Health inspection·June 12, 2024

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide timely incontinence care for 2 of 5 residents (R1 and R2) reviewed for activities of daily living. Residents Affected - Few Findings include: 1.R1 is a [AGE] year-old with diagnoses including pressure ulcer sacral region stage 3, diaper dermatitis, moderate protein-calorie malnutrition, irritable bowel syndrome with diarrhea, and anemia. The care plan dated 04/30/2024 showed that R1 has a limited ability to participate in daily care activities and has an impairment of skin integrity related to incontinent care. The admission MDS (Minimum Data Set) assessment, dated 04/10/2024, showed the resident was cognitively intact, and R1 was always incontinent of bladder and bowel and required extensive assistance from staff for incontinent care. During an observation and interview on 06/11/2024 at 11:30 a.m., R1 was lying on her back and was upset and tearful. R1 said she had a bowel movement at 10:00 a.m., and one of the Nursing Assistants said she needed another person's help to change her briefs for bowel incontinence care but never showed up. R1 said when she called for help again, someone came and said someone would be there in 15 minutes, shut off the call light, and no one showed up. R1 further said that the morning staff changed her briefs around 06:00 a.m., and today is the worst day. R1 said she was also waiting for her shower and that at least someone should explain what was happening. R1 used the call bell in Front of the writer, and V4(Registered Nurse) attended R1 and did not ask why she had called her. V4 assumed that R1 had called her about the shower and told R1 that her assigned CNA was providing a shower to another resident and she would come and take R1 after she finished showering another resident. The writer asked V4 why R1 had to wait for one and a half hours for incontinent care, V4 said she attended R1 a few times and explained why she was delayed. R1 became upset and tearful again and said she was disturbed by what V4 said and did not appreciate V4 telling the writer that she had attended to her a few times to explain, which was not true. V5 and V6 (Certified Nursing Assistant-CNA) said they were not assigned to R1 and, attended to R1 after this writer notified them and provided incontinent care. R1 had a moderate bowel movement with dry feces on both sides of the inner thigh, and V5 and V6 acknowledged the observation. 2. R2 is an [AGE] year-old female with diagnoses including bed confinement status, anemia, obesity, malignant neoplasm of breast, h/o cutaneous abscesses of buttocks, blisters of lower back and pelvis, and anxiety. The care plan dated 05/16/2024 showed limited functional abilities to her Activities of daily care and risk for complication. R2 was on diuretic medications and is occasional to frequent incontinent of bladder and bowel with skin breakdown, and has an intervention to keep as clean (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: 145614 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 145614 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chateau Nrsg & Rehab Center 7050 Madison Street Willowbrook, IL 60521 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)