Health inspection·April 11, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to provide the Physician Ordered treatment to pressure sore to left heel for one of 3 residents ( R10) reviewed for pressure ulcers in the sample of 29. Residents Affected - Few Findings include: 1. On 04/10/24 at 2:46PM during a dressing change and treatment V10, Licensed Practical Nurse (LPN)/ wound nurse, removed boots from R10's feet. R10's left heel boggy and black circular area unopened and left metatarsal open area 2 inches in diameter scabbed . V10 stated metatarsal is to be open to air. V10 wound nurse removed dressing from R10's left heel. R10's left heel had a mesh gauze occlusive impregnated with vaseline dressing underneath padding covering R10's pressure sores. V10, Wound nurse stated there is no order for that dressing to R10's left heel. R10's wound management progress notes dated 3/26/2024 documents, skin moisturizer to left heel daily, cushion with abdominal pad or foam heel cup and may secure with kerlix or gauze wrap. R10's care plan dated 10/12/2023 documents R10 has an alteration in skin integrity. R10's care plan dated 10/12/2023 documents treatments (application of ointment/mediation and /or dressings) to site per physician orders. The facility policy Pressure/skin breakdown-clinical protocol dated January 20217 documents the physician will authorize pertinent orders related to wound treatments, including pressure redistribution surfaces, wound cleansing and debridement approaches, dressings and application of topical agents. Page 1 of 3 145294 145294 04/11/2024 Prairie Village Healthcare Ctr 1024 West Walnut Jacksonville, IL 62650

F 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview, and record review, the facility failed to provide 8 consecutive hours of Registered Nurse (RN) Coverage. This failure has the potential to affect all 48 residents residing in the facility. Residents Affected - Many Findings include: The Schedule, dated 3/4/24 - 3/17/24, fails to document a Registered Nurse working for 8 consecutive hours on 3/5/24, 3/6/24, 3/7/24, 3/8/24, 3/10/24, 3/11/24, 3/13/24, 3/16/24 and 3/17/24. On 4/10/24 at 1:30 PM, V1, Administrator, stated, (V14), (previous Director of Nurses, (DON) ended her employment on 1/18/24. (V15), (Interim DON) worked from 1/18/24 until 3/4/24 as the sitting DON. Then (V15) just quit and that is when I lost my RN coverage. The Long-Term Care Facility Application for Medicare and Medicaid, dated 4/8/24, documents that 48 residents reside in the facility. 145294 Page 2 of 3 145294 04/11/2024 Prairie Village Healthcare Ctr 1024 West Walnut Jacksonville, IL 62650

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview, observation and record review, the facility failed to cleanse a multi-use blood glucose machine completely to insure disinfection for 7 of 16 residents (R4, R12, R17, R23 R38, R45, R47) reviewed for infection control in the sample of 29. Residents Affected - Some Findings include: On 4/8/24 at 11:03 AM, V4, Licensed Practical Nurse, entered (R38's) room to obtain a blood glucose level. V4 got the level of 158 and exited the room. V4 took the blood glucose machine to her medication cart and laid it on a clean tissue. V4 obtained a Microdot Bleach wipe and gently wrapped the machine up and placed it on top of her medication cart. V4 set a timer for 3 minutes. V4 failed to rub the entire machine with the Microdot cloth. On 4/9/24 at 11:00 AM, V1, Administrator stated that the blood glucose machine should be cleansed before wrapping it up. The facility provided list documenting who gets blood glucose monitoring, dated 4/10/24, documents that R4, R12, R17, R23, R38, R45 and R47 all use this multi-use glucose monitor. The Microdot Bleach Wipe container ,documents, Disinfection: 5. Apply towelette and wipe desired surface area to be disinfected. A 30 second contact time is required to kill the bacteria and viruses. 145294 Page 3 of 3