Health inspection·September 4, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide needed care and services in accordance with resident's plan of care as ordered by physician, facility's protocol, and professional standard of practice. This deficiency affects two (R2 and R4) of three residents reviewed for Quality of care. Findings include:R2On 9/2/25 at 10:21AM, Observed R2 up in wheelchair. She is alert with cognitive and communication impairment due to intellectual disability. She needs assistance with ADLs (Activity of daily living) and transfers. Assessed skin condition of R2's bilateral under the breast with V8 LPN (Licensed Practical Nurse) and V9 CNA (Certified Nurse Assistant). Observed redness under both breasts. V9 CNA said that she applied this morning Vitamin D ointment. V8 LPN said that R2 has fungal rash, and she has an order of Nystatin powder twice daily, but she has not applied it yet. On 9/3/25 at 10:41AM, Reviewed R2's medical records with V4 Wound Care Nurse. V4 said that R2 ‘s Braden scale upon admission on [DATE] indicated score of 19 at high risk for skin impairment. She developed fungal rash under the breast as reported by nursing staff due to complaint of family member. She said that she observed the skin impairment under R2's bilateral breast but did not do the assessment but initiated the treatment order on 8/25/25. She also said she did not update care plan. She said that their protocol requires written assessment of skin impairment to be documented in wound assessment or progress notes, notify the physician for appropriate treatment order and update the care plan. She said that she just updated the care plan yesterday 9/2/25 when surveyor asked for it. She is not aware that group home case manager came in for complaint on 8/20/25 based on grievance report completed by V2 DON. V4 said that she did not update R2's family member of the treatment obtained for the redness under the breast. V4 said that Vitamin D ointment is not an appropriate treatment for fungal rash under the breast. R2 is admitted on [DATE] with diagnosis listed in part but not limited to Displaced fracture of olecranon process with intraarticular extension of right ulna, Cognitive communication deficit, Genetic related intellectual disability, Disorder of psychological development, Need for assistance with personal care, Difficulty walking, unsteadiness of feet. Physician order sheet indicated Nystatin external powder 100,000 unit/gm apply under both breasts topically every day and evening shift for fungal rash. Cleanse under the breast area with soap and water then apply powder under breast on affected areas ordered 8/25/25. No care plan formulated for under the breast fungal rash until 9/2/25. No documentation of under the breast fungal rash skin assessment and identification in R2's medical record. R2's admission Braden skin assessment indicated at high risk for skin impairment. R2's grievance form completed by V2 DON dated 8/20/25 indicated that R2's home care case manager presented concern about R2's redness under the breast. No documentation of assessment done. Treatment order not obtained until 8/25/25. R4On 9/2/25 at 11:02AM, Observed R4 lying in bed with low air loss mattress. He is alert and responsive to simple questions. He needs maximum to total care assistance with ADLs and transfers. V8 LPN said that R4 has sacral and right hip wound dressing. On 9/2/25 Residents Affected - Few Page 1 of 3 145860 145860 09/04/2025 Grove of Skokie, The 9000 LA Vergne Avenue Skokie, IL 60077

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few at 11:15Am, V2 DON (Director of Nursing) said that V4, Wound care nurse, is not yet in the building but will come later. She said that the floor nurse does the wound treatment in absence of wound care nurse. Informed V2 that surveyor will observe V8 LPN for R4's wound care. On 9/2/25 at 11:24AM, V8 LPN and V6 LPN reviewed R4's treatment orders and prepared for wound treatment. R4 has left AKA (Above the knee amputation). R4 repositioned to his right side. Observed no sacral wound dressing. R4 has moderate amount of soft brown bowel movement in his adult disposable brief. Observed redness with 100% epithelization tissue. V8 cleansed with NSS. Applied Nystatin powder 100,000 unit/gram to the sacral, applied gauze and covered with bordered gauze dressing. V8 also applied nystatin powder to perineal area. Then R4 repositioned to his left side. V8 removed the wound dressing saturated with moderate serosanguinous drainage. V8 cleansed with NSS. R4 has red wound tissue 50% granulation with 50% yellowish slough attached to the wound base. V8 applied calcium alginate and medical grade honey, gauze and covered with bordered gauze dressing. On 9/3/25 at 10:41AM, Reviewed R4's medical records with V4 Wound Care Nurse. V4 said that R4's re-admission Braden scale assessment dated [DATE] indicated high risk for skin impairment. He has DTI on sacrum and unstageable pressure ulcer on right hip. He has daily dressing and PRN to both sacral and right hip. She said that it's their protocol to follow physician orders in providing