Inspection·January 26, 2023

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide services to prevent the worsening of contractures for 1 of 3 residents (R15) reviewed for contractures in a sample of 26. Findings include: On 01/23/23 at 9:35 AM, R15 was observed in her wheelchair with a carrot (an aid to prevent fingers from going into the palm) in left hand. On 1/23/23 at 9:37 AM, V5, Certified Nurse's Aide (CNA), was questioned if R15 receives any range of motion exercises (ROM) on her hand. V5 stated that they do ROM exercises with R15's left hand. V5 was asked to perform the exercises on R15. V5 then performed finger stretches in and out of the left hand and bending of the first knuckle of the fingers on the left hand. V5 failed to do repeated flexion and extension of the finger at all joints. On 1/23/23 at 9:40 AM, V13, Registered Nurse/ Restorative Nurse, was questioned about where the resident's restorative plan of care could be located and who was in charge of making up the restorative plans. V13 stated that she oversees the restorative nursing program, and she makes up the resident's programs if they need one and the program can be found in the residents Care Plan. On 01/24/23 at 8:45 AM, V13 was questioned as to why R15 did not have a Range of Motion plan of care in place for her left hand due to contractures. V13 stated that the staff do work with R15's hand but there is not a plan made up for it and she is going to get an order from the doctor for range of motion today. V13 further stated that she was not aware that R15 did not have an order or a plan of care for range of motion. On 1/24/23 at 2:30 PM, V1, Administrator, stated, I do expect everyone with a contracture to have a program put in place, so they do not get further contracted and then the staff know what exactly the resident's program is. (V13) and I talked of this last night, and she knows everyone with a contracture needs to have a plan that address it in their care plan. On 1/25/23 at 10:30 AM, V2, Director of Nurses, stated, Range of Motion should be done on all planes. R15's admission Record, print date of 1/24/23, documents that R15 was admitted on [DATE] and has diagnoses of Dementia and personal history of a stroke. (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 2 Event ID: 145271 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 145271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Litchfield Health & Rehab Center 628 S Illinois Ave Litchfield, IL 62056 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)