Health inspection·May 6, 2024

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to re-evaluate and coordinate discharge plans to address the needs of a resident (R1) being discharged home and notify the physician of changes in the discharge plan for one of three residents reviewed for discharge in the sample list of six. Residents Affected - Few Findings include: R1's Physician Order dated 3/5/24 given by V16 Nurse Practitioner documents okay to discharge home with home health pt/ot (physical and occupational therapy). R1's Wound Evaluation & Management Summary dated 3/6/24 and recorded by V20 Wound Physician documents R1's right heel stage three pressure ulcer measured 0.4 centimeters (cm) long by 0.3 cm wide by 0.01 cm deep, had moderate serous drainage, and was 100% subcutaneous tissue. This note documents R1's left heel stage three pressure ulcer measured 1 cm by 3 cm by 0.2 cm, had moderate serous drainage, had 10% thick necrotic (dead) tissue, and 80% subcutaneous tissue. The treatment orders were calcium alginate covered with a foam dressing three times weekly and to wear pressure relieving boots when in bed. R1's Post Discharge Plan of Care dated 3/5/24 documents R1 will discharge home and under the section titled Wound Care, Treatments, Therapy (home health company) will evaluate and setup schedule/frequency, and pt/ot will continue for strengthening. This plan of care does not identify if wound care will be provided by home health and does not list any follow up appointments with a wound clinic. R1's Nursing Note dated 3/6/2024 at 11:32 AM recorded by V11 Post Acute Care Coordinator documents V11 spoke with V21 (R1's Family) regarding R1's discharge planned for 3/8/24 and (home health agency) was set up to be R1's home health provider. There is no documentation after this note of communication with V16 Nurse Practitioner, R1, V21 or V9 (R1's Family) that R1 was not accepted for home health services or to discuss scheduling a wound clinic appointment. R1's Nursing Note dated 3/8/24 at 4:00 PM documents R1 discharged home. On 4/30/24 at 10:33 AM R1 stated R1 admitted to the facility in February 2024 and discharged in March 2024 with facility acquired pressure ulcers to R1's heels. R1 stated the facility did not set up an appointment with a wound clinic or home health services for R1. R1 stated R1's family called V17 (R1's Physician) about R1's heel wounds in early April 2024, R1 was transferred to the hospital, and then a wound clinic appointment was scheduled. On 4/30/24 at 12:39 PM V20 Post Acute Care Coordinator stated V20 is responsible for setting up home health services and follow up appointments prior to a resident's discharge. V20 stated R1 had (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 4 Event ID: 145603 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 145603 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accolade Hc of Paxton on Pells 1001 East Pells Street Paxton, IL 60957 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)