Health inspection·February 21, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to utilize PPE (Personal Protective Equipment) per CDC (Centers for Disease Control) guidelines when coming in contact with Covid positive residents. This has the potential to affect all 74 residents living at the facility. Residents Affected - Many Findings include: On 2/18/25 at 1:00pm, signage to the facility's front entrance read, Community respiratory illness activity is high. Masks are strongly recommended to protect our residents. Notice per IDPH (Illinois Department of Public Health) regulations notice is hereby given that a positive Covid test result has been confirmed (in a) resident. R3's Face sheet documented an admission Date of 1/10/25 and listed diagnoses including Left Fibula Fracture and Hypertension. R3's Physicians Orders for February 2025 documented a 2/13/25 order for droplet/contact isolation due to a positive Covid test result. R12's Face Sheet documented an admission Date of 1/31/25 and listed diagnoses including Parkinson's Disease and Dementia. R12's February 2025 Physicians Orders documented a 2/13/25 order for droplet/contact isolation due to a positive Covid test result. R13's Face Sheet documented an admission Date of 1/23/25 and listed diagnoses including Alzheimer's Dementia and Parkinson's Disease. R13's Physicians Orders for February 2025 documented a 2/13/25 order for droplet/contact isolation due to a positive Covid test result. On 2/19/25 at 8:20am, a sign on R12's door read, Transmission-based droplet contact (isolation) precautions: Respirator (N95) (required) when entering room. V13, Certified Nursing Assistant (CNA) was observed entering the room wearing a gown, gloves, and a surgical mask. On 2/19/25 at 11:05am, V2, Director of Nurses, stated she is the staff member designated as Infection Control Preventionist. V2 stated the facility currently has 5 residents positive for Covid. V2 stated staff should wear a gown, gloves, and an N95 mask into Covid rooms. On 2/19/25 at 1:05pm, V7, family member of R12, stated she is at the facility several hours daily. V7 stated R12 is currently Covid positive. V7 stated when staff provide R12's care, they always wear gloves and a surgical mask but no gown. On 2/19/25 at 1:10pm, a sign on R3's door read, Transmission-based droplet contact (isolation) precautions: Respirator (N95) (required) when entering room. V8, Housekeeper, was observed inside the room removing trash from an isolation barrel. V8 was wearing gloves and a surgical mask but no gown. Page 1 of 2 145685 145685 02/21/2025 Mount Vernon Countryside Manor 606 East IL Hwy 15 Mount Vernon, IL 62864

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 2/19/25 at 1:15pm, a sign on R13's door read, Transmission-based droplet contact (isolation) precautions: Respirator (N95) (required) when entering room. V5, Patient Aid, was observed entering the room with R13's lunch tray. V5 donned a gown and gloves and was wearing a surgical mask. On 2/19/25 at 1:30pm, R3 was alert and oriented to person, place, time, and purpose. R3 stated she is on isolation for Covid. R3 stated when staff provide care, they wear masks and gloves, she is not sure what kind of mask, and sometimes gowns. A Respiratory Illness Policy dated 1/7/25 stated, Infection Prevention and Control: Health care personnel and visitors should adhere to the appropriate precautions when in the presence of a resident with suspected or confirmed respiratory illness. Until the cause of an ARI (Acute Respiratory Illness) outbreak is determined, facilities should use the most protective level of precautions. Transmission based precautions, such as droplet, airborne, and/or contact precautions may be recommended, depending on the type of respiratory virus detected. The table, Recommended precautions for common respiratory viruses, provides a pragmatic approach to transmission based precautions recommended by IDPH (The Illinois Department of Public Health). At a minimum, facilities should follow CDC (Centers for Disease Control) guidelines for the specific type and duration of precautions. Guidance at https://www.cdc.gov/covid/hcp/infection-control/index.html#cdc_infection_control_comm_que-frequently-asked-questions documented, Why does CDC continue to recommend respiratory protection with a NIOSH (National Institute for Occupational Safety and Health) -approved particulate respirator with N95 filters or higher for care of patients with known or suspected COVID-19? CDC ' s guidance to use NIOSH-approved particulate respirators with N95 filters or higher when providing care for patients with suspected or confirmed SARS-CoV-2 (Covid) infection is based on the current understanding of SARS-CoV-2 and related respiratory viruses. Facemasks commonly used during surgical procedures will provide barrier protection against droplet sprays contacting mucous membranes of the nose and mouth, but they are not designed to protect wearers from inhaling small particles. NIOSH-approved particulate respirators with N95 filters or higher, such as other disposable filtering facepiece respirators, powered air-purifying respirators (PAPRs), and elastomeric respirators, provide both barrier and respiratory protection because of their fit and filtration characteristics. The facility's Matrix dated 2/18/25 documented there are 74 residents living at the facility. 145685 Page 2 of 2