Inspection visit

Health inspectionSeptember 28, 2023

MICHAELSEN HEALTH CENTERCMS #1454096 citations on this visit

6 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 6 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure a wound remained covered by a dressing as ordered by the physician. Residents Affected - Few This applies to 1 of 3 (R1) residents reviewed for pressure ulcers in a sample of 22. The findings include: R1's EMR (Electronic Medical Record) showed R1 was readmitted to the facility on [DATE] with multiple diagnoses including acute on chronic congestive heart failure, pneumonia, acute respiratory failure with hypoxia, atrial fibrillation and chronic kidney disease stage 3B. R1's MDS (Minimum Data Set) dated 8/22/2023, showed R1 is cognitively intact and required extensive assistance for bed mobility, bathing, toileting, and dressing, is dependent on staff for transfer and required set up assistance for eating. R1's wound care notes dated 9/19/2023 showed R1 was admitted with an unstageable pressure ulcer to the right buttock being treated with medical honey, calcium alginate covered by border foam dressing. R1's TAR (Treatment Administration Record) showed an order for wound treatment to right buttock initiated 9/20/23 to cleanse wound with saline and apply medical honey and calcium alginate and cover with border foam dressing every evening shift and as needed. On 9/27/23 at 10:15 AM, R1 was lying in bed and was being given incontinence care by V5 (CNA- Certified Nursing Assistant). When V5 rolled R1 to her left side, there was no dressing covering the right buttock wound, the unstageable wound was exposed. There was no dressing lying in the brief or in the bed linens. V5 stated she gave R1 incontinence care at 06:00 AM that morning and noticed the dressing was not there at that time. V6 (RN- Registered Nurse) was informed of the missing dressing at 10:15 AM as she entered the room during the observation. On 9/27/23 at 1:45 PM, V6 (RN) stated she would expect to be told that a wound was not covered immediately. V6 provided documentation to show she replaced R1's wound dressing at 11:04 AM on 9/27/23. On 9/27/23 at 2:20 PM, V2 (DON- Director of Nursing) stated the expectation for staff, who notice a wound dressing missing, is to report it to the nurse immediately. The facility's policy for Wound Care, dated October 2010, showed .2. Report other information in (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 10 Event ID: 145409 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0686 accordance with facility policy and professional standards of practice. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 2 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow their policy to monitor and document urine output for residents with an indwelling urinary catheter. This applies to 2 of 3 residents (R11 and R15) reviewed for indwelling urinary catheters in the sample of 22. The findings include: 1. The EMR (Electronic Medical Record) showed R15 was admitted to the facility on [DATE], with multiple diagnoses including heart failure, diabetes, and obstructive and reflux uropathy. R15's MDS (Minimum Data Set) dated August 14, 2023, showed R15 was cognitively intact and had an indwelling urinary catheter. R15's undated indwelling urinary catheter care plan showed, Indwelling catheter secondary to urinary retention/BPH (Benign Prostatic Hyperplasia). The care plan continued to show multiple interventions dated August 8, 2023, including, Record output per shift. R15's September 2023 Physician Order Sheet dated September 27, 2023, showed an order dated September 10, 2023, for, Catheter: Record Output in milliliters. Frequency: By shift. On September 25, 2023, at 10:58 AM, R15 was lying in bed with an indwelling urinary catheter draining yellow urine with sediment. R15 said he just came back from the emergency room because his indwelling urinary catheter became plugged up. R15 continued to say his indwelling urinary catheter was not draining for about a day before he went to the emergency room. On September 25, 2023, at 10:42 AM, V7 (RN/Registered Nurse) said R15 just returned from the emergency room because he had indwelling urinary catheter issues and his catheter needed to be replaced. R15's September 2023 Treatments Record dated September 26, 2023, did not show urine output documentation for September 23, September 24, and day shift September 25, 2023. R15's hospital documentation showed a progress note by V8 (NP/Nurse Practitioner) dated September 25, 2023, at 9:59 AM. V8's progress note showed, .Patient was sent from [facility] for evaluation of [indwelling urinary catheter]. Staff noted that his [indwelling urinary catheter] was not draining any urine and patient stated he had pressure in his bladder . [Indwelling urinary catheter] removed and a new [indwelling urinary catheter] inserted in which patient had at least 1000 mL (milliliters) of urine. Urine is positive for leukocytes and bacteria as well as white blood cells. Patient feels much better after new catheter inserted . On September 27, 2023, at 2:03 PM, V2 (DON/Director of Nursing) said R15 was