Health inspection·April 8, 2024

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. Based on interview and record review, the Facility failed to follow their policy by not providing written documentation of a bed hold notice for 1 of 1 residents (R76) reviewed for hospitalizations, in the sample of 29. Findings include: On 4/1/2024 at 12:26 PM, R76 stated that he had been hospitalized recently for water on my legs. R76's Progress Notes, dated 3/21/2024, documented that R76 was sent to the local emergency room (ER) due to complaints of having difficulty breathing as well as a weight gain. On 4/2/2024 at 2:53 PM, V10, Licensed Practical Nurse (LPN), stated that when a resident is transferred to the hospital/ER the nurses fill out a form in the computer (Electronic Medical Record/EMR) and provide the resident with a bed hold policy. On 4/2/2024 at 3:07 PM, R76's Bed Hold Notification was requested. On 4/3/2024 at 8:40 AM via Electronic Mail (Email), V1, Administrator (ADM), stated that she was unable to provide the notice as requested. On 4/4/2024 at 9:05 AM, V12, Business Office Manager (BOM) stated, We are supposed to (provide the bed hold notice), but we haven't been. I'll be honest. We will now. The Facility's Bed Hold Notification undated, documented, When a resident is transferred to the hospital, or when the resident takes a therapeutic leave of absence, they have the right to request that their bed be held until their return. Such request is called a 'Bed Hold'. It continues, The bed hold notification will be issued at the time of transfer and in cases of emergency transfer, notice will be given without 24 hours of the leave. Page 1 of 5 145267 145267 04/08/2024 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the Facility failed to ensure a resident on blood thinning medication was examined for potential complications following a fall with head injury for 1 of 24 residents (R80) reviewed for quality of care, in the sample of 29. Residents Affected - Few Findings include: R80's Facesheet, dated [DATE], documented that R80 was admitted to the facility on [DATE] and was discharged on [DATE]. R80's Care Plan, dated [DATE], documented that R80 was on a Short term stay in facility for rehabilitation. It further documented that R80 is on anticoagulant therapy, Eliquis (blood thinner medications). It continues to document that the facility was to monitor and report adverse reactions such as blood tinged or red blood in urine and to avoid activities that could result in injury and take precautions to avoid falls. R80's Progress Notes, dated [DATE] at 12:48 PM documented, MD (Medical Director) made aware of resident having blood in catheter tubing. NOR (New Order Received) to hold Eliquis (Blood thinning medication) 2.5 mg (milligrams) HS (bedtime) dose for 3 days and update. R80's Progress Notes, dated [DATE] at 23:24 PM, documented, At 2100 (9 PM) Res (resident) was yelling, 'Help' and when staff went to check on her, she was found lying on R (Right side) on floor in front of recliner. Res states she was leaning over to pick something up off the floor and fell. Res noted to have a large skin tear to RFA (Right Forearm) measuring 16.7 cm (centimeters) x (by) 4.4 cm, skin tear to R lower leg measuring 6/4 cm x 4.5 cm and a small hematoma (bruise) to R side of head measuring 1.1 cm x 0.7 cm. Areas cleansed with steri-strips and dry drsg (dressing) applied. R80's Progress Notes continue to document that R80 was placed on neuro checks and assisted to bed. R80's Progress Notes also documented that R80's MD was notified at 23:23 (11:11 PM). R80's Progress Notes, dated [DATE] at 12:54 PM, documented that R80 was evaluated by Speech Therapy (ST) and diet was changed to pureed. R80's Progress Notes, dated [DATE] at 3:56 AM, documented that R80 was noted with no respiration or pulse and that the time of death 3:37 AM. On [DATE] at 11:18 AM, V10, Licensed Practical Nurse (LPN), stated that R80 came to the Facility covered in bruises and skin tears. V10 continued to state that R80 fell out of her recliner and had a bruise to her head and an extensive skin tear to her arm. V10 also stated that R80 had quite a bit of bleeding when V10 would perform dressing changes as well as R80 having blood in her urine, therefore staff were holding her blood thinning medication. V10 continued to state that he was R80's nurse on the dayshift prior to her expiring the next day (early morning). V10 stated that R80 usually knew V10's name but kept calling him Gail. V10 also stated that there was no other nurse at the Facility named Gail. On [DATE] at 11:39 AM, V6, Registered Nurse (RN) stated, Our doctors would want them (resident) sent to the ER (Emergency Room) and if they didn't, we would suggest it. We would remind them they hit their head and are on a blood thinner. You always have to be familiar with who is on a blood thinner 145267 Page 2 of 5 145267 04/08/2024 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0684 Level of Harm - Minimal harm or potential for actual harm because they could have a brain bleed. If they (resident) was on Coumadin or Eliquis (blood thinning medications) we would definitely send them out (to the ER). On [DATE] at 1:36 PM, V11, RN stated, More than likely the doctor would say to send them out if they had a fall and was on a blood thinner. Residents Affected - Few On [DATE] at 1:18 PM, V16, LPN stated, (R80) hit her head 'a little bit' and had an abrasion on the side of her head. On [DATE] at approximately 1:30 PM, V18, Speech Therapist (ST), stated that R80 came to the facility with a regular diet ordered. V18, also stated that R80 had a decline in condition, was evaluated, and placed on a pureed diet. V18 stated that R80 expired that night. The Facility did not have a Policy addressing the use of anticoagulants and the need for further evaluation after a head injury. 