Health inspection·July 6, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide residents with weekly scheduled showers for 6 (R1, R3, R4, R5, R6, R7) of 7 residents reviewed for showers in a sample of 7. Residents Affected - Some The Findings Include: 1. R1's July POS (Physician's Order Sheet) documents an admission date to this facility of 05/18/21 with diagnoses to include incomplete quad, alcoholic, cirrhosis of liver, ascites, paraplegia, osteomyelitis of cervical spine, quadriplegia C5-C7 (cervical spine), and incomplete fusion. R1's most recent quarterly MDS (Minimum Data Set) dated 6/20/23 documents are Section C that R1 has a Brief Interview for Mental Status (BIMS) score of 15, indicating R1 is cognitively intact. Section G documents that R1 is totally dependent on staff for bathing. On 07/05/23 at 9:05 AM, R1 stated she has been a resident in this facility for 2 years. R1 stated her showers are scheduled to be given during second shift on Wednesday and Saturday, usually around 3:00 PM or right after supper time. R1 stated at this time she had not been given a shower for over 3 weeks now. R1 stated she thinks this is because the facility has lost several staff from second shift in the last few weeks. R1 stated the CNAs (Certified Nursing Assistants) who are here are aware she had not received an actual shower in weeks. R1 stated she gets her face washed and her hair brushed. When asked what kind of hygienic care she receives, R1 stated the only time she gets any kind of body care is when she has been incontinent of bowel. R1 stated she is a paraplegic from a previous accident and is totally dependent on staff for her care. R1's progress note dated 07/01/23 at 10:00 PM by V7 (Registered Nurse/RN) documents, Resident complaining of not having a real shower in some time being that 2 aides are present on floor, so asked resident if she wanted shower now as it's only 10:00 PM. They say they would gladly give one. She stated, No, I don't want to. The facility Shower Sheet Schedule indicates R1 receives her showers during the evening shift on Wednesday and Saturday. R1's shower sheets dated April 2023 to July 5, 2023, document she has missed 14 showers in this time frame with the last shower received on 06/13/23 confirming it has been over three weeks since R1 was given a shower. 2. R3's most recent quarterly MDS dated [DATE] documents in section C that R3 has a BIMS score of 15, indicating she is cognitively intact. Section G documents that R3 is totally dependent on staff for bathing. Page 1 of 4 145759 145759 07/06/2023 Axiom Healthcare of Rosiclare 1807 Fairview Rd Rosiclare, IL 62982

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The facility Shower Sheet Schedule indicates R3 receives her showers during the evening shift on Sunday and Thursday. R3's shower sheets dated April 2023 to July 5, 2023, document she has missed 15 showers during this time. On 07/06/23 at 9:15 AM, R3 stated there is a big crowd in the facility and CNAs do their best. R3 stated they are very good about washing her when she does not get a shower. 3. R4's most recent quarterly MDS dated [DATE] documents in section C that R4 has a BIMS score of 9, indicating R4 has moderate cognitive impairment. Section G documents that R4 requires physical help in part with bathing. The facility Shower Sheet Schedule indicates R4 receives her showers during the evening shift on Saturday and Thursday. R4's shower sheets dated April 2023 to July 5, 2023, document she has missed 16 showers during this time. On 07/06/23 at 10:30 AM, R4 was asked if she was scheduled for two showers a week. R4 stated, Yes, I am. When asked if she was getting two showers a week, she stated No, I'm not. When asked if she would like to be getting her scheduled showers, she stated, Yes! 4. R5's most recent quarterly MDS dated [DATE] documents are section C that R5 has a BIMS score of 14, indicating R5 is cognitively intact. Section G documents that R5 requires supervision and oversight help with bathing. The facility Shower Sheet Schedule indicates R5 receives her showers during the evening shift on Sunday and Wednesday. R5's shower sheets dated April 2023 to July 5, 2023, document she has missed 12 showers during this time. On 07/06/23 at 9:22 AM, R5 stated she does not always get her showers. R5 stated she is relatively independent but does require help in the shower, so she doesn't fall. When asked if she would like to get her two scheduled showers a week, she stated, I'd at least like to get one. 5. R6's most recent quarterly MDS dated [DATE] indicates she is moderately cognitively impaired with a BIMS score of 12. Section G documents that R6 requires physical help in part with bathing. The facility Shower Sheet Schedule indicates R6 receives her showers during the evening shift on Tuesday and Friday. R6's shower sheets dated April 2023 to July 5, 2023, document she has missed 12 showers during this time. On 07/06/23 at 9:24 AM, when asked specific questions, R6 was able to answer and be understood. When asked if she was getting her two weekly showers, she said no. When asked what days she is scheduled to be given a shower, she said Tuesdays and Fridays. When asked if she would like to be getting her showers, R6 said yes. 6. R7's most recent quarterly MDS dated [DATE] indicates she is moderately cognitively intact with a BIMS score of 10. Section G documents that R7 is totally dependent on staff for bathing. The facility Shower Sheet Schedule indicates R7 receives her showers during the evening shift on Monday and Thursday. R7's shower sheets dated April 2023 to July 5, 2023, document she has missed 15 showers during this time. 145759 Page 2 of 4 145759 07/06/2023 Axiom Healthcare of Rosiclare 1807 Fairview Rd Rosiclare, IL 62982

