Health inspection·January 25, 2024

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review the facility failed to establish and implement interventions for one resident (R5), with a behavior of urinating and defecating in a waste basket. This failure has affected two residents (R5 and R6) and has the potential to affect 54 other residents who reside on the second floor. Findings include: R5 is [AGE] year-old with diagnoses including but not limited to: Catatonic Schizophrenia, Unspecified Psychosis, Depression, and Anxiety Disorder. R6 is [AGE] year-old with diagnoses including but not limited to: Chronic Diastolic Heart Failure, Peripheral Vascular Disease, Osteoarthritis, Hypothyroidism and Type 2 Diabetes Mellitus. R6 has a BIMS (Brief Interview of Mental Status) score of 14, which indicates cognitively intact. R5 and R6 are roommates on the second floor at the facility. On 01/22/2024 at 10:25 AM, Surveyor exited the elevator on the second floor and noted a strong odor of urine. At that time, Surveyor inquired about the odor. On 01/22/2024 at 10:27 AM, V4 RN (Registered Nurse) said, I don't know where the urine smell is coming from, but it is strong. Surveyor and V4 RN entered R5's room and noted the urine odor becoming stronger. Surveyor observed a basket full of clothes near R5's bed. On 01/22/2024 at 10:27 AM V4 said, Those clothes have urine on them (referring to R5's clothes). They have to be washed. That is probably were the urine odor is coming from. R5 urinates and defecates in the waste basket sometimes because she does not like to use the toilet. On 01/24/2024 during unit rounds, Surveyor observed R5 lying in her bed. At this time, R5's room smelled like urine. Page 1 of 4 145806 145806 01/25/2024 Warren Park Health & Living Ctr 6700 North Damen Avenue Chicago, IL 60645

F 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 01/24/2024, at 10:47 V14 CNA (Certified Nurse Assistant) Manager said, R5 often urinates in the waste basket in her room because she (R5) hates things touching her body. She is independent with toileting but has incontinent episodes. We try to keep the urine odor down. On 01/24/2024 at 11:15 PM, R6 said, R5 urinates in the trash can sometimes. Our room smells like urine a lot, but I don't like to complain about it because I like R5. I try to help her. R5's Care plan documents, Focus: R5 has a behavior of urinating and defecating in trash bin in room. R5's Care plan excludes any intervention regarding incontinence and/ or the need to verbally que and/ or encourage R5 to utilize toilet or brief. R5's MDS (Minimum Data Set) Section GG- Functional Abilities and Goals indicates that R5 requires supervision or touching assistance (verbal cues and/ or touching/ steadying or contact guard assistance with toileting. R5's MDS (Minimum Data Set) Section H- Bladder and Bowel indicates that R5 is always incontinent. R5's MDS (Minimum Data Set) Section H- Bladder and Bowel indicates that No trial of a toileting program had been attempted on admission/ entry or reentry or since urinary incontinence was noted in the facility. Facility document titled Attachment E: Statement of Resident Rights documents, the right to live in an environment that promotes and supports each resident's dignity, individuality, independence, self-determination, privacy, and choice and to be treated with consideration and respect. Facility document titled Care Plans, Comprehensive Person- Centered policy documents, care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment; The care planning process will include an assessment of the resident's strengths and needs; Areas of concern that are identified during the resident assessment will be evaluated before interventions are added to the care plan. 145806 Page 2 of 4 145806 01/25/2024 Warren Park Health & Living Ctr 6700 North Damen Avenue Chicago, IL 60645

