Health inspection·September 18, 2025

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 Based on record review and interview the facility failed to initiate a physician ordered antibiotic timely for 1 of 1 resident (R2) reviewed for Urinary Tract Infection (UTI) in the sample of 4.Findings include:1. On 9/17/2025 at 8:59AM R2 stated she had symptoms of Urinary Tract Infection (UTI) and a specimen to the lab and results had been sent to the physician, but (the physician) was in the hospital. R2 stated she was not receiving an antibiotic for a UTI. R2 stated she has had UTI's in the past and septic. R2's culture report dated 9/15/2025 documents greater than 100,000 Eschericia Coli in urine. R2's report (faxed back to the facility from the physician) documents Macrobid (antibiotic) 100 milligrams (mg) twice a day (BID) x10 days dated 9/16/2025. R2's Medication Administration Records dated 9/16/25 did not document the initiation/administration of physician ordered Macrobid. R2's current face sheet dated 9/17/2025 documents R2 has a diagnosis in part of chronic kidney disease, stage 4 (severe), and personal history of urinary tract infection. On 9/17/2025 at 12:44PM V1, Administrator stated the facility had notified the physician and the report with the order had been faxed to the facility and R2 would be provided initial dose from convenience box. V1 stated she would expect the facility to follow up on lab results to ensure orders are received.The facility policy Test results dated 7/1/23 documents the resident's physician will be notified of the results of diagnostic tests. The policy documents results of laboratory, radiological, and diagnostic tests shall be reported in writing to the resident's attending physician or to the facility. The policy documents should the test results be provide to the facility, the attending physician shall be promptly notified of the results. The policy documents the Director of Nursing (DON), or charge nurse receiving the test results, shall be responsible for notifying the physician of such results.The facility policy Culture Testing dated 7/2/23 documents should the attending physician order cultures, they shall be obtained and completed as soon as practical. The policy documents all test results shall be reported to the physician as soon as the results are obtained. Residents Affected - Few 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: 145367 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 145367 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gillespie Health & Rehab Ctr 7588 Staunton Road Gillespie, IL 62033 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)