wound treatment. The floor nurses are knowledgeable to perform wound care as indicated in treatment record /Physician order. Informed above observation made during wound care with V8 LPN and V6 LPN. R4 is re-admitted on [DATE] with diagnosis listed in part but not limited to Acquired absence of left leg below the knee, Cognitive communication deficit, Dysphagia, Lack of coordination, Difficulty walking, Dermatitis, Type 2 Diabetes Mellitus, Parkinson's disease. Physician order sheet indicated: Right hip: Cleanse with normal saline, apply medical grade honey to wound bed, cover with calcium alginate and secure with bordered foam dressing daily and as needed. Sacrum: cleanse with normal saline, apply skin prep to site and cover with bordered foam dressing daily and as needed. Nystatin external powder 100,000 unit/gm apply to perineal area topically every day and evening shift for redness and itching. Comprehensive care plan indicated: R4 has an actual impairment to skin integrity related to contractures, Braden score and medical diagnosis. Left AKA- surgical wound, Sacrum- DTI (Deep tissue injury), Right hip- unstageable, and perineal fungal infection. He has an ADL self-care performance and impaired mobility. R4's wound /skin assessment report completed by V14 Wound care Nurse Practitioner dated 8/27/25 indicated: Sacrum Pressure ulcer, DTI, 2cm x 2cm x 0cm, 100% epithelial. Right hip Pressure ulcer, Unstageable, 2.8cm x 3cm x0.3cm, 40% slough, 60% granulation, peri wound-erythema, moderate amount of serosanguineous exudate. re-admission Braden scale assessment completed on 8/5/25 indicated at high risk for skin impairment. On 9/3/25 at 12:01PM, Informed V3 ADON of above observation made and concerns identified to R2 and R4. V3 said that V4 Wound nurse or floor nurse should document newly identified skin impairment to resident's wound assessment or progress notes, call physician for appropriate treatment order, update care plan and notify family member. The nurses should follow the physician orders when providing wound care. On 9/3/25 at 2:18PM, Informed V1 Administrator, V2 DON and V15 Nurse Consultant of concerns identified to R2 and R4. Facility's policy on Skin Care Regimen and Treatment Formulary reviewed 7/3/25 indicated: Policy Statement: it is the policy of the facility to ensure prompt identification, documentation and to obtain appropriate treatment for residents with skin breakdown. Procedures: 1. Charge nurse must document in the electronic health record any skin breakdown upon assessment and identification. Furthermore, treatment must be obtained from the patient's physician. 2. Routine daily wound care treatment/dressing change is administered by the wound care nurse or designee unless otherwise indicated by patient's attending physician.a) Pressure injuriesc) Other skin conditions5. Refer any 145860 Page 2 of 3 145860 09/04/2025 Grove of Skokie, The 9000 LA Vergne Avenue Skokie, IL 60077

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few skin breakdown to the skin care team and physician including wound physician/NP for further review and management as indicated.7. Notify the patient family/next of kin or POA for any new skin alteration that is identified during stay at the facility. 11. Treatment protocol: III. Stage 3 and Stage 4: Calcium alginate, Thera Honey, Deep tissue Injury (DTI): Foam dressinge) Rashes associated with allergy, dermatitis:*Incontinent rash with yeast infection: Antifungal: Triamcinolone/NystatinFacility's policy on Wound Care Guidelines reviewed 1/24/24 indicated: Procedures: 9. Documentation: c. The care plan shall be evaluated and revised based on resident's response to treatment, treatment, goals, and outcomes.d. The resident's skin alteration/breakdown shall be documented in the resident's clinical records in accordance with the facility's policy and in compliance with current regulatory standards. 12. Wound assessment for non-pressure skin alterations: non-pressure skin alterations documentation shall include but are not limited to perineal dermatitis, excoriation, skin tears, cuts, abrasions, surgical wounds, burns, rashes and abrasions and wound related pain. Facility's policy on Physician orders revised 7/3/5 indicated: Policy statement: It is the policy of this facility to ensure that all resident/patient medications, treatment, and plan of care must be accordance to the licensed physician's orders. The facility shall ensure to follow physician orders as it is written in the POS. 9. Provision of care, treatment and services administered by the facility to the patient must be approved by the attending physician unless these treatment and services are governed by the facility's clinical policy and procedures as approved by the medical director. Facility's policy on Care plan revised 6/30/25 indicated: Policy statement: It is the policy of the facility to ensure that all care plans including base line care plans are in conjunction with the federal regulations. Procedures: 5. These will be periodically reviewed and revised by a team of qualified person after each assessment. 145860 Page 3 of 3