Health inspection·April 26, 2024

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to ensure food containers are stored off the floor and ensure staff are employing hygienic practices during food handling in the dining room. This deficiency has the potential to affect all 165 residents receiving food from the kitchen. Findings include: On 4/23/2024 at 11:05 AM, observed 6 cans of fruit cocktail on the floor in the dry storage room during the initial tour. On 4/23/2024 at 11:05 AM, V12 (Cook) stated those cans should not be on the floor. On 4/23/2024 at 01:00 PM, V1 (Administrator) stated cans of food should be stored on the shelves when delivered. It should be off the floor. On 4/23/2024 at 12:23 PM, observed V13 (Dietary Aide) during lunch in the dining room touched and adjusted her eyeglasses with gloved hands then proceeded to continue preparing food without performing hand hygiene and changing gloves. On 4/23/2024 at 12:24 PM, V13 said I should have changed gloves before continuing to prepare food. On 4/24/2025 at 10:31 AM, V3 (Assistant Director of Nursing/Infection Control) stated V13 should have removed her gloves and performed hand hygiene after touching her eyeglasses and before continuing her task. Policy: Food Storage - Dry Goods, Revision History Date: October 2019 Policy Statement: It is the center policy to insure all dry goods will be appropriately stored in accordance with guidelines of the FDA Food Code. Action Steps: Dry Storage 1. Page 1 of 4 145835 145835 04/26/2024 Bella Terra Wheeling 730 West Hintz Road Wheeling, IL 60090

F 0812 Level of Harm - Minimal harm or potential for actual harm The Dining Services Director or designee is responsible to store all items 6 inches above the floor on shelves. Facility unable to provide Food Handling Policy Residents Affected - Some 145835 Page 2 of 4 145835 04/26/2024 Bella Terra Wheeling 730 West Hintz Road Wheeling, IL 60090

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to implement appropriate transmission-based precaution and to provide the necessary personal protective equipment (PPE) supplies readily accessible for use by staff and visitors for 3 of 3 residents (R153, R47, R131) reviewed for transmission-based precaution in a sample of 37. Residents Affected - Few Findings include: On 4/23/2024 at 12:05 PM, R153 identified positive COVID 19 and on isolation. Observed isolation signage outside room as Contact Precaution, no other sign identified. On 4/23/2024 at 12:05 PM, V11 (License Practical Nurse - LPN) stated R153 is on isolation for COVID 19 and should have a signage of Contact and Droplet Precaution. On 4/23/2024 at 01:00 PM, V2 (Director of Nursing - DON) said R153 should be Droplet Precaution. On 4/24/2024 at 10:31 AM, V3 (Assistant Director of Nursing/Infection Control) stated R153 should have a signage outside the room of Contact and Droplet Precaution. On 4/23/2024 at 11:45 AM, R47 and R131 on Contact Precaution with Personal Protective Equipment (PPE) bin set-up outside the room. PPE bin without the necessary glove supplies readily accessible for use by staff and visitors. On 4/23/2024 at 11:49 AM, V10 (Registered Nurse - RN) said there should be gloves on the isolation bin for immediate use. Central Supply Personnel is responsible for making sure there is PPE supplies available. V10 stated I will go look for gloves now. On 4/24/2024 at 10:31 AM, V3 (Assistant Director of Nursing/Infection Control) stated isolation bin should have the complete PPE supplies, including gloves, readily accessible for use. (R153) Order Summary Report include: Isolation Precaution: Contact/Droplet - Reason for Isolation: COVID+ (R47, R131) Order Summary Report include: Isolation- contact precautions, Reason for isolation: MRSA sacral wound Care Plan: Focus: R153 requires Droplet/Contact Precautions related to: COVID 19 Focus: Isolation Contact Precautions: R47 is on contact isolation related to MRSA of wound Focus: Isolation Contact Precautions: R131 is on contact isolation related to MRSA of wound Policy: Name: Infection Prevention and Control, Revised 10/23/23 145835 Page 3 of 4 145835 04/26/2024 Bella Terra Wheeling 730 West Hintz Road Wheeling, IL 60090

F 0880 Policy Statement: Level of Harm - Minimal harm or potential for actual harm The facility has established a policy to Identify, Record, Investigate, Control, Test, and Prevent infections in the facility. The facility will also maintain a record of incidents and corrective actions implemented for identified infection. Residents Affected - Few Procedures 7. A transmission-based precaution set up will be provided outside the resident's room to provide Personal Protective Equipment (PPE) like gown and gloves to staff and visitors entering the resident's room. 8. A sign will be provided outside the room for residents on transmission-based precaution indicating the type of the precaution (Contact, Droplet, or EBP). 145835 Page 4 of 4