Health inspection·December 27, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide assistance to a resident for ADLs (Activities of Daily Living). This applies to 1 of 1 resident (R11) reviewed for ADLs. Residents Affected - Few The findings include: On 12/21/23 at 08:37 AM, V14 (Family Member) told V16 (LPN/Licensed Practical Nurse) she wanted R11 up and out of bed because it was not good for him to be laying down since he had pneumonia. At 08:41 AM, V14 said the staff do not come check on her husband often enough and he was waiting to get cleaned up. V14 said R11 was not able to move too much because of his weakness, and he also had COVID-19 and pneumonia. On 12/21/23 at 09:07 AM, V11 (CNA/Certified Nurse Assistant) went into R11's room to provide incontinence care. R11 was laying on his back. When V11 removed R11's incontinence brief, there was urine and stool in the brief. R11's skin around his perineal area was excoriated and red. When V11 rolled R11 to the side to provide pericare, R11's buttocks and sacrum were excoriated and between shades of red and purple. When V11 was wiping R11, R11 began wincing and crying in pain. V11 rolled R11 onto a clean incontinence brief and positioned him on his back in bed. On 12/21/23 at 12:28 PM, V16 (LPN) said R11's wife was upset because she did not want him sitting in the bed all day. V16 said the last time she saw him, he was still in the bed. V16 said V11 had not told her about any skin breakdown or concerns about R11. On 12/21/23 at 01:41 PM, V28 (Wound LPN) and V29 (Wound Tech) and surveyor entered R11's room. R11 remained sleeping on his back with his head of bed elevated to 30 degrees. V28 and V29 observed R11's skin with surveyor. R11 had an episode of urine and stool. V28 said R11's skin had moisture associated damage and he had excoriated skin around the shaft of the penis and the sac. V28 turned R11 to observe his buttocks and said he had excoriated and broken skin on the buttocks and sacrum. V28 said all the excoriated areas were a result of prolonged moisture to the skin. R11 also had a lunch tray on his bedside table. R11's lunch tray was untouched, and no food particles were visible on his silverware. V28 said she was not made aware by staff of R11's skin alterations. On 12/21/23 at 03:35 PM, V2 (DON/Director of Nursing) said the staff should check on the residents every two hours and as needed to provide incontinence care. V2 said the excoriated skin can be caused by the skin staying moist. V2 also said when the residents have their meal trays delivered, the staff should return within an hour to see what the resident has consumed. V2 said this is done to know what their intake is, whether they are eating or not, and to notify the nurse. (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 9 Event ID: 145582 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 145582 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Estates of Naperville 1525 South Oxford Lane Naperville, IL 60565 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)