Health inspection·July 3, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observations, and record review, the facility failed to arrange a specialty Physician appointment for 1 of 3 residents (R2) reviewed for doctor appointments in the sample of 7. This failure resulted in R2 not receiving treatment for his poor vision, worsening vision, and only being able to see shadows.Findings include:R2's admission Record, print date of 7/2/25, documents R2 was admitted on [DATE] with diagnoses of Blindness one eye, low vision other eye, and Cortical age - related cataract right eye.R2's Minimum Data Set, dated [DATE], documents R2 is cognitively intact and has severely impaired vision.R2's Minimum Data Set, dated [DATE], documents R2 is cognitively intact, has severely impaired vision and requires supervision/ touching assistance with walking.R2's Hospital Transfer Orders For The Receiving Facility, dated 7/18/24, documents, Follow Up Instructions and Future Appointments: Referred to SLUCARE Physician Group - Ophthalmology.R2's Physician Order, dated 10/17/24, documents, Refer to ophthalmology for evaluation and treatment of bilateral cataracts.R2's Physician Order, dated 2/12/25, documents, refer to ophthalmologist r/t (related to) cataracts.R2's Physician Order, dated 5/15/25, documents, Referral to Ophthalmologist. Worsening vision.R2's eMAR (electronic Medications admission Record)- Medication Administration Note, dated 2/20/2025 19:54, documents, I also see a note that he has a referral for an eye doctor. Can we confirm or make a referral for an ophthalmologist? Thank you, STAT (urgent) Referral, printed and provided to Transportation to set appointment.R2's Care Plan, dated 7/26/24, documents, (R2) is at risk for falls due to Functional Deficits, Visual Impairments. Intervention: 6/9/25 Educate resident on being more aware of surroundings and ensuring clear pathway when walking.R2's Care Plan, dated 7/26/24, documents, VISION: Resident has impaired Vision as evidenced by sign. vision loss, Cataract right eye. Interventions: Orient to surroundings PRN (as needed) Interventions: Place items within easy reach and orient to placement. Provide the following environmental adaptations: -adequate lighting -avoid clutter, avoid obstructed pathways -avoid glares, shadows -braille markings as indicated.On 6/30/25 at 10:09 AM, V3, Social Worker, stated R2 let me know last week that he wanted to see an eye doctor since I know exactly what insurance he has now, I will send out referrals.On 6/30/25 at 9:48 AM, R2 stated, I have never seen the eye doctor since I have been here. I have a cataract on the right eye. I got bit by a dog last April/May and it caused me to get an infection. After that I could only see shadows. I could see someone come in and take my body wash. Since I don't see that well, I couldn't tell you who it was.On 6/30/25 at 1:21 PM, V12, Licensed Practical Nurse, stated, R2 only sees shadows.On 7/2/25 at 9:40 AM, R2 stated, Since I have been here my vision has gotten worse in my right eye and better in my left eye. My right eye hurts too when I open and close my eye.On 7/2/25 at 10:00 AM, V19, Transport, stated she is the person that makes all of the appointments. V19 stated, I had (R2) set up with (eye doctor) in November but his insurance was not active at that time, so they canceled the appointment, and it was rescheduled. When the rescheduled appointment came up, they canceled it because they did not take his Residents Affected - Few Page 1 of 2 145427 145427 07/03/2025 Nexus at Alton 3523 Wickenhauser Alton, IL 62002

F 0684 Level of Harm - Actual harm Residents Affected - Few insurance. I kept trying to find him a doctor that took his insurance and treated cataracts. I just found one and he goes on 6/18/25. V19 stated that she just has notebooks to keep track of appointments and who was called. At this time, V19 provide one undated note about referring R2 to an eye doctor who does cataracts.On 7/3/25 at 10:10 AM, V21, Nurse Practitioner, stated, Cataracts only get worse over time. I don't know how many doctors they reached out to find him care. That is something I would like to know. V21 was informed the facility had no proof of reaching out to eye doctors for R2.On 6/30/25 at 9:48 AM, R2 was observed ambulating in his room. R2 walks with a slow gait, slightly hunched over, with his hands out in front of him to touch objects with.On 7/2/25 at 9:20 AM, R2 was informed that the facility was able to get him into an eye doctor on 6/18/25. R2 became visibly emotional with happiness and thanked surveyor for all of the help.The policy Physician Orders, dated 9/24, documents, Physician orders are followed as written; if there is a question about the order, contact the physician for clarifications. 145427 Page 2 of 2