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 interviews and record review, the facility failed to ensure that two dependent residents (R4 and R8) received showers as scheduled. This failure has affects two of five residents reviewed for ADLs (Activities of Daily living). Residents Affected - Few Findings include: R4 is [AGE] year-old with diagnoses including but not limited to: Encounter for Antineoplastic Chemotherapy, Generalized Anxiety disorder, Low back pain and Type 2 Diabetes Mellitus with Diabetic Neuropathy. R4 has a BIMS (Brief Interview of Mental Status) score of 15, which indicates cognitively intact. R8 is [AGE] year-old with diagnoses including but not limited to: Muscle Weakness, Other Lack of Coordination, Alzheimer's disease, Hypothyroidism and Essential Hypertension. R4 and R8 are roommates on the first floor in the facility. On 01/24/2024 during unit rounds, Surveyor observed both R4 and R8 in their room in bed. On 01/24/2024 at 11:30 AM, R4 said, I really need a shower. I was supposed to have a shower on yesterday, but no one ever came to give me a shower. My last shower was about a week and a half ago. At that time, R8 said, My last shower was weeks ago and that's only because I went to the nurse's station and asked the nurse to help me with a shower. I feel like we are bullied or teased when it comes to showers because we are offered a shower, and no one never shows up. Surveyor inquired about the day that R4 and R8 usually are given showers. On 01/24/2024 at 11:33 AM, R4 said, The staff don't follow a shower schedule here. The showers are randomly offered to us when they (staff) feel like giving us a shower. We don't have a shower day. On 01/24/2024 at 11:33 AM, R8 said, She (R4) is right! I don't have a specific shower day either. I get a shower whenever. I'm lucky to get a shower around here. Surveyor asked if R4 and R8 were given their scheduled shower on Tuesday (yesterday). On 01/24/24 at 2:50 PM, V22 CNA (Certified Nurse Assistant) said, I was going to do their (R4 and R8's) showers but I got busy yesterday and didn't get a chance to do it. I did ask them (R4 and R8) yesterday if they wanted a shower, but I was trying to prioritize care with other residents like feeders and a patient on hospice. There were like four CNAs working on the unit yesterday, but everybody was also busy with their own residents. I am still learning. I just got out of training. I will try to do better with organizing the showers. Neither of them had their shower on days yesterday. I know that they need their showers. On 01/24/23 at 3:10 PM, V14 (CNA Manager) said, I make the shower schedule. R4 and R8 are scheduled for showers on Tuesdays, Thursdays and one day on the weekend (Saturday or Sunday). 145806 Page 3 of 4 145806 01/25/2024 Warren Park Health & Living Ctr 6700 North Damen Avenue Chicago, IL 60645

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Surveyor asked if R4 and R8 had received their showers on yesterday (Tuesday). On 01/24/23 at 3:10 PM, V14 (CNA Manager) said, No, R4 and R8 didn't receive their showers on yesterday. The 3p- 11p CNA (V23) came in after V22. V23 didn't document any showers given on the 3p- 11p shift. V22 is a new CNA. I will do some more training with her, but R4 and R8 should have received their showers on yesterday. R4's Care plan documents, Focus: R4 has decreased bathing skills; R4 has an ADL self-care performance deficit related to disease process and fatigue; R4 has decreased range of motion. R4's MDS (Minimum Data Set) Section GG- Functional Abilities and Goals indicates that R4 requires Supervision or touching assistance with showers and transfers to shower. R8's Care plan documents, Focus: R8 had an ADL self-care performance deficit related to dementia; R8 is a risk for falls related to gait and balance problems. R8's MDS (Minimum Data Set) Section GG- Functional Abilities and Goals indicates that R8 requires Setup or clean-up assistance with showers. Facility document titled First floor showers 7am- 3pm; Tuesday, Thursday and Saturday or Sunday indicates R4 and R5 on the schedule. Facility document titled CNA's Daily Assignment Sheet documents V22 (CNA) working 7am- 3pm shift on 1/23/2024 and V23 (CNA) working 3pm- 11 pm shift on 1/23/2024. Facility document titled, Activities of Daily Living documents, Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Facility document titled, Bath/ Shower/ Tub documents, The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. Facility document titled Attachment E: Statement of Resident Rights documents, the right to live in an environment that promotes and supports each resident's dignity, individuality, independence, self-determination, privacy, and choice and to be treated with consideration and respect. 145806 Page 4 of 4