Health inspection·December 26, 2023

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify either the resident or their representative of a significant change in condition and room changes. This applies to 2 of 4 residents (R1, R8) reviewed for notifications when changes occur in the sample of 4. The findings include: 1). The EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], and discharged from the facility on [DATE], at the local hospital, where R1 expired. R1 had multiple diagnoses including bipolar disorder, chronic obstructive pulmonary disease, asthma, heart failure, type 2 diabetes, spondylolisthesis lumbosacral region and morbid obesity. R1's MDS (Minimum Data Set) dated [DATE], showed R1 to be cognitively intact, and required extensive assistance with ADLs (Activities of Daily Living) including bed mobility, transfer, dressing, toileting, personal hygiene and required total assistance with bathing and limited assistance with mobility while using a wheelchair. On [DATE]. 2023, at 1:03 PM, V7 (RN-Registered Nurse) stated she was R1's nurse on [DATE] at 3:00 AM when R1 was found unresponsive, CPR (Cardiopulmonary Resuscitation) had been initiated and R1 was transferred to the local hospital. V7 stated she did not contact V9 (R1's mother/POA/ Power of Attorney) to notify her of R1's transfer to the hospital. V7 also stated she was R1's nurse on [DATE], at 1:20 AM, when R1 had a fall that required transfer to the local hospital for a CT (computer tomography) scan of his head. V7 stated she could not recall if she contacted V9 regarding the fall incident and transfer to the hospital. R1's progress notes, written by V7, of [DATE], regarding the fall incident and transfer and the progress note of [DATE], describing R1's change in condition and transfer to the hospital did not include notification to V9. On [DATE], at 3:00 PM, V2 (DON) stated R1 had a room change on [DATE], due to his roommate's request due to odors caused by R1. There is no documentation to include R1's agreement to the move, or notification to either R1 or V9 (R1's representative) regarding the room change. V2 also stated R1 and R8 had exchanged rooms to accommodate room change requests. On [DATE], at 2:00 PM, V9 stated she was not informed by the facility of R1's transfer to the hospital or his change in condition. V9 further stated during the summer she was not informed of her son's fall or transfer to the hospital. V9 stated her last conversation with R1 was on [DATE], when R1 Page 1 of 2 145715 145715 12/26/2023 Wheaton Village Nrsg & Rhb Ctr 1325 Manchester Road Wheaton, IL 60187

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few complained to her that his room had been changed, R1 did not understand why his room was changed and he did not like the roommates in his new room. 2). R8's MDS (Minimum Data Set) dated [DATE], showed R8 was cognitively intact and required extensive assistance with ADLs including bed mobility, transfer, toileting, dressing and personal hygiene, and mobility while using wheelchair, and limited assistance with eating. The EMR showed R8 was admitted to the facility on [DATE], and had multiple diagnoses including Chronic obstructive pulmonary disease, dementia, type 2 diabetes, schizophrenia, and chronic kidney disease. R8's progress notes showed R8 developed a cough, and an X-ray of his chest was ordered and completed on [DATE]. The next progress note was written on [DATE], by R8's physician. R8's admission record has an emergency contact person listed. There is no documentation that either R8 or the emergency contact was informed of either his illness or the room change that the census report showed occurred on [DATE]. On [DATE], at 2:15 PM, V2 (DON) stated there should be documentation when a resident agrees to a room change or when resident representatives are notified of condition changes or transfer to the hospital. The facility's policy Notification of Change in Condition Policy dated [DATE], showed under Standards: A licensed nurse shall promptly inform the resident, consults with the resident's physician and if known, notify the resident's legal representative or an interested family member of - a. An accident involving the resident in which there is a potential or an actual injury b. a significant change in the resident's physical, .deterioration .in either life threatening conditions or clinical complications c. a need to alter treatment and d. a decision to transfer or discharge the resident facility. 145715 Page 2 of 2