Inspection·February 13, 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 Observation, Interview and Record Review, the facility failed to ensure nursing assistants provided a resident at risk for falling with supervision, failed to provide residents with dining assistance, and failed to document meal and fluid intakes and episodes of incontinence for three of three residents (R1, R2, R3) reviewed for nursing care in the sample of four. Residents Affected - Few Findings include: The facility's Assistance with Meals policy, dated 3/2022, documents Residents shall receive assistance with meals in a manner that meets the individual needs of each resident. All residents will be encouraged to eat in the dining room. Facility staff will serve resident trays and will help residents who require assistance with eating. Residents who cannot feed themselves will be fed with attention to safety, comfort and dignity, for example: not standing over residents while assisting them with meals; keeping interactions with other staff to a minimum while assisting residents with meals. The facility's Certified Nursing Assistant job description, dated 4/16/20, documents The primary purpose of your job position is to provide your assigned residents with routine daily nursing care procedures, and as may be directed by your supervisors. Record all entries on flow sheets, notes, charts, etc. (etcetera), in an informative and descriptive manner. Use the Care Plan to identify residents before serving meals, transferring, etc., as necessary. Create and maintain an atmosphere of warmth, personal interest and positive emphasis, as well as a calm environment throughout the unit and shift. Maintain intake and output records as instructed. Keep incontinent residents clean and dry. Serve food trays. Assist with feeding as indicated (example; cutting foods, feeding, assist in dining room supervision, etc.). Assist residents with identifying food arrangements (example; informing residents with sight problems, what foods are on the tray, where it is located, if it is hot/cold, etc.). Record the residents' food/fluid intake. Report changes in the resident's eating habits. The facility's Behavioral Programs and Toileting Plans for Urinary incontinence policy, dated 10/2010, documents The purpose of this procedure is to provide guidelines for the initiation and monitoring of behavioral interventions and/or a toileting plan for the resident with urinary incontinence. Monitor, record and evaluate information about the resident's bladder habits, and continence or incontinence, including: voiding patterns (frequency, volume, time, quality of stream, etc.); associated pain or discomfort; type of incontinence (stress, urge, mixed, overflow, functional, etc.); level of incontinence; and response to specific interventions. If the resident does not respond and does not try to toilet, or for those with such severe cognitive impairment that they cannot either point to an object or say their own name, staff will use a check and change strategy. A check and change strategy involves checking the resident's continence status at regular intervals and using incontinence devices or garments. The primary goals are to maintain dignity and comfort and to protect the skin. (continued on next page) 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 5 Event ID: 145800 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 145800 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunset Home 418 Washington Street Quincy, IL 62301 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)