Inspection·November 16, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on observation, interview, and record review the facility failed to use extensive assistance of two staff members during a mechanical lift sit-to-stand transfer for one of four residents (R3) reviewed for falls in a sample of eight. This failure resulted in R3 falling during a mechanical lift sit to stand transfer, sustaining a severely painful dislocated left shoulder. Findings include: The facility's Safe Resident Handling/Transfers policy, dated 12/15/22, documents Policy: It is the policy of this facility to ensure that residents are handled and transferred safely to prevent or minimize risks for injury and provide and promote a safe, secure, and comfortable, experience for the resident while keeping the employees safe in accordance with current standards and guidelines. Policy explanation: All residents require safe handling when transferred to prevent or minimize the risk for injury to themselves and the employees that assist them. While manual lifting techniques may be utilized dependent upon the resident's condition and mobility, the use of a mechanical lifts are a safer alternative and should be used. Compliance Guidelines: 10. Two staff members must be utilized when transferring residents with a mechanical lift. R3's current admission Record documents R3 has the following, but not limited to, diagnoses: Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Non-Dominant Side, Cerebral Infarction due to unspecified Occlusion or Stenosis of right middle Cerebral Artery, Hyperlipidemia, Essential Hypertension, other Abnormalities of Gait and Mobility, other Lack of Coordination, and Morbid Obesity due to excess calories. R3's MDS (Minimum Data Set), dated 10/3/24, documents R3 is cognitively intact. This same MDS documents, Mobility. 01. Dependent- Helper does all the effort. Resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity. (R3) is dependent on toilet transfers and chair to bed/bed to chair transfers. R3's current Care Plan documents R3 has limited physical mobility related to Hemiplegia/Hemiparesis of Left Nondominant Side following a CVA (Cerebrovascular Accident). R3's Progress Note, dated 10/26/24 and signed by V21/RN (Registered Nurse), documents This RN was in another resident's room and was notified by (V8/CNA (Certified Nursing Assistant) that (R3) had a fall in his room. This RN walked into room and noticed (R3) laying on floor with sit-to-stand machine (mechanical lift) pulled back at the base of (R3's) feet, pillow under head. This RN began to physically assess (R3) and (R3) stated nine out of ten left shoulder pain and was unable to move arm. (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 11/16/2024 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)