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 07/06/23 at 9:30 AM, R7 was asked if she was getting her scheduled showers. R7 replied, They don't do them. When asked why, she said she didn't know and shrugged her shoulders. When asked if she would like to be getting two showers a week, R7 nodded her head and stated, Yes. On 07/05/23 8:50 AM, V6 (CNA) stated she works a lot of 12-hour shifts now and there are a lot of showers for 2 CNAs to complete on 2:00 PM to 10:00 PM shift. V6 stated right now they don't have any full-time CNAs on evenings. V6 stated they have one that works a few days a week and one that works just under full-time during a 15-day schedule period. V6 stated they are trying their best with what they have. V6 stated she does know R1 had missed some showers. V6 stated no one other than CNAs help with showers. V6 confirmed they are always able to provide incontinence care, catheter care, and everything else. It's only the showers that don't get done. V6 stated in the morning they do give quick bed baths, so the residents don't have an odor. On 07/05/23 at 9:58 AM, V4 (CNA) stated there is an issue on the evening shift with not enough CNAs due to losing 4-5 CNAs recently for various reasons. V4 stated this has happened in the last several weeks, and CNAs here are doing everything they can. V4 stated she was not aware of any resident who has not gotten at least a bed bath. V4 stated, We have been diligent on residents getting pericare, catheter care, and overall washing/hygiene care. On 07/05/23 at 10:45 AM, V5 (CNA) stated evening shift from 2:00 PM to 10:00 PM is short CNAs because they have lost several recently, and that's when showers are done. V5 stated day shift CNAs usually work from 6:00 AM to 2:00 PM, but a couple of CNAs are working 12-hour shifts at this time to try and get as much done as they can, including resident showers. V5 stated this allows us to cover part of the evening shift and help them out. V5 stated when showers are done, the CNAs turn in the shower sheet for that resident. On 07/05/23 at 2:20 PM, V8 and V9 (CNAs) were present on second shift. When asked if they were able to complete resident showers scheduled twice a week on second shift, they both stated it just depended on the workload. V9 stated when we had 3-4 CNAs on a shift, we would get them done and do extra. Now, showers do not always get done. V9 stated they take special care to wash residents well and do an extra check before their shift ends and provide incontinence/hygiene care at bedtime when they used to be doing paperwork at the end of shift, but the residents come first. V9 stated they did hire 2 new CNAs, but they never showed up. V8 and V9 stated the day shift CNAs do a good job washing people up and that makes a big difference. The facility policy titled, Bath/Shower reviewed 03/20/23 includes the following statement, The policy and procedures of the facility are not intended to replace sound clinical judgement in the delivery of health care and are not intended to replace the prevailing standard of care. The policy also includes - Policy: To Ensure adequate hygiene needs are met. A bath/shower is scheduled for all residents in the facility at least weekly. Responsibility: All nursing staff . Procedure: . 6. Assist resident with ambulation/transfer/mobility to the tub/shower room . 10. Assist the resident on to the tub/shower chair, if appropriate . 17. Shampoo hair unless done by beautician. 18. Bathe, rinse, and dry upper body with special attention under breasts. 19. Bathe and rinse lower body with special attention to groin, skin folds, and between toes. 20. Wash and rinse genital area and peri-anal area. Dry thoroughly. 21. Dry lower body . On 07/06/23 at 9:35 AM, when asked about the difference in the shower schedule documenting 2 showers per week versus the facility policy requiring 1 shower a week, V1 (Administrator) stated, We try to ensure residents are at least getting showered once a week, so our policy documents one shower 145759 Page 3 of 4 145759 07/06/2023 Axiom Healthcare of Rosiclare 1807 Fairview Rd Rosiclare, IL 62982

F 0677 weekly, but our schedule is for two showers weekly. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 145759 Page 4 of 4