Inspection·January 2, 2024

F 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 prevent the use of an unnecessary antibiotic for 1 of 3 residents (R3) reviewed for unnecessary medication in the sample of 4. Residents Affected - Few Findings include: R3 Order Summary Report, print date of 1/2/24, documents that R3 was admitted on [DATE] with the diagnosis of End Stage Renal Disease. R3's Progress Note, dated 12/1/23, documents, Orders received back from (V8, Physician Assistant) from U/A (urinalysis), urine culture for Macrobid (Nitrofurantoin) 100mg (milligram) po bid (by mouth twice a day) x 7 days. Send Urology and Nephrology copy of report. R3's Medication Administration Report, print date of 12/28/23, documents, Macrobid Oral Capsule 100 mg. Give 100 mg by mouth two times a day for UTI (Urinary Tract Infection) Order date of 12/01/23. R3's Urine Culture, Final Report date of 11/29/23, documents, Gram Negative rods less than 10,000 COL (colony)/ ML (milliliter). In V8's handwriting, 1. Macrobid 100 mg BID x 7 d (day). 2. Send culture. 2. copy to nephrology / urology. R3's Urine Culture, Final Reported date of 11/30/23, documents, Providencia rettgeri greater than 100,000 COL/ML. Proteeus mirabilis greater than 100,000 COL/ML Nitrofurantoin R (resistant). On 1/2/24 at 12:10 PM, V7, Infection Preventionist, stated, I called the provider (V8) and questioned him on why R3 got Macrobid when the organism was resistant to Macrobid. He is just as perplexed as we are. I have found some documentation that had not been scanned into the system yet. I found where the Dialysis center did send a fax over to us stating to change the Macrobid because of his End Stage Renal Disease but by this time he (R3) had finished the antibiotic. I usually go back and check that the organism is sensitive to the antibiotic. This one just got past me. On 1/2/24 at 12:33, V2, Director of Nurses, stated, We just found V8's fax response and it looks like V8 ordered the Macrobid before the culture came back. We did send to Nephrologist (Dialysis Center Doctor) but by the time they answered the antibiotic was finished. The Antibiotic Stewardship Policy / Procedure, dated 3/9/23, documents, Antibiotic Time 'time - out At 72 hours after antibiotic initiation or first dose in the facility, each resident will be reassessed for consideration for antibiotic [NAME], duration, selection, and de-escalation potential. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 145783 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145783 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Skilled Nur & Rehab 333 South Wrightsman Street Virden, IL 62690 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)