Health inspection·June 5, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record review, the facility failed to follow physician orders for a resident (R2) who required a physical and occupational therapy evaluation. This failure affected 1 resident out of 3 residents reviewed for therapy services. Residents Affected - Few Findings include: R2 has a history of diverticulosis, syncope, congestive heart failure, chronic kidney disease, and alcohol abuse. R2's Brief Interview of Mental Status (BIMS) dated 4/15/25 score is 8, which indicates R2 has moderate cognitive impairment. R2's mobility function requires mobility devices walker and wheelchair. Functional status for toileting hygiene, shower/bath, lower body dressing, putting on /taking off footwear requires partial/moderate assistance. R2's Physician orders dated 4/9/25 documents in part, may evaluate and treat PT/OT (Physical Therapy/Occupation Therapy). On 6/4/25 at 10:18 am, V3 DON (Director of Nursing) stated that Doctors orders should be followed. Therapy department is notified by the floor nurse for an evaluation order. The therapy supervisor is in the morning meetings and made aware of the therapy orders. The stand down meetings in the evening we follow up to make sure that therapy is done. On 6/4/25 at 10:40 am V14 Occupational Therapist stated We (Therapy Department) get the information from the nurses or facility staff who needs to be seen or evaluated for therapy. The communication is verbal or in the morning meeting. I would not know to evaluate him (R2) if I am not told. V14 looked at R2's orders and stated, He (R2) should have been seen by the therapy department. V14 looked at her computer and then stated, I do not see where therapy evaluated him. He was not seen for therapy. On 6/4/25 at 2:40 pm, V17 Physical Therapy Assistant stated, If there were an ancillary order for an evaluation for therapy, the nurses would notify the department. The nurses did not notify the therapy department for the order to evaluate. I (V17) would have done an evaluation with insurance approval if I was aware of the order. He (R2) was not evaluated from the order of 4/9/25. On 6/4/25 requested from V3 DON facility policy for following doctor's orders. Received a policy titled Physician Orders for Medication . On 6/5/25 at 10:30 am, V3 sent an email stating the policy for medications in the one the facility have for following doctor's orders. Page 1 of 2 145688 145688 06/05/2025 Princeton Rehab & Hcc 255 West 69th Street Chicago, IL 60621

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R2's Care plan revision date 4/24/25 documents in part, Focus: R2 has an ADL (Activity of Daily Living) functional performance deficit secondary to unsteady gait and general weakness. Status post GI surgery. Uses a cane to ambulate. Facility's policy titled Direct therapy Services and dated 3/10/22, documents in part, Policy: The qualified therapist, in conjunction with the physician and nursing administration, is responsible for determining the necessity for and the frequency and duration of the therapy services provided to residents. Residents are provided direct therapy services upon the written order of their physician. Facility's job description titled Staff Nurse (Registered Nurse/License Practical Nurse) documents in part, Essential Functions: BB. Arrange for diagnostic and therapeutic services, as ordered by the physician. Facility's job description titled Staff Physical Therapist documents in part, Adhere to the policies and procedures necessary for day-to-day operations of the rehab department: Maintain communication between therapy department and interdisciplinary team. Facility's job description titled Occupational Therapist documents in part, Adhere to the policies and procedures necessary for day-to-day operations of the rehab department: Maintain communication between therapy department and interdisciplinary team. 145688 Page 2 of 2