to back and then back to front with same cloth several times. R35's Care plan, dated 06/01/2021, documented, Moisture barrier with incontinent care, Use mild cleansers for peri-care and washing. It continues, TOILET USE: assist me to toilet at least every 2 hours and (As needed). provide incontinent skin care per protocol. R35's admission record, dated 03/22/2023, documented a diagnosis of Malignant neoplasm of bladder. On 03/22/2023 at 2:30 PM, V2, Director of Nurses, stated that she would expect the staff to perform complete incontinent care including abdominal fold, groin areas and labia. The facility policy, Perineal Care policy and procedure, dated 11/2016, documented, Cleanse the perineal area: for female genitalia - use gentle downwards strokes from the front to the back of the perineum, using a clean section of the washcloth or pre-moistened wipe with each stroke. 145267 Page 2 of 5 145267 03/23/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 03/20/2023 at 10:56 AM, R128's oxygen tubing was not dated nor was it on R128. There was no respiratory bag in the resident's room either. Residents Affected - Some R128's Health Status note dated, 03/09/2023 at 5:36 PM documented, (Medical Doctor) here to see (R128) (new order) for (oxygen) at 2 (Liters) to keep sats above 90% till Monday, and CBC and BMP (lab tests: complete blood count, basic metabolic profile) to be done 3/16. On Monday remove (oxygen), wait 30 minutes then recheck (oxygen) levels, call MD and update him after you recheck (oxygen) He will decide then if he wants to keep her on it or remove it. R128's Health Status note, dated 03/14/2023 at 10:33 PM documented, (Resident) resting in bed at this time, no change in condition noted. (pulse oximetry) (within normal limits) (with) supplemental O2 There were no physicians order for oxygen nor was it care planned. 5. On 03/21/2023 at 9:54 AM, R48's nasal cannula oxygen tubing was not dated. It was connected to the portable oxygen tank but that was not turned on. There was no respiratory bag in the resident's room either. R48 stated that they have not changed the tubing. R48's Physicians order, dated 03/14/2023 documented, May apply supplemental (oxygen) to keep (pulse oximetry) (greater than) 90% two times a day for (Congestive Heart Failure). On 03/22/2023 at 2:25 PM, V2, Director of Nurses, stated that she would expect the staff to change oxygen tubing weekly. The facility's policy, Oxygen Administration, dated 05/04/ 2018, documented, 14. Keep a plastic bag available to store the oxygen delivery system (cannula or mask) when not in use. Date and initial the bag when placed and change weekly. 15. Guidelines for changing respiratory equipment will be as follows: A. Oxygen tubing-weekly. Based on observation, interview, and record review, the facility failed to ensure oxygen tubing is dated when placed for weekly replacement and stored in plastic bag when not in use for 5 of 9 residents (R8, R12, R48, R52, R128) reviewed for respiratory care in a sample of 34. Findings include: 1. On 03/21/23 at 9:35 AM, R8 was sitting in her wheelchair in her room. R8 had her oxygen on and there was no date noted to be on the oxygen tubing. On 03/22/23 at 8:45 AM, R8 is sitting in her room in her wheelchair with her oxygen in place. There was no date noted to the oxygen tubing at this time. R8's admission Record, print date of 03/22/023, documents R8 has a diagnosis of respiratory failure with hypoxia. R8's Minimum Data Set (MDS), dated [DATE], documents R8 is moderately cognitively impaired. 