residing in the facility on September 23 and September 24, 2023, with an indwelling urinary catheter. V2 continued to say it is the expectation of facility staff to document a resident's urinary output from the indwelling urinary catheter every shift on the Treatment Record every shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 3 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. The EMR showed R11 was admitted to the facility on [DATE], with multiple diagnoses including heart failure, chronic kidney disease, spinal stenosis, and flaccid neuropathic bladder. R11's MDS dated [DATE], showed R11 was cognitively intact and had an indwelling urinary catheter. R11's undated indwelling urinary catheter care plan showed, 18 French indwelling catheter secondary to neurogenic bladder. The care plan continued to show multiple interventions dated May 11, 2023, including, Record output per shift. On September 26, 2023, at 2:09 PM, R11 was lying in bed and had an indwelling urinary catheter draining yellow urine. On September 27, 2023, at 1:54 PM, V2 said R11's indwelling urinary catheter was discontinued on September 21, 2023, but was reinserted. A progress note dated September 21, 2023, at 6:28 PM, by V7 (RN) showed R11 had an indwelling urinary catheter in place. R11's September 2023 Treatment Record dated September 28, 2023, did not show urine output documentation for September 21 to September 27, 2023. On September 27, 2023, at 12:18 PM, V2 said the facility's procedure for measuring and documenting input and out is facility staff should document intake and output every shift. The facility's policy titled, Catheter Care, Urinary dated August 2022, showed, Purpose: The purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections . Intake/Output: 1. Observe the resident's urine level for noticeable increases or decreases. If the level stays the same or increases rapidly, report it to the physician or supervisor. 2. Follow the facility procedure for measuring and documenting input and output . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 4 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Observation, Interview, and Record Review the Facility failed to have a Physician's order for oxygen administration in accordance with their policy. Residents Affected - Few This applies to 1 of 1 (R1) resident reviewed for oxygen administration in a sample of 22. The findings include: R1's EMR (Electronic Medical Record) showed R1 was readmitted to the facility on [DATE] with multiple diagnoses including acute on chronic congestive heart failure, pneumonia, acute respiratory failure with hypoxia, atrial fibrillation and chronic kidney disease stage 3B. R1's MDS (Minimum Data Set) dated 8/22/2023, showed R1 is cognitively intact and required extensive assistance for bed mobility, bathing, toileting, and dressing, is dependent on staff for transfer and required set up assistance for eating. On 9/25/23 at 2:24 PM, R1 was sitting up in the wheelchair, receiving oxygen at three liters per nasal cannula, while talking the resident exhibited shortness of breath. The resident also had an implanted chest catheter drainage device to the right lower chest covered with a dry dressing. On 9/26/23 at 12:52 PM, R1 is seated in a wheelchair, eating lunch and receiving oxygen at three liters per nasal cannula. On 9/27/23 at 10:15 AM, R1 is lying in bed with nasal cannula and receiving 3.5 liters of oxygen via oxygen concentrator. V6 (RN, Registered Nurse) stated there was 350 milliliters output of drainage from the implanted chest catheter drain during the previous shift. On 9/27/23 at 1:45 PM, V6 validated there was no Physician's order in the EMR for oxygen administration since R1's readmission on [DATE], when R1 return from the hospital with the implanted chest catheter drain. V6 also verified that the last documentation of R1's oxygen saturation was on 9/15/23, and there was no documentation that R1 was receiving oxygen. On 9/27/23 at 2:15 PM, V2 (DON, Director of Nursing) stated the expectation for residents receiving oxygen would be to have a Physician's order for oxygen administration and oxygen saturation monitoring parameters in place. The facility policy for Oxygen Administration dated October 2010, showed 1. Verify there is a physician's order for this procedure.and document .3. The rate of oxygen flow, route, and rationale .6. All assessment data obtained before during and after the procedure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 5 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to perform monthly Medication Regimen Reviews (MRR) for residents residing in the facility. This applies to 4 of 7 (R2, R21, R34, and R42) reviewed for medication regimen review. The findings include: 1. Face sheet, dated 9/27/23, shows R2 was admitted to the facility on [DATE]. POS (Physician Order Sheet), dated 9/27/23, shows R2 had physician-ordered medications since 4/18/23. Review of Consultant Pharmacist's Medication Regimen Review reports, dated 5/1/23 to 9/13/23, show R2 was not reviewed by the pharmacist during the months of 5/2023, 7/2023, 8/2023 and 9/2023. 