145267 Page 3 of 5 145267 04/08/2024 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 - Some 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. Based on observation, interview, and record review, the facility failed to ensure that out dated Tuberculin Purified Protein Derivative (TB) solution was removed from the 300 hallway medication refrigerator. This failure has the potential to affect all the residents residing on the 300 hall. Findings include: On 04/01/24 at 02:53 PM, the refrigerator in the 300 hall medication room was inspected and observed to have an open vial of TB solution that was half full with an open date of 11-21 written on the vial. On 04/01/24 at 02:55 PM V5, Registered Nurse (RN), stated that yes everyone in the facility uses the TB solution. She continued to state that each hallway may have their own vial but she wasn't sure, and that she isn't sure for how long the solution is good for after it's opened. She continued to state that night shift does the TB test, so she wasn't really a good person to ask that. V5 verified the open date on the TB solution vial was 11-21. On 04/04/24 at 11:35 AM, V1, Administrator, stated that the TB solution should be discarded 30 days after opening. The TB solution box documented, Discard opened product after 30 days. The facility's Medication Storage Policy, dated 07/01/23, documented, Purpose: To provide guidance to facility nursing staff on the proper storage of medication. Policy: The facility stores all drugs and biological's in a safe, secure, and orderly manner and in accordance with state and federal regulations. It continues, 4. Drug containers that have missing, incomplete, improper, or incorrect labels shall be returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biological's shall be returned to the dispensing pharmacy or destroyed. 145267 Page 4 of 5 145267 04/08/2024 Pana Health and Rehab Center 1000 East Sixth Street Road Pana, IL 62557

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the Facility failed to follow their Contact/Droplet Precautions Policy while administering medications to 1 of 3 residents (R34) reviewed for Transmission Based Precautions (TBP), in the sample of 29. Residents Affected - Few Findings include: On 4/2/2024 at 8:05 AM, V6, Registered Nurse (RN) was observed passing medications. At this time, there was a Contact/Droplet Precaution sign outside of R34's room. At this time, V6 donned a gown and N95 (mask) and was wearing eyeglasses. V6 did not apply gloves. At this time, V6 stated, (R34) has a Coronavirus, but it is not COVID 19. He (R34) went to the ER (Emergency Room) because he had a temp (elevated temperature). He (R34) is on isolation while he is taking his antiviral meds (medications). R34's Progress Note, dated 3/28/2024 at 10:05 PM, documented that R34 returned from the local ER with a diagnosis of a systematic viral illness and was placed on isolation precautions. R34's Progress Note, dated 3/29/2024 at 6:27 AM, documented that R34 continues Droplet isolation due to Coronavirus OC43 and an antiviral medication was ordered by the physician. R34's Progress Note, dated 4/2/2024 at 12:09 PM, documented that R34 continues the antiviral medication. On 4/4/2024 at 10:25 AM, V2, Director of Nursing (DON), stated that R34 was on contact/droplet precautions on 4/2/2024 and that she would expect staff to don a gown, gloves, N95 mask and eye shield while within 6 feet of a resident on contact/droplet precautions. On 4/4/2024 at 12:55 PM, V1, Administrator stated, she would expect gloves to be worn in a resident's room when the resident is on droplet/contact isolation. The Facility's Transmission Based Precautions Policy, dated 7/1/2023, documented, Purpose: To provide staff guidelines for transmission-based precautions to protect residents and themselves while provides cares. Policy: Transmission- Based Precautions are initiated when a resident develops signs and symptoms of a transmissible infection; arrives for admission with symptoms of an infection or have a laboratory confirmed infection, and is at risk of transmitting the infection to other residents. Responsibility: It is the responsibility of all staff and agents of the facility to adhere to the transmission-based precaution guidelines. It continues, When a resident is placed on transmission- based precautions, appropriate notification is placed on the room entrance door so that personal and visitors are aware of the need for and the type of precaution. It continues, Contact Precautions: Contact Precautions may be implemented for residents known or suspected to be infected with microorganisms that can be transmitted by direct contact with he resident or indirect contact with environmental surfaces of resident-care items in the resident's environment. It continues, Staff and visitors will wear gloves (clean-non sterile) when entering the room. 145267 Page 5 of 5