Health inspection·December 10, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews, and record review, the facility failed to adequately maintain an effective infection prevention and control program to help prevent and control the transmission of a highly contagious communicable disease, the norovirus. This failure has the potential to affect all 165 residents that currently reside at the facility. Residents Affected - Many Findings include: On 12/10/2024 at 08:40 AM, surveyor entered the facility and did not observe any signs posted at the front doors or lobby area indicating current norovirus outbreak. Review of resident roster dated 12/10/2024 documented census of 165 residents and indicated residents highlighted in grey are on isolation. On 12/10/2024 at 09:15 AM, V1 (Administrator) said the facility has had a recent norovirus outbreak. V2 (Director of Nursing/DON) was also present during this interview and said she is currently overseeing infection preventionist duties including the current norovirus outbreak. V2 (DON) then said the outbreak is clearing up and that currently there was only one resident with watery stools reported yesterday (12/09/2024) and a resident with one reported watery stool today but did not identify residents. Review of initial facility reported incident report submitted by V2 (DON) with onset date of 11/22/2024, indicated that 24 residents and 11 staff exhibited gastrointestinal (GI) symptoms which started on 11/22/24. Local health department was made aware of the GI symptoms and received guidance on disinfection, resident management, contact and droplet precautions, testing and staff management. Facility continues to monitor for GI signs and symptoms; in-service staff on proper precautions (hand washing, use of proper bleach-based products per regulation). As of 12/02/24 there are only 5 residents and 1 staff with moderate symptoms. Continued surveillance is in effect. On 12/10/2024 at 11:41 AM, V4 (Registered Nurse) said she is assigned to the locked (garden) unit and indicated that R1 had watery stools last night and this morning, R2 had a watery stool this morning, and R10 had a watery stool this morning. V4 added that she trying to sort out which residents are having symptoms, then said all symptomatic residents are on contact isolation precautions. On 12/10/2024 at 11:46 AM, observed R2 sitting in her wheelchair in the hallway outside of her room door on the locked (garden) unit. R2 said they told her that she has the virus because she had a loose stool this morning. No posted contact isolation sign or personal protective equipment (PPE) was observed on R2's door or next to room door at this time. At 11:48 AM, observed R10 in her room with no posted contact isolation sign or PPE observed on R2's door or next to room door at this time. Page 1 of 5 145316 145316 12/10/2024 Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 12/10/2024 at 11:50 AM, V5 (Certified Nursing Assistant/CNA) said R1 is on contact isolation for nausea and vomiting. V5 also said staff should wear a gown, gloves, and mask when caring for these residents, then wash hands and use hand sanitizer afterwards. No posted contact isolation sign or PPE was observed on R2's door or next to room door at this time. On 12/10/2024 at 11:56 AM, V6 (CNA) said she is working on the locked (garden) and indicated that R1 and R10 each had a watery stool this morning. V6 then said staff should wear a gown, gloves, and mask when caring for these residents. On 12/10/2024 at 12:00 PM, observed V7 (Housekeeper) cleaning a private room on the short hall west unit that is next to the locked (garden) unit. V7 said when cleaning a resident's room who has norovirus, she first cleans with bleach spray or bleach wipes then uses a disinfectant. V7 then said she has only been using a disinfectant cleaner because she's out of bleach cleaner and was told that she could do this. On 12/10/2024 at 12:25 PM V2 (DON) said some residents who have no symptoms for 48 hours can be taken off contact isolation then indicated there were a few residents that met this criterion, but some are having symptoms and need to be isolated again so she will need to update the current line list. On 12/10/2024 at 1:10 PM V2 (DON) provided an updated line list for acute gastroenteritis dated 11/26/2024 that documented nine current symptomatic residents with their dates of symptom onset and last occurrence. V2 indicated that the letter D means the symptom is diarrhea. The following residents were documented on the line list: R1's date of symptom onset was 11/22/2024 with episodes of diarrhea documented on 12/09/2024 and 12/10/2024. Resident roster dated 12/10/2024 indicated R1 last admitted to facility on 11/27/2024. R2's date of symptom onset was 11/24/2024 with episodes of diarrhea documented on 12/08/2024 and 12/10/2024. Resident roster dated 12/10/2024 indicated R2 last admitted to facility on 04/17/2023. R3's date of symptom onset was 11/23/2024 with episodes of diarrhea documented on 12/08/2024 and 12/09/2024. Resident roster dated 12/10/2024 indicated R3 last admitted to facility on 07/11/2024. R4's date of symptom onset was 11/25/2024 with episode of diarrhea last documented on 12/08/2024. Resident roster dated 12/10/2024 indicated R4 last admitted to facility on 12/17/2022. R5's date of symptom onset was 11/27/2024 with episode of diarrhea last documented on 12/08/2024. Resident roster dated 12/10/2024 indicated R5 last admitted to facility on 04/05/2018. R6's date of symptom onset was 12/03/2024 with episodes of diarrhea documented on 12/05/2024 and 12/09/2024. Resident roster dated 12/10/2024 indicated R6 last admitted to facility on 09/01/2024. R7's date of symptom onset was 12/09/2024 with episodes of diarrhea documented on 12/09/2024. Resident roster dated 12/10/2024 indicated R7 last admitted to facility on 01/13/2021. R8's date of symptom onset was 12/09/2024 with episodes of diarrhea last documented on 12/09/2024. Resident roster dated 12/10/2024 indicated R8 last admitted to facility on 01/20/2023. R9's date of symptom onset was 12/10/2024 with episodes of diarrhea last documented on 12/10/2024. 145316 Page 2 of 5 145316 12/10/2024 Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481