2. Face sheet, dated 9/27/23, shows R42 was admitted to the facility on [DATE]. POS, dated 9/27/23, shows R42 had physician-ordered medications since 8/17/22. Review of Consultant Pharmacist's Medication Regimen Review reports, dated 3/1/23 to 9/13/23, show R42 was not reviewed by the pharmacist during the months of 3/2023, 4/2023, 6/2023, 7/2023, 8/2023 and 9/2023. 3. Face sheet, dated 9/27/23, shows R21 was admitted to the facility on [DATE]. POS, dated 9/27/23, shows R21 had physician-ordered medications since 6/17/21. Review of Consultant Pharmacist's Medication Regimen Review reports, dated 3/1/23 to 9/13/23, show R42 was not reviewed by the pharmacist during the months of 6/2023 and 8/2023. 4. POS, dated 9/28/23, shows R34 was admitted to the facility on [DATE]. POS, dated 9/28/23, shows R34 had physician-ordered medications since 10/14/22. Review of Consultant Pharmacist's Medication Regimen Review reports, dated 3/1/23 to 9/13/23, show R34 was not reviewed by the pharmacist during the month 9/2023. On 9/27/23 at 3:00 PM, V2 (Director of Nursing) stated the consulting pharmacist is expected to review each resident's medications monthly. Facility policy/procedure Medication Regimen Review and Reporting, dated 1/23, shows, The consultant pharmacist reviews the medication regimen and medical chart of the resident at least monthly to appropriately monitor the medication regimen and ensure that the medications each resident receives are clinically indicated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 6 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on observation, interview, and record review, the facility failed to identify person-centered, non-pharmacological approaches for residents receiving psychotropic medications. The facility also failed to identify resident specific behaviors to monitor the response/effectiveness/side effects of psychotropic medications. This applies to 1 of 5 residents (R49) reviewed for psychotropic medications in the total sample of 22. The findings include: A Progress note written by the V14 (Psychiatric Nurse Practitioner), dated 9/18/23 at 6:41 PM, shows R49 has resided in the facility since 8/11/23, previously living in Assisted Living, now needing increased level of care with declining mobility and other concerns. The MAR (medication administration record), dated 9/26/23, shows R49 has a diagnosis of Parkinson disease, hallucinations unspecified, neurocognitive disorder with Lewy bodies, and dementia in other diseases classified elsewhere. The POS (Physician's Order Sheet) and the MAR (medication administration record) for R49 show R49 is receiving quetiapine (anti-psychotic) 100 milligrams every 2:00 PM and 200 milligrams every 8:00 PM. On 9/25/23 at 11:23 AM, R49 was in a wheelchair in her room. R49's speech was slow. R49 talked about students she is teaching here in this school. R49 stated she is aware she sometimes has hallucinations. R49 was able to respond appropriately to questions about care in the facility after moments of confused speech. R49 had a flat affect. The facility record includes Progress Notes including notes showing some presence of hallucinations and or delusions at times and at baseline. This is the only record of tracking medication effectiveness provided by the facility. On 9/27/23 at 11:08 AM, V2 (Director of Nursing) stated the facility has no psychotropic medication Nurse and has no Psychiatric Medical Director. V2 stated V14 talks with staff weekly and should document information from the discussions. The facility was not able to provide any record of monitored symptoms in any organized tracking for this resident other than discussion between V14 and the nurse on duty. The facility could provide no record of regular monitoring for side-effects from quetiapine for R49. There is no order in the POS for monitoring of effectiveness or of side-effects from quetiapine for R49. The facility could provide no record of targeted non-pharmacological interventions for R49 after repeated requests. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 7 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The Care Plan for R49, in the facility record, shows interventions are to be done including, Assess behaviors and signs/symptoms of safety risk; and Assess and monitor confusion and signs/symptoms of safety risk. The same Care Plan shows, in the care plan for Falls, Assess for non-pharmacological interventions. The complete Care Plan provided by the facility contains no care plan regarding effectiveness or side-effects of any psychotropic medications. On 9/27/23 at 12:00 PM, V12 (Social Worker) stated she provides information to the MDS (Minimum Data Set) for R49, for the sections on Cognition, Mood, and Behavior from discussion with R49 and a review of the Progress Notes in the facility record. The MDS for R49 dated 8/17/23 shows R49 had no hallucinations or delusions in the period of the assessment. The facility provided the signed Informed Consent for Psychotropic Medications for R49 which shows general purposes for anti-psychotic medications including hallucinations and delusions and also lists possible side-effects including neurological side-effects. The Consent form contains a line stating, The following information has been explained/provided: and there is no information following. The same Consent shows the Black Box warning regarding the use of anti-psychotic medications in persons with dementia. (Copies of the Consents are attached as provided by the facility). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 8 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0808 Level of Harm - Minimal harm or potential for actual harm Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on observation, interview and record review, the facility failed to provide a therapeutic diet as ordered by the physician. Residents Affected - Few This applies to 3 of 3 (R5, R14, R45) residents reviewed for therapeutic diets in a sample of 22. The findings include: R5's EMR (Electronic Medical Record) showed R5 had multiple diagnoses including end stage renal disease requiring hemodialysis, paroxysmal atrial fibrillation, mixed hyperlipidemia, anemia, osteoporosis, and gastro-esophageal reflux disease. R5 had a physician order initiated 9/4/23 for a Renal diet with thin liquids. R14's EMR showed R14 had multiple diagnoses including fracture of the left femur shaft with orthopedic aftercare, mixed hyperlipidemia, atherosclerotic heart disease, paroxysmal atrial fibrillation, and anemia, unspecified. According to the resident listing diet report on 9/25/23, R14's diet order was listed as Heart Health. R45's EMR showed R45 had multiple diagnoses including urinary tract infection with acute kidney failure, chronic congestive heart failure, hypertensive heart disease, mixed hyperlipidemia, type 2 diabetes mellitus, pressure ulcer sacral area and right buttock, and morbid obesity due to excess calories. According to the resident listing diet report, on 9/25/23, R45's diet order was listed as CCD (Carbohydrate Controlled Diet), NAS (No Added Salt), Heart Health. The diet spreadsheet for Tuesday, 9/26/23 lunch meal showed the entrée for renal and heart health diets was 3 ounces herb crusted pork loin, and the renal diet lunch plan included 4 ounces of parsley rotini noodles. On 9/26/23 at 12:30 PM R5 was observed with her lunch tray and stated they was unable to eat most of her lunch as she was served ham, and garlic green beans and further stated the ham is too salty for me to eat and she never eats garlic, and garlic green beans were served. There were no rotini noodles served on R5's lunch tray. On 9/27/23 at 10:30 AM, V4 (Cook) stated he was the cook for the lunch meal on 9/26/23 and there was no herb crusted pork prepared for that meal. V4 further stated no one told me there was a renal diet to prepare for I and was unaware that the heart health diets were to be served herb crusted pork. On 9/27/23 at 11:43 AM, V3 (RD, Dietician) after reviewing the spreadsheet for the lunch meal on 9/26/23, stated staff should have prepared the herb crusted pork for the renal and heart health diet. V3 referred to the choice menu the residents use and clarified that the menu choices should include the menu items available for the prescribed diet for both the renal and heart health diets but was not aware if those choices were included as options for the residents. V3 also stated she did not know why R5's diet order remained as a renal diet since 9/4/23 and would seek clarification with R5's dialysis center. The facility's diet manual, dated 2015, shows renal diets were to have ham limited and heart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 9 of 10 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 145409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Michaelsen Health Center 831 North Batavia Avenue Batavia, IL 60510 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 0808 healthy diets should be served fresh cuts of pork and limited smoked meat such as bacon, or corned beef. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145409 If continuation sheet Page 10 of 10

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Citations

6 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0756GeneralS&S Epotential for harm
F756 - Drug Regimen Review
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
0758GeneralS&S Dpotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0808GeneralS&S Dpotential for harm
F808 - Therapeutic Diets
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

FAQ · About this visit

Common questions about this visit

What happened during the September 28, 2023 survey of MICHAELSEN HEALTH CENTER?

This was a inspection survey of MICHAELSEN HEALTH CENTER on September 28, 2023. The surveyor cited 6 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at MICHAELSEN HEALTH CENTER on September 28, 2023?

Yes, 6 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate pressure ulcer care and prevent new ulcers from developing."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

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Data from CMS Care Compare public records. Dataset last refreshed June 22, 2026. If you believe any information is inaccurate, report it here.

Health inspection·September 28, 2023