Inspection·June 25, 2023

F 0760 Ensure that residents are free from significant medication errors. 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 follow physician orders and administer a newly ordered laxative and antibiotic to help reduce the risk of Hepatic Encephalopathy (altered level of consciousness as a result of liver failure) for one of three residents (R1) reviewed for medication errors in the sample of three. Residents Affected - Few Findings include: The facility's Medication Error policy dated 1/4/23, states, Significant medication error means one of which causes the resident discomfort or jeopardizes his/her health and safety. The facility shall ensure medications will be administered as follows: a. According to physician's orders. Medication errors, once identified, will be evaluated to determine if considered significant or not by utilizing the following three general guidelines: a. Resident's Condition: If the resident's condition requires rigid control, such as strict intake and output measurement, daily weights, or monitoring of lab values. b. Drug Category: If the medication is from a category that usually requires the resident to be titrated to a specific blood level such as a medication with a narrow therapeutic index. c. Frequency of Error: If an error is occurring repeatedly such as an omission of a resident's medication several times. R1's Hospital Progress Notes dated 6/5/23-6/12/23, documents R1 was admitted with a primary diagnosis of Hepatic Encephalopathy triggered by constipation related to Hepatic Cirrhosis. R1's Hospital re-admission orders dated 6/12/23, document new orders for Senna 8.6 mg (milligram) by mouth two times per day for a diagnosis of constipation and Xifaxan 550 mg by mouth two times per day for a diagnosis of Hepatic Encephalopathy. R1's Medication Administration Record dated 6/2023, documents R1 was not administered Senna 8.6 mg or Xifaxan 550 mg until 6/17/23. Xifaxan.com states Xifaxan is a non-systemic antibiotic that slows the growth of bacteria in the gut that are believed to be linked to symptoms of overt HE (Hepatic Encephalopathy). Xifaxan is the only FDA- (Food and Drug Administration) approved medicine indicated for the reduction in risk of overt HE recurrence in adults. It was also proven to help reduce the risk of HE-related hospitalizations. Expert guidelines strongly recommend that doctors use Xifaxan together with lactulose as part of a plan to help manage overt HE. R1's Medication Error Report Form dated 6/16/23, documents R1's physician ordered Xifaxan (antibiotic to help prevent recurrence of certain liver problems) 550 mg tablet twice a day was omitted (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: 145600 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 145600 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loft Rehab & Nursing of Canton 2081 North Main Street Canton, IL 61520 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)