F 0880 Resident roster dated 12/10/2024 indicated R9 last admitted to facility on 11/11/2019. Level of Harm - Minimal harm or potential for actual harm R10 was not identified as having current norovirus symptoms on the provided line list. R1 through R10 were not highlighted grey which indicated resident was on isolation as per above mentioned resident roster dated 12/10/2024. Residents Affected - Many On 12/10/2024 at 01:16 PM V2 (Director of Nursing) said the facility is currently in outbreak for norovirus and if each room has an isolation sign posted, that covers not posting any signs up front. V2 added that visitors are not informed of or screened for symptoms of norovirus themselves. V2 then said if a visitor is visiting a resident who is symptomatic, then the receptionist instructs them on precautions. When asked if the receptionist is a nurse, V2 said no she is not but she can call for either V1 (Administrator) or V2 (DON) to intervene and provide education to the visitor. At 01:18 PM, V2 (DON) said staff have been in-serviced over the last couple of weeks on symptoms of norovirus, hand hygiene, and infection control/PPE use with return demonstration. She also said staff are to notify her as soon as a resident has symptoms and whether there were multiple occurrences, and if a resident has two or more episodes of loose stools or one episode of vomiting, then that resident is placed on enteric contact precaution isolation with that isolation sign posted on their door. When asked what precaution is taken if they have a roommate, she said it usually affects the roommate who will be assessed for symptoms. V2 (DON) then said when caring for a resident with norovirus, gown and gloves are mandatory and a mask for protection from splatters with loose stools, and staff must wash their hands with soap and water because they are hand sanitizer doesn't work on norovirus. At 01:24 PM, V2 said when cleaning and disinfecting resident rooms, all touch surfaces should be cleaned with a bleach water mixture or bleach wipes with a one-minute dry time and housekeeping can use a disinfectant that works on the norovirus. V2 (DON) also said that if housekeeping is using bleach wipes, then they don't have to use disinfectant. At 01:28 PM, V2 said the importance of staff to adhere to the infection control policy and procedures for norovirus and/or any communicable disease to avoid spreading to other residents or bringing home to their families and stressed that this is done through good hand washing especially after leaving an isolated resident's room, following all isolation precautions and guidelines, and through limiting exposure. On 12/10/2024 at 1:39 PM, V8 (Maintenance Director) said is currently overseeing the housekeeping department as well due to that manager being out on medical leave. V8 then said that housekeepers are to clean resident rooms who have the norovirus and high touch surface areas with a bleach and water combination or bleach wipes with a one-minute dry time then they are to use a disinfectant cleaner afterwards. When asked how many parts each of water and bleach are needed, V8 said he was unsure and would need to look it up. He added that housekeepers know they are to ask for more bleach cleaner and/or wipes when they are out, and if not in stock, he will go to the local store to obtain them. On 12/10/2024 at 02:24 PM, no contact isolation sign was observed posted on R6's or R9's room doors. R6 resides on the locked (garden) unit and R9 resides on the short hall west unit that is next to the locked unit. At 02:26 PM, no contact isolation sign was observed posted on R1's room door. R2's room door was observed with a small pink contact isolation sign posted next to PPE bin that was hanging on her door. Both R1 and R2 reside on the locked (garden) unit. R1, R2, R6, and R9 are all listed on the updated gastroenteritis line list provided by V2 (DON). On 12/10/2024 at 02:28 PM, V9 (Certified Nursing Assistant) was observed interacting with R2 in her room without wearing any PPE. Upon exiting R2's room V9 said she was passing ice water and had looked through R2's bag to help her find a wallet. When asked if R2 is on contact isolation, V9 (CNA) said she just came in to work and has been off for a week and was unsure. When shown the contact 145316 Page 3 of 5 145316 12/10/2024 Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many isolation sign on the R2's door, V9 said the sign isn't specific about what PPE to wear but she should be wearing PPE when in an isolation room. V9 then said she did not wash her hands after leaving R2's room but will do so now then