Health inspection·April 12, 2024

F 0776 Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them. 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 obtain a timely x-ray for 1 of 4 residents (R3) reviewed for diagnostic services in the sample of 4. Residents Affected - Few Findings include: R3's Minimum Data Set, MDS, dated [DATE] documents R3 has a BIMS (Brief Interview for Mental Status) of 10, which is moderate cognitive impairment. R3's Progress Note, dated 4/8/24 at 7:30 AM, documents the following: Writer called to resident room, noted right knee deformity and resident complained of inability to move leg. No redness or swelling noted. Resident denies bumping or twisting leg at any time. CNA (Certified Nursing Assistant) reports resident ambulated to bathroom approximately 5 AM with gait belt and 1 assist with walker. No difficulty noted by caregiver or complaints of pain voiced by resident. Spoke with son who stated resident has had both knees replaced in the past. Further stated, 'she doesn't even move around that much.' Informed son we would be requesting X-ray and would update when results received. R3's Progress Note, dated 4/8/24 at 8:30 AM, documents MD (medical doctor) notified of resident c/o (complaining of) right knee pain with deformity noted. New order received for x-ray of right knee stat. POA (Power of Attorney) aware. R3's Progress Note, dated 4/8/24 at 8:44 AM, documents Upon current assessment, resident resting in bed with eyes closed. Noted discoloration evolving to right lower thigh above knee. Awaiting x-ray at this time. Resident in no apparent distress. R3's Progress Note, dated 4/8/24 at 7:45 PM, documents the following: x-Ray company in facility at this time to complete x-ray to right knee. R3's Progress Note, dated 4/8/24 at 8:08 PM, documents the following: On call physician returned call to facility at this time. He was updated on resident increased pain. New order received to send resident to emergency room for evaluation. R3's Progress Note, dated 4/9/224 01:08 AM, documents the following: Resident admitted to hospital. R3's x-ray Report with a date of service 4/8/24, no time, documents the following: right knee x-ray, impression - knee arthroplasty, proximal to which is an acute fracture. Page 1 of 2 145271 145271 04/12/2024 Litchfield Health & Rehab Center 628 S Illinois Ave Litchfield, IL 62056

F 0776 Level of Harm - Minimal harm or potential for actual harm R3's Hospital Records, SNF (Skilled Nursing Report) dated, 4/9/24 documents R3 was admitted with a right femur fracture. R3's POS (Physician Order Sheet, documents an order dated 4/8/24 at 8:30 AM, for a portable x-ray of the right knee due to pain and deformity. Portable due to resident limited mobility. Residents Affected - Few On 4/11/24 at 9:08 AM, V3, LPN (Licensed Practical Nurse), stated when she came into work on 4/8/24, R3 was waiting for an x-ray. V3 stated she received the results, which showed a fracture, she notified the on-call physician and V14, R3's Son and then sent R3 to the local hospital for further evaluation. On 4/11/24 at 12:51 PM, V14, R3's Son, stated he was notified by the facility sometime early in the day that R3 was complaining of pain in her knee, and they were ordering an x-ray. V14 stated he came to the facility around 5:00 PM and stayed until around 7:30 PM and no one came to do the x-ray. V14 stated he asked the staff what was going on and he was told they (x-ray company) would be at the facility in about an hour. V14 stated he stayed until 7:30 PM and they hadn't shown up. V14 stated around 45 minutes after he left the facility, he received a call stating that R3 had a fracture, and they were sending her to the local emergency. On 4/11/24 at 1:35 PM, V15, Registered Nurse (RN)/ Assistant Director of Nurses (ADON), stated she had requested an x-ray for R3, and it was ordered just as a regular x-ray, the doctor didn't say stat or routine. V15 stated it was quite a while, close to 12 hours before the x-ray was completed. On 4/11/24 at 1:35 PM, V2, Director of Nurses, DON, stated V15 had come and gotten her, and they went and assessed R3's leg. V2 stated there was a deformity and the physician was notified for an x-ray. V2 stated the order was placed at 8:30 AM and wasn't obtained until around 7:30 PM that night, around 11 hours later. The Mobile Imaging Services Agreement, dated 11/8/19, documents the following: provider shall provide the following services to facility's patients: Provider, an independent contractor using their equipment and qualified staff, will provide portable diagnostic x-ray and doppler, ultrasound and EKG (electrocardiogram) services where available that have been ordered by a qualified MD (Medical Doctor), DO (Doctor of Osteopathy) or NPP Non-Physician Provider). Provider will respond within a reasonable time frame to requests for services, usually within a few hours. A duly licensed radiologist radiologic exams and cardiologist will interpret cardiology exams. Provider will notify facility by phone of positive exam findings as soon as possible and will provide a full written report to facility within twenty-four hours of the exam. Images and reports are also available on-line for review 24/7. 145271 Page 2 of 2