Health inspection·September 26, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure resident's call lights were within easy reach for 1 of 11 residents (R2) reviewed for call lights in a sample of 11. Findings include: R2's Face Sheet, print date of 09/26/23, documents R2 has diagnoses of Hemiplegia, unspecified affecting left nondominant side, Epilepsy, and Gastroesophageal reflux disease, (GERD). R2's Minimum Data Set, (MDS), dated [DATE], documents R2 is moderately cognitively impaired and requires extensive assistance, two plus person physical assist with bed mobility, transfer, dressing, toilet use, personal hygiene, and he is frequently incontinent of bowel and bladder. On 09/20/23 at 10:50 AM, R2's call light was observed to be lying on the floor beside his bed where he was unable to reach it. When this surveyor questioned R2 about his call light, he stated it's supposed to be hooked to the bed, but sometimes they will drop it on the floor, and he is unable to reach it and he must scream for someone to come in and help him. R2 stated sometimes it may take them 45 minutes to an hour to answer his call light. On 09/26/23 at 1:57 PM, V2, Director of Nursing, (DON), stated she expects the call light to always be within reach and for it to be answered as quickly as possible. The facility's policy, Answering the call light, with a revision date of July 2014, documents Purpose: The purpose of this procedure is to respond to the resident's request and needs. It further documents General guidelines 5. When a resident is in bed or confined to a chair be sure the call light is within easy reach of the resident. Page 1 of 2 145483 145483 09/26/2023 Montgomery Nursing & Rehab Ctr State Route 127 Hillsboro, IL 62049

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain the resident's environment in a clean and sanitary condition for 1 of 11 residents (R2) in a sample of 11. Findings include: R2's Face Sheet, print date of 09/26/23, documents R2 has diagnoses of Hemiplegia, unspecified affecting left nondominant side, Epilepsy, and Gastroesophageal reflux disease (GERD). R2's Minimum Data Set, (MDS), dated [DATE], documents R2 is moderately cognitively impaired and requires extensive assistance, two plus person physical assist with bed mobility, transfer, dressing, toilet use, personal hygiene, and he is frequently incontinent of bowel and bladder. On 09/20/23 at 10:50 AM, upon entry to R2's room, a strong odor of urine was noted; there were two urinals hanging on the side of the trash can with urine in them. One had approximately 500 milliliters, (ml), of dark yellow urine in it and the other had approximately 200ml of dark yellow urine in it. The trash can was full of trash/food wrappers. There was a couple of pieces of trash lying on the floor in R2's room. On 09/21/23 at 1:40 PM, upon entering R2's room there was a smell of urine noted, and the urinals hanging on the waste cans in his room both had a moderate amount of urine in them. On 09/26/23 at 12:05 PM, R2 stated he would have to say they come in and empty his urinals more than once a day, but he doesn't think they come in and check and empty them every two hours. On 09/26/23 at 1:57 PM, V2, Director of Nursing, (DON), stated she would expect the urinals to be checked on every two hours. The facility's policy, Cleaning Guidelines Environmental Services, not dated, documents POLICY It is the policy of this facility that the workplace will be maintained in a clean and sanitary condition with a written schedule of cleaning and decontamination based on the area of the facility, type of surface to be cleaned, type of soil present and tasks being performed in the area. PURPOSE It is important that a clean, safe and sanitary environment is maintained for our residents. 145483 Page 2 of 2