Health inspection·December 22, 2023

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to safely transfer a resident (R1). This failure resulted in R1 being hit in the head with the arm of the mechanical lift, resulting in a large skin tear, being admitted to the hospital, and requirng sutures to her head. This applies to one of three residents (R1) reviewed for safety in the sample of five. The findings include: The facility assessment dated [DATE] shows R1 to be cognitively intact, requires maximum assistance for her activities of daily living and uses a mechanical lift for her transfers. On 12/21/23 at 11:15 AM, R1 said she was being lifted from her bed to her wheelchair using the mechanical lift. R1 said as she was being lowered to her wheelchair, the arm bar on the lift hit her in the head. R1 said she saw stars and was in a lot of pain. R1 said she had to be taken to the hospital for sutures, and had to spend the night and have scans to her brain to rule out a brain injury. R1 said she was very scared and in a lot of pain after the incident. On 12/21/23 at 12:15 PM, V8 Certified Nursing Assistant (CNA) said she was one of the two CNA's transferring R1 when she hit her head. V8 said she was directing the lift and the other CNA (V10) was guiding R1 into her chair. V8 said after R1 was in the chair she moved forward and hit her head on the bar. On 12/21/23 at 12:40 PM, V10 said he was assisting with the transfer of R1 into her wheelchair. V10 said R1 hit her head on the lift bar and it began to bleed. V10 said it happened so fast, but he did not remember where he was during the transfer. On 12/21/23 at 2:23 PM, V2 Licensed Practical Nurse (LPN) said he does the staff training for the mechanical lifts and the staff are trained to always have two staff present, one staff is to drive the lift and the other staff is responsible for guiding the resident safely to their chair or bed. V2 said the lift used for the incident was pulled from use. It was inspected and a padding was added to the arm of the lift. Observations of the facility mechanical lifts was completed on 12/21/23. Numerous mechanical lifts were observed in the facility. Only one lift was observed with padding to the arm of the lift and was located on the first floor. R1 resides on the second floor. A mechanical lift was observed outside R1's room, but no padding was observed to the arm of the lift. Page 1 of 2 145621 145621 12/22/2023 Pavilion of Waukegan 2217 Washington Street Waukegan, IL 60085

F 0689 Level of Harm - Actual harm Residents Affected - Few The facility report regarding the incident dated 11/23/23 shows R1 recieved a skin tear to her right forehead measuring approximately 10 centimeters. A pressure dressing was applied, 911 was called and R1 was sent to the local hospital. The emergency room report dated 11/23/23 shows R1 had a mechanical lift dropped on her head, which required nine staples and 14 sutures to her right forehead and scalp. The open area was reported to be approximately 12 centimeters in length. R1 was kept at the hospital overnight to rule out brain injury. The facility total mechanical lift competency checklist with a revision date of 4/2008 shows a).two caregivers are present during the transfer, h) gently raises the resident minimally from surface, i). turn resident legs toward the perpendicular support bar during the move and j). gently lower the resident into proper position. 145621 Page 2 of 2