Health inspection·November 3, 2023

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to complete assessments for medication self-administration and failed to obtain orders to keep medications at the bedside. This applies to 2 of 3 residents (R8, R57) reviewed for medications in sample of 18. Residents Affected - Few The findings include: 1. On 10/31/23 at 10:58 AM, during initial tour, surveyor went to R57's room. R57 and R60 are husband and wife and share a room together. Neither R57 nor R60 were in their room; per staff, they were in the hospital. There was a container of Triamcinolone Acetonide 0.1% ointment on R57's bedside table. On the label of the container of the Triamcinolone Acetonide, it showed it belonged to another resident (R68), who was in a different room. On 11/1/23 at 1:20 PM, surveyor went with V2 (Director of Nursing/DON) to R57's room. R57 had still not come back from the hospital. The container of the Triamcinolone Acetonide that belonged to R68 was inside his drawer. R60, (R57's wife) stated I just came back from the hospital. (R57) is my husband and he's still in the hospital. This ointment has always been here. I didn't know it belonged to another resident. R57 was putting it on himself for itching because he has a rash on his chest. Surveyor then went with V2 to the wound cart and could not find R57's Triamcinolone Acetonide cream. On 11/1/23 at 1:27 PM, V2 stated R68's medicated cream should not be in R57's room. The nurse should not be using another resident's cream on R57. There should be orders for all medication and an order to be at the bedside. There should be a self-administration of medication assessment for the resident as well. On 11/2/23 at 9:43 AM, surveyor went with V3 (Licensed Practical Nurse/LPN) to the wound cart on the unit. V3 found R57's Triamcinolone Acetonide in the treatment cart. The medicated ointment was not in a container, but rather in a tube with barely anything in it. V3 stated, It's running out. The nurse shouldn't have used another resident's Triamcinolone for R57. The nurse also should not have left it in the resident's room. It should have been stored in the medication cart. The nurse should have also ordered a new medication It wasn't me who was giving it to him when he was here. I'm only working on this unit today. This is not my regular unit. R57's face sheet documents an admission date of 7/13/23. R57's POS (Physician Order Sheet) documents the following order that started on 10/2/23: Triamcinolone Acetonide External Lotion 0.1%--Apply to both arms, chest/abdomen, and upper/lower back topically two times a day for skin condition. R57's (Nurse Practitioner) dated 8/9/23 documents: (R57) seen today for evaluation of rash. Nurse reported patient states he has a rash that started today. (R57) states when he woke up this am, his arms and trunk were itching and about lunch time, he noted a red rash. Skin: Scattered papules to top of (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 6 Event ID: 145536 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 145536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Bourbonnais,the 20 Briarcliff Lane Bourbonnais, IL 60914 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)