Health inspection·November 15, 2023

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 observation, interview, and record review the facility failed to provide ADL (Activities of Daily Living) assistance for a resident that was totally dependent on staff for toileting/incontinence care for 1 of 28 residents (R74) reviewed for ADLs in the sample of 28. Residents Affected - Few The findings include: R74's resident assessment dated [DATE] showed R74 was totally dependent on staff for toileting/incontinence care. R74 was always incontinent of urine and stool. R74 was cognitively impaired. On 11/13/23 at 9:15 AM, R74 was awake, lying in bed. A strong odor of urine was noted in R74's room. On 11/13/23 at 9:25 AM, V13 Certified Nursing Assistant (CNA) entered R74's room to provide cares. V13 CNA removed R74's incontinence brief. The brief was saturated with urine. R74's buttocks were bright red with areas of excoriation noted. A small, pinpoint, open area was noted to R74's left buttock. A scant amount of bleeding was noted from the open area. R74 complained of pain to his buttocks as V13 began cleansing his buttocks. V13 stated, The skin redness and peeling (to R74's buttocks) is new for him. I took care of him last week and it didn't look like that. This is the first time I have changed him today. I am not sure when he was changed last. It would have been some time on nights . Incontinence care should be done every two hours. I am going to tell the wound nurse. V13 left R74's room and returned with V10 Wound Nurse. V10 Wound Nurse examined R74's buttocks and stated, That redness is new for him. His buttocks look excoriated. It's caused by him being wet. He also can't reposition himself. On 11/14/23 at 9:18 AM, V2 Director of Nursing stated staff should round on and provide incontinence care to residents every two hours. R74's Bowel/Bladder Incontinence record dated 11/12/23 showed staff last provided incontinence care to R74 at 11:19 PM on 11/12/23. The record showed no documentation that staff provided incontinence care to R74 from 12:00 AM-9:20 AM on 11/13/23. R74's nurses notes dated 10/25/23-11/3/23 showed no documentation of R74 refusing cares offered by staff. Page 1 of 13 145872 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review the facility failed to transport a resident to the shower room in a manner to prevent resident injury. The facility failed to ensure a resident was transferred in a safe manner. The facility failed to ensure fall interventions were in place for a resident at risk for falls. These failures apply to 3 of 28 residents (R23, R55, R27) reviewed for safety/supervision in the sample of 28. The findings include: 1. R23's current care plan showed R23 had a diagnosis of paraplegia (paralysis of her bilateral lower extremities) related to the progression of her multiple sclerosis. The care plan showed R23 was cognitively intact. R23 was totally dependent on staff for activities of daily living (showering, transferring, toileting). A facility incident report dated 9/23/23 showed R23's right big toe was found by staff to be swollen and bruised after R23 bumped her foot on the wall on the way to the shower. The note showed facility staff were educated, post-incident, to be careful with (R23's) lower extremities when maneuvering the shower chair. R23's progress notes dated 9/25/23 showed an X-ray was completed of R23's right foot. R23's X-ray report showed no fracture and/or dislocation to her right foot/toes. On 11/14/23 at 8:29 AM, a large Band-aid was noted to R23's right big toe. A small amount of dried blood was noted, next to R23's big toe, on the foam boot to R23's right foot. V17 Registered Nurse removed the Band-aid to R23's right big toe. R23's toe appeared slightly reddened and swollen with a small healing laceration to the top of the toe. When R23 was asked what happened to her toe, R23 stated, I hit my foot when they were taking me to the shower. I don't remember when it happened. On 11/14/23 at 12:24 PM, R23 stated she was seated in a shower chair, in the shower, when the injury to her toe happened. R23 stated, I can't move my legs on my own. My (right) foot was dragging on the floor when the CNA (certified nursing assistant) was pushing me in the shower chair. My toe got caught on the floor. The shower chair doesn't have any footrests. On 11/14/23 at 8:55 AM, V11 CNA stated, I was putting (R23) in the shower when I noticed her toe (right) was bleeding. The skin to the top part of it was peeled back. I don't know what happened but something happened. Her toe wasn't bleeding prior to taking (R23) to the shower. V11 stated R23 was totally dependent on staff for cares. On 11/14/23 at 8:45 AM, V10 Wound Nurse stated R23 was totally dependent on staff to move her lower extremities. V10 also stated R23 was at risk for delayed wound healing due to her diagnoses of multiple sclerosis and diabetes. 