Health inspection·April 17, 2025

F 0684 Level of Harm - Actual harm Residents Affected - Few V4 and V5 said they did not have barrier cream to apply to R1's buttocks or groin area because they were not allowed to keep the cream in the resident's rooms, and they would have to ask V7 (LPN-Licensed Practical Nurse) to obtain the cream. V4 and V5 applied a clean incontinence brief to R1 and did not apply barrier cream and prepared to leave the room. V5 (CNA) said she has been assigned to care for R1 many times, and the rash on R1's perineal area and buttocks had been present since at least February 2025. V4 and V5 lifted R1's gown. R1 was not wearing a bra. V5 lifted R1's right and left breast. R1's skin appeared bright red under R1's right and left breasts, approximately one to two inches wide, and approximately 4 inches long. A white, pilled substance was under each breast and V5 speculated it was old powder. V5 used a disposable wipe to clean the white substance from under R1's breasts, and R1 flinched when V5 cleaned the area and indicated the area was painful by mouthing the words that hurts. As V4 and V5 were ready to leave R1's room, V7 (LPN) entered the room with a small medication cup filled with a white cream and a wood tongue depressor. V7 said the white cream was zinc oxide. V4 and V5 opened R1's incontinence brief and again turned her to her right side. V7 (LPN) used her gloved hand to smear the zinc oxide on R1's buttocks. V7 did not cover the rash on R1's upper back with the zinc oxide. R1 was turned to her back by V4 and V5. With approximately one teaspoon of zinc oxide left in the medicine cup, V7 (LPN) used the wood tongue depressor to smear the remaining zinc oxide to R1's front perineal area in a swiping motion. The remaining zinc oxide ointment did not cover all red areas of R1's front perineal area, or R1's inner thighs. V7 (LPN) said she would have to return with more zinc oxide ointment to cover the reddened areas. On April 16, 2025 at 11:11 AM, V10 (Mother of R1) remained at R1's bedside, and said V7 (LPN) had not returned to R1's room to apply zinc oxide ointment to R1's front perineal area. V7 also said no other facility staff had come to the room to apply the ointment. On April 16, 2025 at 11:45 AM, V10 (Mother of R1) remained at R1's bedside, and said V7 (LPN) had not returned to R1's room to apply zinc oxide ointment to R1's front perineal area. V7 also said no other facility staff had come to the room to apply the ointment. On April 16, 2025 at 11:50 AM, V7 (LPN) came to R1's room and applied zinc oxide ointment to R1's front perineal area, and said she was unable to do it sooner due to caring for other residents. V7 did not assess the skin under R1's breasts or apply the zinc oxide ointment. As V7 was ready to leave R1's room, V7 was asked what the treatment would be for R1's skin redness under her bilateral breasts, and V7 turned around and applied the remaining zinc oxide ointment to the area under R1's bilateral breasts. The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE] with multiple diagnoses including metabolic encephalopathy, pneumonia, UTI (Urinary Tract Infection), acute and chronic respiratory failure, COPD (Chronic Obstructive Pulmonary Disease), acute pulmonary edema, myotonic muscular dystrophy, ascites, dependence on ventilator, gastrostomy tube, tracheostomy, and intestinal obstruction. R1's MDS (Minimum Data Set), dated February 6, 2025, shows R1 is cognitively intact, requires partial/moderate assistance with oral hygiene, substantial/maximal assistance with bed mobility, and dependent on facility staff for all other ADLs (Activities of Daily Living). R1 has an indwelling urinary catheter and is always incontinent of stool. The MDS continues to show R1 receives 51 percent or more of her total calories from tube feeding. R1 had no unhealed pressure ulcers, rashes or MASD (Moisture-Associated Skin Damage) at the time of this MDS assessment. R1's care plan for potential/actual impairment to skin integrity, created on January 31, 2025, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145372 If continuation sheet Page 2 of 4 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 04/17/2025 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)

