Inspection·May 20, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to treat a residents (R1) urinary tract infection (UTI) for nearly 48 hours. This applies to 1 of 3 residents (R1) reviewed for improper nursing care in the sample of 5. Residents Affected - Few The findings include: R1's admission Record (Face Sheet) showed an admission date of 8/23/23 with diagnoses to include partial paralysis following a stroke, ESBL (bacteria in the urinary tract that are resistant to many antibiotics), history of urinary tract infections, morbid obesity, and congestive heart failure. R1's 3/26/25 Nurse's Note from 5:05 PM showed, Final report received for urine C&S (culture and sensitivity, a urine test showing which bacteria are present in the urine) . The note showed which bacteria and fungi were present and that R1's doctor, nurse practitioner, and the director of nursing were notified. R1's 3/27/25 Nurse's Note from 11:04 AM showed, (no other progress notes were documented between this note and the previous note listed) Resident in bed sleeping, easily awakened to take scheduled medications. c/o (complains of) urinary frequency, burning, and level 10 generalized pain with fatigue. Temp 97.8. PM [narcotic pain medication] given. Urine noted to be dark and concentrated. U/A (urine analysis) with C&S completed with results to [R1's doctor, nurse practitioner, and director of nursing] notified of results. R1's 3/27/25 Nurse's Note from 1:14 PM showed, (this is the next consecutive progress note) This nurse called [local area hospital] for [V10 Infectious Disease Doctor] switchboard took message regarding patient needing antibiotic for UTI. Awaiting return call from [infectious disease doctor]. R1's 3/27/25 Nurse's Note from 1:40 PM showed, (this is the next consecutive progress note) [V10] returned phone call to this nurse. [V10] states he has not seen resident recently enough and will not prescribe antibiotics for UTI at this time. R1's 3/28/25 Nurse's Note from 7:53 PM showed, (This is the next note with information pertaining to R1's UTI and more than 24 hours after the previous note) Res (Resident) requesting to be evaluated in ER (Emergency Room) for urinary symptoms. VS (vital signs) wnl (within normal limits) .Res left facility at [7:50 PM] (over 48 hours after positive UTI test results) . R1's 3/29/25 Nurse's Note from 1:54 PM showed, .res admitted with UTI . R1's March 2025 Medication Administration Record (MAR) showed she was taking Doxycycline 20 (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: 145556 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 145556 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Winning Wheels 701 East 3rd Street Prophetstown, IL 61277 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)