2.) R55's face sheet shows she has diagnoses including: Senile degeneration of the brain, and unspecified dementia. R55's 9/21/23 restorative assessment shows R55 requires staff assistance with transfers, and extensive staff assistance with toileting. 145872 Page 2 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0689 R55's care plan initiated on 12/8/2020 shows she is at risk for falls due to poor safety awareness. Level of Harm - Minimal harm or potential for actual harm A facility provided incident list shows R55 had recent falls at the facility on 9/20/23 and 9/22/23. Residents Affected - Few On 11/13/23 at 1:09 PM, R55 was taken into the bathroom by V6 (Certified Nursing Assistant/CNA) she had white tube socks on and no shoes. V6 took her over to a bar in the bathroom and asked her to stand up. V6 did not apply a gait belt to R55 but assisted her to stand, turn and sit on the toilet. At 1:14 PM, when R55 was finished V6 stood her up assisted her to use toilet paper and pulled her pants up and assisted her to stand and turn and sit with no gait belt or shoes on. On 11/14/23 at 9:00 AM, V5 (CNA) said gait belts should be used for all resident during transfers. V5 said R55 requires one staff person to assist her during transfers and that she should be wearing shoes or at least slipper socks. The facility provided Transfer Technique policy dated 2/11 shows staff should apply gait belts prior to transferring a resident. The policy does not reflect proper footwear required. 3. On 11/13/2023 at 12:51PM, R27 was observed laying in bed watching television with the head of bed elevated. There was a fall mattress leaning up against the wall. There was no fall mattress observed on the floor. R27 said facility staff don't always put down floor mats during the day. On 11/13/2023 at 12:53PM, V14 Registered Nurse (RN) said [R27] should have fall mats on the floor while he is in bed. On 11/14/2023 at 11:57AM, V2 Director of Nursing (DON) said care planned interventions such as floor mats should be in place while a resident is in bed. R27's current care plan lists [R27] at risk for falls related to a history of falls with an initiation date of 3/6/2023. R27's care plan interventions list floor mattress while in bed with an initiation date of 7/5/2023. The facility's Fall Management Program, dated 8/2020, shows while prevention all resident falls is not possible, it is the facility's policy to act in a proactive manner to identify and assess those residents at risk for falls, plan for preventative strategies and facilitate a safe environment. 145872 Page 3 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, interview, and record review the facility failed to maintain a resident's indwelling urinary catheter bag below the level of a resident's bladder for a resident with a history of urinary tract infections (UTI) for 1 of 6 residents (R44) reviewed for catheter care in the sample of 28. The findings include: R44's current care plan showed R44 had an indwelling urinary catheter due to the diagnosis of neuromuscular dysfunction of her bladder. The care plan showed R44 had a history of UTI's. On 11/13/23 at 10:10 AM, V12 and V13 Certified Nursing Assistants (CNA) repositioned R44 as she laid flat in bed. Once R44 was repositioned on her back, V12 CNA lifted R44's indwelling urinary catheter bag, up and over R44 (above the level of R44's bladder), as she lay in bed. A backflow of cloudy urine was noted from the catheter bag, towards R44. V12 CNA handed R44's catheter bag to V13. V13 hung the catheter bag off the left side of R44's bed. On 11/14/23 at 9:18 AM, V2 Director of Nursing stated urinary catheter bags are to be kept below the level of a resident's bladder to prevent the backflow of urine into the bladder which could increase a resident's risk of a UTI. The facility's Catheter Care policy September 2020 showed, Daily and PRN (as needed) catheter care will be done to promote comfort and cleanliness . 145872 Page 4 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. R103's face sheet shows he is a [AGE] year old male with diagnosis including senile degeneration of the brain, vascular dementia, type 2 diabetes, hemiplegia and hemiparesis following cerebral infract affecting left non-dominant side, dysphagia, and chronic kidney disease. Residents Affected - Some R103's Nutrition assessment dated [DATE] documents a significant weight change. His supplements include fortified pudding with lunch and dinner. Magic cup with lunch and fortified potatoes with lunch. R103 stated his likes the fortified pudding. He stated he likes the potatoes. R103's weights indicating a significant weight loss of 13.8% in six months. 11/2/23- 175.1 lb (pounds) 10/1/23- 173.8 lb 9/2/23- 178.0 lb 8/4/23- 180 lb 7/1/23- 190.2 lb 6/1/23- 195.4 lb 5/4/23 - 203. 