145267 Page 3 of 5 145267 03/23/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0695 Level of Harm - Minimal harm or potential for actual harm R8's Care Plan, admission date of 08/29/22, documents R8 has impaired gas exchange, has a diagnosis of respiratory failure with hypoxia, administer oxygen as prescribed or per standing order. R8's Physician's Order, 08/29/22, documents R8 is to receive O2 (oxygen) @ (at) 2L (liters) per N/C (nasal canula). Keep sats (saturations) > (greater) than 90%. May gradually taper. Residents Affected - Some 2. On 03/21/23 at 9:24 AM, R12 was sitting in her room in her wheelchair. The oxygen tubing on her portable oxygen concentrator was not dated. There was no bag with a date on the oxygen concentrator she uses at nighttime. On 03/22/23 at 9:10 AM, R12 was up and in her wheelchair getting ready to go down to the activity room. The oxygen tubing on her portable oxygen concentrator was not dated. R12's admission record, print dated of 03/22/23, documents R12 has a diagnosis of Chronic obstructive pulmonary disease (COPD). R12's MDS, dated [DATE], documents she cognitively intact. R12's Care Plan, admission date of 10/11/22, documents R12 has O2 dependent COPD, and give oxygen as ordered by the physician. R12's Physician's Orders, dated 01/25/23, document R12 is to receive O2 @ 2L per N/C continuously. 3. On 03/21/23 at 9:35 AM, R52 was sitting in her wheelchair in her room. R52 had her oxygen on and there was no date noted to the oxygen tubing. There was a bag taped to the O2 concentrator with the date of 3/6. On 03/22/23 at 8:45 AM, R52 was sitting in her room in her wheelchair with her oxygen in place. There was no date noted to the oxygen tubing at this time. The bag noted on the O2 concentrator had the date of 3/6 wrote on it. R52's admission Record, print date of 03/22/23, documents R52 has diagnoses of COPD and Chronic respiratory failure with hypoxia. R52's Care Plan, with admission date of 07/31/20, documents chronic oxygen therapy r/t (related to) chronic respiratory failure with hypoxia, COPD, and oxygen as per MD (medical doctor) orders. R52's Physician's Orders, dated 08/25/20, documents R52 is to receive O2 2-3 LPM (Liters Per Minute) NC to keep SPO2 (oxygen saturation) above 92%. 145267 Page 4 of 5 145267 03/23/2023 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure medications were properly administered and/or stored for 1 of 5 residents (R64) reviewed for medications in the sample of 34. Findings include: 1. On 03/21/23 at 12:20 PM, R64 was sitting in his room. A medication cup with medications in it was setting on R64's over the bed table. When R64 was questioned about the medication on his over the bed table, R64 stated it was his Gabapentin he takes. He said he knows he should have taken it when the nurse handed it to him, but he didn't because he likes to take it with food. R64's admission Record, print date of 03/22/23, documents R64 has a diagnosis of Peripheral Vascular disease, unspecified, Muscle wasting and atrophy, and Type I Diabetes Mellitus. R64's Minimum Data Set (MDS), dated [DATE], documents R64 is cognitively intact. R64's Care Plan, with admission date of 02/02/23, does not have any documentation regarding R64 being able to administer his own medications. R64's Physician's Order, dated 02/02/23, documents R64 is to receive Gabapentin Oral Tablet 600 by mouth three times a day for Neuropathy related to type 1 diabetes mellitus with diabetic polyneuropathy. On 03/21/23 at 12:35 PM, V4, Licensed Practical Nurse (LPN), stated she handed R64 his pill and then she was called away. V4 stated he usually takes his medications she didn't don't know why he didn't take it this time. On 03/21/23 at 12:37 PM, V4 went in to check on R64 at this time to see if his medication was still sitting in his room. After coming out of his room, V4 stated that R64 just told her that he likes to take his meds with food so now she knows. On 03/21/23 at 12:44 PM, V2, Director of Nursing (DON), stated she would expect the nurse to watch the residents take their medications unless they were assessed and able to administer their own medications. The facility's Medication Administration Policy, dated 1/11/10, documents Objective: To provide accuracy during medication pass to assure quality care for residents. Policy: It is the policy of this facility to accurately administer medication following physician's orders. It further documents 13. Make sure the resident takes the medication. Generally- Do not leave meds at bedside (may be exceptions after thorough assessment and care planning). 145267 Page 5 of 5