Health inspection·May 15, 2024

F 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Physician visited and examined residents at least once every 30 days for the first 90 days after admission or at least once every 60 days thereafter for 3 of 3 residents (R1, R2 and R3) reviewed for physician services in a sample of 7. Residents Affected - Few The findings include: 1. R1's admission record documents R1 was admitted to the facility on [DATE] and documents R1's primary physician as V3. The same document lists R1's diagnoses in part as unspecified systolic (congestive) heart failure, chronic obstructive pulmonary disease, Type 2 diabetes mellitus with unspecified complications, acquired absence of left leg above knee, peripheral vascular disease, and anxiety disorder. R1's MDS (Minimum Data Set) dated 4/25/24 documents that R1 has a BIMS (Brief Interview of Mental Status) of 12, indicating R1 has mild cognitive impairment. On 5/14/24 at 9:00am, V1(Administrator) said V3 (Medical Director) has not been coming to the facility to see residents for a while. V1 said he will answer calls when needed after hours, when the Nurse Practitioner is not working. V1 said the only progress notes from visits by V3 she can produce for R1 is 6/7/23 and 7/21/23. V1 said there is no other physician notes in R1's chart. On 5/14/24 at 1:30pm, R1 said she has been seen several times by V4 (Nurse Practitioner). R1 said that she usually sees her once a week but usually every other week. R1 said she has not seen V3 in a long time. R1 said she has no complaints about V4 and she is easy for nurses to get a hold of and she follows up. R1 said she likes V4 better than V3. R1 was alert and oriented to person, place and time. 2. R2's admission record documents that R2 was admitted to the facility on [DATE] and lists her primary physician as a physician that is no longer practicing at the facility. The same document notes some of R2's diagnoses as cellulitis of left lower limb, Type 2 diabetes mellitus without complications, unspecified atrial fibrillation, chronic kidney disease, stage 3 unspecified, dysphagia following cerebral infarction, essential (primary) hypertension. R2's MDS dated [DATE] documents that R2 has a BIMS of 14, indicating R2 is cognitively intact. On 5/14/24 1:00pm , V1 said the physician that is listed as R2's primary physician was the previous Medical Director and has not been here since around May 2023. V1 said that V3 is R2's primary physician and the admission record has not been updated. V1 said she can not produce any documents where R2 was seen by V3. On 5/14/24 at 2:00pm, R2 said she has not seen V3 that she knows of. R2 said she has seen the Nurse Page 1 of 3 145517 145517 05/15/2024 Axiom Healthcare of Mount Vernon 1700 White Street Mount Vernon, IL 62864

F 0712 Practitioner (V4) several times. R2 was alert and oriented to person, place and time. Level of Harm - Minimal harm or potential for actual harm 3. R3's admission record notes that R3 was admitted to the facility on [DATE] and her alternate physician is documented as V3. R2's admission record also lists the previous Medical Director as primary physician. The same document lists R3's diagnoses in part as Parkinson's disease with dyskinesia, with fluctuations, Bipolar disorder, current episode depression, mild or moderate severity, unspecified, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety. R3's MDS dated [DATE] documents that R3 has a BIMS of 12, indicating R3 has mild cognitive impairment. Residents Affected - Few On 5/14/24 at 1:00pm, V1 said she can not produce any documentation where R3 was seen by V3. V1 said she looked back to 2023 and could not find any notes documenting that R3 was seen by V3. On 5/14/24 at 2:30pm, R3 said she sees the Nurse Practitioner (V4) pretty regularly. R3 said she has not seen V3 lately and can not remember the last time she saw him. R3 was alert and oriented to person, place and time. On 5/14/24 at 2:00pm, V5 (LPN/Licensed Practical Nurse) said there is no physician that rounds on residents, just a Nurse Practitioner. On 5/15/24 at 11:30am, V2 (DON/Director of Nurses) said that V3 has not been to the facility in a long time and she does not remember the last time he was there. On 5/15/24 at 1:30pm, V3 (Physician) said he has not been to the facility in a while. V3 said the facility has not paid him since September 2023. V3 said he takes care of resident's urgent needs and that is it. On 5/15/24 at 12:50pm, V4 (Nurse Practitioner) said she sees the residents at the facility about every other week. V4 said that sometimes she is there weekly depending on the resident's needs. V4 said she works for a private group and works under V8 (Physician) who is out of Chicago. V4 said she has not talked to V3 only once or twice. V4 said she has been coming to the facility for close to a year. V4 said she is licensed in the State of Illinois and so is V8 . The Illinois Department of Financial and Professional Regulation License Look Up for V4 does not document that V4 has Full Practice Authority when checked on 5/14/24. The facility Medical Director Agreement signed by V3 and dated 5/19/23 documents in Article III Services of Physician, Section 30.2 (i) Provision of physician services, including (but not limited to) .(iv) Frequency of visits, as required; and Section 30.4 (d) Ensure the physicians visit residents, provide medical orders, and review a resident's medical condition as required. 145517 Page 2 of 3 145517 05/15/2024 Axiom Healthcare of Mount Vernon 1700 White Street Mount Vernon, IL 62864

F 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review the facility failed to provide 8 hours of daily Registered Nurse (RN) coverage. This has the potential to affect all 27 residents residing in the facility. Residents Affected - Many Findings Include: On 5/15/24 at 11:00am, V1 (Administrataor) said that they are short on Registered Nurses but it is getting better. V1 said she knows there is times when they did not have the 8 hours a day of coverage. On 5/14/24 at 11:30am, V2 (DON/Director of Nurses) said she is always trying to get more Registered Nurses, but it is better than it was. Review of the nursing staff schedules for March, April and May 2024 documents the facility did not have RN coverage on 3/2/24, 3/30/24, 4/6/24, 5/4/24, and 5/12/24. The facility Midnight Census Report Form dated 5/14/24 documents that 27 residents reside at the facility, with 1 resident in the hospital. 145517 Page 3 of 3