F 0684 shows multiple interventions initiated on January 31, 2025 including, keep skin clean and dry. Identify/document potential causative factors and eliminate/resolve where possible. Level of Harm - Actual harm On January 31, 2025 at 6:46 AM, V6 (LPN) documented, [R1] buttock dry, redness, and flaky to touch Residents Affected - Few V6's (LPN) Admission/readmission Evaluation, dated January 31, 2025, shows R1 was readmitted to the facility with groin redness, redness on her inner thighs, and perineal area. The evaluation also shows R1 was high risk for skin breakdown. The EMR shows the following order, dated January 31, 2025: Zinc oxide external ointment 20 percent to groin, peri, and buttock topically every 12 hours for redness. The facility's Skin Monitoring/CNA Shower and Grooming sheets show the following for R1: January 21, 2025: Redness on R1's bilateral groin areas and redness on R1's buttocks. March 18, 2025: Redness under R1's right breast, and redness in R1's perineal area. April 1, 2025: Redness under R1's right and left breasts, and redness in R1's perineal area. The facility does not have documentation to show R1's physician was notified about the redness/rash on R1's skin, or that the redness/rash was assessed by nursing staff between January 31, 2025 and April 9, 2025. The facility does not have documentation to show the nurse assessed the reddened areas or completed a wound or skin event within risk management. The facility does not have documentation to show the wound care nurse checked risk management and proceeded with an assessment or investigation. On January 7, 2025, V9 (Wound Care NP-Nurse Practitioner) documented, Wound #2 groin is a partial thickness moisture associated skin damage and has received a status of not healed. Initial wound encounter measurements are 20 cm. (centimeters) length by 15 cm. width x 0.1 cm. depth, with an area of 300 square cm, and a volume of 30 cubic cm. There is a scant amount of serous drainage noted which has a mild odor. The patient reports a wound pain of level 3/10 (0/10 equals no pain, 10/10 most pain). The wound margin is undefined. Active problems, irritant contact dermatitis due to friction or contact with body fluids, erythema intertrigo (inflammatory skin condition caused by skin-to-skin friction). Wound orders groin: cleanse wound with wound cleanser, topical treatment: apply house stock antifungal cream twice a day. Follow-up: re-evaluation in 1 week. Incontinence/moisture management: barrier cream/ointment 3 x (times) per day and after incontinent episodes, recommend antifungal, keep area clean and dry, reduce briefs whenever possible. The facility does not have documentation to show R1 received the antifungal cream or barrier cream as ordered by V9 (Wound Care NP) on January 7, 2025. The facility does not have documentation to show R1 was re-evaluated in one week. The facility does not have documentation to show measurements were obtained after January 7, 2025 to determine if the rash area was improving or deteriorating. On April 9, 2025, V9 (Wound Care NP-Nurse Practitioner) documented, Patient being evaluated for skin assessment due to at risk conditions/Braden score for skin breakdown of 12. V9's documentation continues to show R1 had irritant contact dermatitis due to friction or contact with body fluids, and erythema intertrigo. V9's documentation continues to show, Incontinence/Moisture Management: Barrier cream/ointment 3 x (times) per day and after incontinent episodes, maintain prompt cleansing and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145372 If continuation sheet Page 3 of 4 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 04/17/2025 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)

F 0684 moisture management to support skin health, use breathable alternatives to briefs when appropriate to promote skin integrity. Level of Harm - Actual harm Residents Affected - Few The facility does not have documentation to show R1 received the barrier cream as ordered by V9 (Wound Care NP) on April 9, 2025. On April 16, 2025 at 1:16 PM, V9 (Wound Care Nurse Practitioner/NP) said he assessed R1 on April 9, 2025. V9 said the skin redness on R1's buttocks is due to MASD (Moisture Associated Skin Damage), and if there is moisture involved, R1 may also have a fungal rash. I was asked to see the resident because the rash was not improving and was getting worse. This skin condition can be handled by the nurses, and they can call me anytime, if the need arises. Last week when I saw her, she had dermatitis and the area had not spread up her back. I told them to apply barrier cream three times a day and after every incontinent episode. I was not notified by the facility before today that the rash looked worse. If they left her in feces or urine overnight or for a long period of time, it could go from zero to 100. It needs to be addressed immediately and appropriately. On April 17, 2025 at 11:11 AM, V9 (Wound Care NP) said, I saw [R1] on January 7, 2025. She had MASD in the groin area. We recommended house stock antifungal to the bilateral groin area twice a day and barrier cream three times a day. We did not specify a stop date. They should have put the antifungal cream and barrier cream order in place when I saw her on January 7, 2025. It is my expectation that they institute my recommendations. The skin issue will deteriorate if they do not do it. If it is a recommendation and it was never done, then I would say that is why the rash got worse. On April 17, 2025 at 2:55 PM, V11 (Physician) said, Based on (V9's, Wound Care NP) documentation dated April 9, 2025, there has been an acute change in (R1's) skin since last week, possibly caused by the antibiotic medication (R1) was taking. V11 said it would be his expectation that facility staff follow provider recommendations for wound care, and they should follow the facility's policy for nursing assessment of abnormal skin conditions and completing wound or skin events in risk management. The facility's policy entitled Wound Prevention Program, dated March 2025, shows, Purpose: The purpose of this program is to assist the facility in the care, services and documentation related to the occurrence, treatment, and prevention of pressure as well as non-pressure related wounds. Process: 1. Upon admission and in conjunction with the Resident Assessment Instrument, and when a significant change in the resident status occurs, the resident's skin will be evaluated head-to-toe by licensed nurse. 2. Weekly skin checks will be conducted by the licensed nurse. This will be documented in the resident's EMR. 3. Daily, during routine care, the CNA will observe the resident's skin. When abnormalities are noted, this will be communicated to the licensed nurse and the licensed nurse will proceed as mentioned in step 2 and complete a wound or skin event within risk management. The wound care nurse will check risk management daily for any new wound/skin event and proceed with an assessment/investigation. The facility's policy entitled Wound Prevention and Healing, reviewed 06/01/2024, shows, Policy Statement: To provide wound care treatments/services using a multidisciplinary approach based on evidence-based standards of care under the direction of a physician. 1. Risk Assessment and Prevention: a. Braden Scale will be completed upon admission, readmission, quarterly, and when there is a change in condition by a licensed or registered professional nurse.c. Skin will be inspected during showers, following orders for daily and/or weekly skin checks as scheduled, and PRN (as needed). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145372 If continuation sheet Page 4 of 4