proceeded to walk down the hall and headed towards the nurse's station. On 12/10/2024 at 02:30 PM, V10 (Certified Nursing Assistant) said she has worked on the locked (garden) unit all day shift and will continue working second shift on the unit. V10 said she wore a gown, gloves, and a mask every time she entered R2's room but said did not wash her hands prior to exiting the room. V10 (CNA) said upon exiting R2's room, she went down the hall and washed her hands in the clean utility room. On 12/10/2024 at 02:35 PM, no contact isolation signs were observed posted on R3, R4, R5, and R10's room doors, all reside on the locked (garden) unit, and are all listed on the updated gastroenteritis line list provided by V2 (DON). On 12/10/2024 at 02:41 PM, no contact isolation signs were observed posted on R7 and R8's room doors, both residents reside on the front hall east unit, and are both listed on the updated gastroenteritis line list provided by V2 (DON). On 12/10/2024 at 02:50 PM, V1 (Administrator) and V2 (Director of Nursing) both indicated during interview that there should be a contact isolation sign on a resident's door who is having symptoms of norovirus with personal protective equipment (PPE) supplies in hanging door bins or three drawer bins next to room door and housekeepers should clean with either a bleach cleaner or a bleach and water combination then disinfect afterwards. V2 (DON) added that staff should be wearing gloves in contact isolation rooms and should wear a gown when making direct contact with the resident. At 2:56 PM, V2 (DON) said she was told today that R6's loose stools are from of a prescribed medication due to an irregular lab and not from the norovirus. No documentation was provided to support this finding. On 12/10/2024 at 03:00 PM, V1 (Administrator) said the health department is aware of what disinfectant the facility is currently using which does kill the norovirus. When asked whether V1 has informed the health department that the facility does not continuously use bleach cleaner first followed by a disinfectant and whether this is an acceptable method, V1 said no. On 12/10/2024 at 3:15 PM, V11 (Quality Assurance Nurse) said staff have been educated continuously regarding the norovirus and precautions to be taken and will continue to in-service staff more so that they can better understand isolation precautions and the seriousness of those precautions. V11 then said while rounding around noon, there was a sign posted on the locked unit door to inform staff of the outbreak on the unit. When asked if this sign indicated which residents were symptomatic, V11 said it did not. Resident information documents were not provided for R6 or R10 by the facility during complaint investigation. Review of Norovirus Outbreak Measures policy with effective date of 02/15/2028 indicated in part: Purpose: This guideline has been developed to help stop the spread of viral gastroenteritis. The Center for Disease Control (CDC) reports that nearly two thirds of all norovirus outbreaks occur in long term care facilities. Noroviruses are highly contagious and cause acute gastroenteritis in humans. They are transmitted in health care settings by direct person-to-person contact; by hand transfer 145316 Page 4 of 5 145316 12/10/2024 Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many of the virus after touching contaminated materials or environmental surfaces; via droplet from vomit; or foodborne/waterborne contamination. Outbreaks of norovirus in long term care facilities may be prolonged due to potentially high level of contact, increased population of those most vulnerable and regular introduction of susceptible individuals. Norovirus is very resilient, surviving temperature extremes from freezing to 140 degrees Fahrenheit and low chlorine levels. The virus has been known to survive in the environment for at least 12 hours. Infected persons can continue to shed the virus for up to two weeks after they have recovered. Guidelines: Control Measures for Residents include but not limited to: isolate all ill residents from others by encouraging the ill resident to remain in their room until symptom free for 48 hours (2 days after their last symptom of vomiting and/or diarrhea); post signs explaining the risk of infection of ill patients and ill visitors; Control Measures for Residents include but not limited to: staff should wash hands when entering and leaving every resident room with soap and water for at least 20 seconds. Do not use alcohol-based hand sanitizers. Wash hands thoroughly and often during the outbreak; staff should wear gloves when caring for ill residents who are vomiting or have diarrhea or when touching potentially contaminated surfaces. Gloves should be discarded, and hands washed immediately after completing care; Disinfection and Sanitation: Use a bleach solution of 1:10 or 5000 parts per million (ppm) to frequently clean all common touch surfaces. This should be done twice a day during the outbreak. Common surfaces can include door handles, remote controls, call buttons, railings, bed rails, elevator buttons, arm rests, telephones, water faucets and fountains, toilet seats, ice machines, light switches, walkers, etc.; use a freshly made bleach solution between each room or area cleaned; use another Environmental Protection Agency (EPA) registered disinfectant for norovirus according to manufacturer instructions. 145316 Page 5 of 5