Health inspection·October 13, 2024

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and records review, the facility failed to maintain an effective pest control program to ensure the facility is free of pests and rodents. This deficiency has the potential of affecting all 178 residents residing in the facility. Residents Affected - Many Findings include: R1's current face sheet documents R1 is a [AGE] year-old individual with medical diagnosis that include but not limited to: chronic obstructive pulmonary disease, unspecified, cervical disc disorder with myelopathy, unspecified cervical region, acute embolism, and thrombosis of unspecified deep veins of lower extremity, bilateral. R1's MDS (Minimum Data Set) section C-Brief Interview for Mental Status (BIMS) dated [DATE], documents R1's BIMS score as 15/15, indicating R1 has intact cognitive function. On 10/12/2024, at 10:20 AM, R1 was observed laying in bed awake watching television. R1 stated He saw mice in his room a couple of days ago and mice traps were placed around his room. R1 stated this has been going on for a while and he does not like the mice moving around in his room. Especially since R1 cannot get out of bed by himself. If the rats come near him, he gets uncomfortable, when he hears the mice running around at night. R2's current face sheet documents R2 is a [AGE] year-old individual whose medical diagnosis include but not limited to: paraplegia, unspecified, unspecified convulsions, other muscle spasm. R2's MDS (Minimum Data Set) section C-Brief Interview for Mental Status (BIMS) dated [DATE], documents R2's BIMS score as 14/14, indicating R2 has intact cognitive function. On 10/12/2024 at 11:14 AM, R2 was observed in a wheelchair in the dining room interacting with peers. R2 stated he tries not to stay in his room because of mice. He sees them all the time. R2 stated she saw a mice run around in his room yesterday, and staff are aware. R2 stated he does not like mice and the mice running around makes him very uncomfortable because R2 is paralyzed from the waist down and there is nothing he do to help himself when the rats start running around. R2 stated the facility is aware but the rat problem continues to be a problem in his room. R2 stated the treatments being applied do not work because there are mice everywhere, and he sees mice droppings in his room all the time. R3's current face sheet documents R3 is a [AGE] year-old individual with medical conditions that include but not limited to: chronic obstructive pulmonary disease with (acute) exacerbation, Page 1 of 3 145688 145688 10/13/2024 Princeton Rehab & Hcc 255 West 69th Street Chicago, IL 60621

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease R3's Minimum Data Set (MDS) Section C - Cognitive Patterns-Brief Interview for Mental Status (BIMS) dated July 15, 2024, documents R3's BIMS as 15/15, indicating R3 has intact cognitive function. On 10/12/2024, at 10:19AM, R3 was observed laying in bed awake and stated staff use a mechanical lift to get her in and out of the bed to the wheelchair and vice versa. R3 stated she has heard mice ruining in her room at night when she is sleeping, but does not remember when. She does not like mice or any pests. On 10/12/2024 at 11:06AM, V14 (Certified Nursing Assistant-CNA) V14 and surveyor went to R2's room and on the floor of the big dresser was observed some tiny blackish pallets on the floor. V14 stated the tiny pallets were mice droppings. V14 opened the dresser drawers, and more mice droppings were observed inside the drawers. V14 stated mice should not be in residents' rooms. On 10/12/2024, at 11:21 AM, V15 (housekeeping) and surveyor went to R2's room and observed mice droppings on the floor by the dresser and inside the main dresser and the side tables. V15 stated he sees a lot of mice droppings in residents' rooms and when he cleans especially on the 3rd floor, and mice can scare residents. V15 stated he also sees the pest control in the facility and put out rat poison. On 10/12/2024, at 11:31AM, V16 (Housekeeping) was observed in the hallway and stated he has worked at the facility for nine months and he has seen mice dropping on corners around the units and in residents rooms, and most of the mice droppings are on the third floor because the residents in this unit have behavioral health issues and they take food to their rooms and leave it there. V16 stated the food can attract mice and roaches. V16 said when residents see mice in their rooms, they ask for mice traps to be put in their rooms. V16 further stated mice carry a lot of germs which they can spread, and the mice can also scare residents. He sees pest control company come to the facility to apply treatments. On 10/12/2024, at 2:22 PM, V4 (Maintenance Director) stated he has worked at the facility for about six months. Since he started working at the facility ten months ago, the pest control company would come to the facility once a week to treat pest sightings. But since March 2024, the pest control company has been coming two times a week. V4 stated the kitchen, laundry room, and boiler room are treated every time the pest control company comes to the building, and so far, the kitchen has not had any pest sightings. V4 stated per the pest control company policy, the company only treats places where there have been pest sightings, and that is why every floor has a maintenance log where staff document any pest sightings. V4 stated he checks the pest maintenance log three times a day on every floor and puts mice traps around the walls and base boards, and under the radiators in the rooms were the mice were sighted. V4 stated there is a pipe that runs from the radiator into the wall and goes up to the boiler room and that's how the radiator is cooled or heated. V4 stated the hole where the pipe runs through has a small gap and this is where mice get in and into the building. V4 stated the maintenance department is in the process of filling those gaps. V4 stated he is aware of rat/mice sightings, but he was not aware of rat droppings in the residents' rooms. V4 stated until all the gaps/holes are fully sealed, the mice problem will not be completely solved. V4 further said he will see if he can get approval from corporate for more contractors to 145688 Page 2 of 3 145688 10/13/2024 Princeton Rehab & Hcc 255 West 69th Street Chicago, IL 60621

F 0925 Level of Harm - Minimal harm or potential for actual harm help fill the holes to speed up the elimination of the mice in the facility. V4 stated pest can be harmful to the residents mentally because residents can be scared. V4 stated he was not sure if the mice can spread diseases in the facility. V4 stated he is aware of rat/mice sightings, but he was not aware of rat droppings in the residents' rooms. V4 stated until all the gaps/holes are fully sealed, the mice problem will not be completely solved. Residents Affected - Many On 10/12/2024, at 4:18 PM, V1(administrator) stated the pest control company is now coming two times a week to provide treatments. V1 thinks their treatments are working because the pest complaints are not as many as they used to be, and the residents don't complain and much as they used to. V1 stated the facility has been working with the pest control company for a while because V1 found the company providing services when she started at the facility in December 2023. V1 stated the residents have not complained the mice and other pests. V1 stated she does not think the mice are affecting residents. V1 further stated even in the communities, there are mice problems even in the best neighborhoods. Facility maintenance and house keeping request logs dated 10/10/2024,10/11/2024, 10/09/2024, 10/07/2024, 09/20/2024, 09/23/2024, 09/13/2024, 9/17/2024, 9/19/2024, 10/02/2024, 09/09/2024, 09/10/2024 document there were roaches and or rats/mice observed in various parts of the facility. Pest control policy dated 1.23 documents: -Administrator will ensure that all recommendations concerning sanitation, maintenance needs, food storage problems and Pest Control Contractor's report are addressed. Pest control company treatment logs from 08/01/2024 to 10/11/2024 document pest/rodents/mice sightings in the facility on multiple occasions. 145688 Page 3 of 3