Inspection·May 8, 2025

F 0880 Provide and implement an infection prevention and control program. 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 implement Enhanced Barrier Precautions (EBP) for one (R1) of three residents reviewed for pressure ulcers in the sample list of four. Residents Affected - Few Findings include: The facility's Enhanced Barrier Precautions policy dated 10/21/22 documents EBP expands the use of gloves and gowns to be worn during high-contact care activities that provides opportunities for Multidrug Resistant Organisms (MDROs) to be transferred between staff hands or clothing and between residents during these high-contact cares. This policy documents residents with wounds and indwelling medical devices are at high risk of acquisition and colonization of MDROs. This policy documents to wear gown and gloves when assisting residents on EBP with high-contact care activities, including dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, providing device care or wound care. R1's readmission Skin assessment dated [DATE] documents R1 has a stage three pressure injury to R1's left Achilles area and a stage four pressure injury to R1's left Ischial area. R1's care plan dated 1/11/2025 documents staff will always maintain Enhanced Barrier Precautions (EBP) during high-contact resident care areas. R1's order summary report dated 4/17/2025 documents an order for EBP when providing cares involving R1's urinary catheter and wounds. On 5/7/25 at 1:20 PM, R1's doorway contained an EBP sign that indicated to wear gown and gloves during the high-contact care activities listed which included wound care. On 5/7/25 at 1:25 PM, V4 Registered Nurse and V5 Licensed Practical Nurse entered R1's room and completed wound care for R1's left ischial wound and R1's left Achilles wound. V4 and V5 did not don gowns to complete the treatments. On 5/7/25 at 1:40 PM, V5 Licensed Practical Nurse stated the EBP sign and supplies on R1's room door are for use when providing cares to R1's roommate not for R1. On 5/7/25 at 1:40 PM, V4 Registered Nurse agreed with V5 and stated she never puts on a gown when performing R1's wound treatments because the EBP sign and the supplies are for the other resident in that room. (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 2 Event ID: 145439 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 145439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accolade Healthcare of Savoy 302 West Burwash Savoy, IL 61874 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)