Health inspection·October 4, 2024

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 observation, interview, and record review, the facility failed to assess and obtain treatment orders for a resident (R2) with known skin tears. Residents Affected - Few This applies to 1 of 4 residents (R2) reviewed for quality of care. The findings include: R2's Care Plan, dated 10/02/2024, said R2 was at risk for potential impairment of the skin integrity related to fragile skin and a history of skin tears. R2's care plan showed multiple interventions including, If skin tear occurs, treat per facility protocol and notify MD . Monitor/document location, size, and treatment of skin tear . On 10/02/2024 at 11:24 AM, R2 was observed with a dressing on her right lower leg. R2 was confused and not interviewable. At 12:20 PM, V3 (Wound Care Nurse/WCN) and V4 (Wound Care Aide) were asked to assess R2's right lower leg dressing. V3 said she was not aware of R2 having active wounds. V3 said R2 had frail skin and was prone to skin tears. V3 removed R2's right lower leg dressing, and R2 had two dry scabs to her mid-shin and lower lateral areas. Then V3 noticed R2 had other dressings on her left lower leg and bilateral upper arms. V3 removed R2's dressings to assess her extremities, R2 had old, opened skin tears to her left mid-shin and right elbow, and then had another skin tear to her left upper arm which was actively bleeding. V3 said she was unaware of R2's opened skin tears, and R2 did not have treatment orders in her EMR (Electronic Medical Record). Then V3 said she asked V15 (Registered Nurse/RN) about R2's skin tears, and V15 said they were last changed by V16 (Hospice RN) on 9/30/2024. V3 said she would return to assess R2's wounds and notify the physician to obtain treatment orders. V3 said all wounds need to be reported to the wound care and be assessed and documented weekly. On 10/02/2024 at 1:30 PM, V15 (RN) said on 9/30/2024, she asked V16 (Hospice RN) to change R2's soiled dressings on her lower legs and right elbow. V15 said she was unaware of R2's left upper arm skin tear. V15 said R2 did not have skin tear treatment orders, and was unsure where V16 documented R2's weekly hospice visit. On 10/03/2024 at 12:05 PM, V16 (Hospice RN) said she visited R2 weekly for hospice services. V16 said she was asked by V15 to change R2's dressings on 9/30/2024. V16 said she did not have access to R2's facility EMR to check her treatment orders. V16 said she applied the same type of dressings she removed from R2's extremities. V16 said she changed R2's right elbow and left upper arm dressings. V16 said she also applied protective dressings to R2's lower legs. V16 said the facility nursing staff should be monitoring hospice residents' wounds and treating them per their protocol. V16 said hospice nursing staff does assist the facility staff with providing routine care, including wound care, (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 4 Event ID: 145372 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 145372 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Joliet, The 306 North Larkin Avenue Joliet, IL 60435 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)