Health inspection·November 7, 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 follow its policy to notify Responsible Party of change in condition for one (R1) of three residents reviewed for notifications in a sample of three. Findings include: The facility's Responsible Party Notification of Resident Change of Condition Policy, Dated 7/8/17, documents: Purpose: To ensure that residents' responsible parties are notified of changes in conditions that occur. Residents' responsible parties will be notified of changes that occur in residents condition as warranted. It is the responsibility of all licensed personnel to notify the family or responsible parties of a change in residents' condition. 1. Primary family member or responsible party will be notified of change in residents condition. R1's diagnoses include: Dementia, Muscle Weakness, Parkinson's disease. R1's Minimum Data Set (MDS), dated [DATE], documents no score for R1's BIMS (Brief Interview of Mental Status); R1 was not able to be scored. (MDS indicates that on a scale of 0 - 15, 13 to 15 cognitively intact; 8 to 12 moderate impairment; and 0 to 7 severe impairment.) R1's Care Plan documents: I am being monitored for Covid19 per IDPH/(State) Department of Public Health and CDC/Centers for Disease Control and Prevention guidelines. Covid Positive 10/24/23. On 11/3/23 at 12:05pm, V7 Licensed Practical Nurse/LPN stated that V9 Power of Attorney/POA to R1 was not notified of R1's positive Covid test; stated that R1 tested positive on 10/24/23. (V7 LPN showed that there were no computer documentation supporting notification to V9 POA, that no staff charted that they notified V9 POA.) On 11/7/23 at 10:55am, V14 Ombudsman, stated: (V9 POA was very upset that she was not notified about (R1's) Covid. On 11/6/23 at 8:40am, V9 POA stated that she visited R1 on 10/27/23, that V8 Registered Nurse/RN met her at the door to the 200 wing and told her that there was Covid on the wing and that R1 had Covid as well; stated that the staff had not notified her prior to her arrival at this time. On 11/7/23 at 11:45am, V1 Administrator stated that (V9 POA) had not been notified about R1's Positive Covid Test, that V9 POA found out about this on 10/27/23. Page 1 of 2 145793 145793 11/07/2023 Renaissance Care Center 1675 East Ash Street Canton, IL 61520

F 0580 Level of Harm - Minimal harm or potential for actual harm At this same time, V1 stated, We missed one there, of all the people to miss. So much going on with the covid. Yes, we should have been following the policy for notification; we apologized to (V9 POA) about this; and the ombudsman (V14 Ombudsman) was involved with this also. We do notify POAs about any change in conditions, notify them about anything. We knew we were late on (R1's) notification. (V9 POA) usually comes in every day and she got missed about the Covid notification. Residents Affected - Few 145793 Page 2 of 2