2lb On 11/13/23 at 12:34 PM, R103 was observed in the dining room during the noon meal. He was served Swedish meatballs/noodles and vegetables. He was not served his fortified potatoes. R103 said he did not receive the potatoes and likes the potatoes. On 11/14/23 at 12:32 PM, R103 was served the noon meal including pork, augratin potatoes and green beans. He was not served his fortified potatoes or fortified pudding. On 11/5/23 at 10:48 AM, V16 (Dietitian) said residents should receive supplements to prevent weight loss. R103's Physician Orders dated November 2023 shows orders fortified potatoes with lunch and fortified pudding with lunch and dinner. 3.) R3's face sheet shows she has diagnoses including: cognitive communication deficit and senile degeneration of the brain. R3's 8/22/23 nutrition assessment completed by V16 (Dietician) shows that R3 has had a significant weight loss of 8.2% in 3 months and 13.2% in 6 months. R3's weight on 2/1/23 was 113.4 lbs. and on 8/1/23 her weight was 98.4 lbs. a total weight loss of 15 lbs. in 6 months. V16's dietary note shows she added interventions for R3 to include fortified potatoes daily with lunch on 8/4/23. R3's physician order summary shows she has an active order with a start date of 8/5/23 for her to 145872 Page 5 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0692 receive fortified pudding daily with lunch and dinner, and fortified potatoes daily at lunch. Level of Harm - Minimal harm or potential for actual harm On 8/14/23 at 12:40 PM, R3 was eating her lunch in the small dining area. Her meal ticket was still present on her tray which showed she should have fortified pudding and fortified potatoes with lunch. Her meal tray had chicken, scalloped potatoes, bread, beans and cake. There was no fortified potatoes on her meal tray. Residents Affected - Some Based on observations, interview, and record review the facility failed to provide dietary supplements for residents with a history of weight loss or at risk for weight loss. This applies to 9 of 9 (R58, R68, R34, R60, R112, R144, R35, R103, and R3) residents reviewed for dietary supplements in the sample of 28. The findings include: 1. Facility provided Diet Type Report dated 11/14/23, shows R68, R34, R58, R60, R112, R144, R35, R3, and R103 are to receive fortified potatoes with lunch. On 11/13/23, V21 (Cook) did not serve fortified potatoes during lunch. On 11/14/23 at 12:43 PM, R58 received ground pork chop with gravy, au gratin potatoes, and green beans for lunch. Also on R58's tray were nectar thick liquids and a magic cup. R58 did not receive fortified potatoes. R58 only consumed a few bites of the au gratin potatoes and the full magic cup. R58 said he is always hungry and dislikes the food. R58's Quarterly Nutrition assessment dated [DATE] states, . Weight loss is not desirable. On multiple nutrition supplements to add extra calories and protein. R58's diet card for lunch on 11/14/23 shows R58 is to receive 1/2 cup of fortified potatoes. On 11/15/23 at 8:38 AM, V21 said fortified potatoes were not made for lunch on 11/14/23. V21 said fortified potatoes are served in a separate dish on the side of the plate and is provided when it is on the card or if nursing requests it. On 11/15/23 at 10:46 AM, V16 (Registered Dietitian) said fortified potatoes are ordered for residents that have experienced weight loss, both gradual and/or a significant weight loss, or for residents who are at risk for weight loss to prevent further weight loss. V16 expects residents to receive dietary supplements as ordered. 145872 Page 6 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure a resident with a dementia diagnosis was immediately redirected for 1 of 8 residents (R131) reviewed for Dementia care in the sample of 28. Residents Affected - Few The findings include: R131's face sheet shows she has a diagnosis of Dementia with other Behavioral Disturbances. R131's active care plan shows she can exhibit periods of aggression and needs re-direction. On 11/13/23 at 10:12 AM, R131 was sitting in the activity/dining room at the table in the memory care unit next to R132. There were 2 activity groups taking place in the room. R131 was sitting at the table playing a game with Styrofoam noodles and a balloon. R131 was visibly agitated, crying, and yelling out swear words. At 10:12 AM, R131 reached over and hit R132 on his left arm. V4 (Activity Therapy/AT) was present and observed R131's action attempting to offer her a puzzle but did not separate or remove R131 or R132 from the table. At 10:16 AM, R131 again hit R132 on his left arm and pinched him. This surveyor asked V4 if this behavior was typical of R131 and what they do when she becomes aggressive. V4 responded that R131 often thinks R132 is her husband, and if they try to move her away from R132 it makes it worse. At 10:19 AM, R131 continued agitated and when V4 told R131 not to cry, R131 responded angrily stating, Don't cry of course I am gonna f****** cry. After this incident V4 left the activity room briefly to get lemonade for the residents. At 10:22 AM, R131 looked at R132 and stated, I am not going to get anything else thanks to you. R131 then extended her arm and shoved R132 in his left shoulder area. At 10:35 AM, V15 (Registered Nurse/RN) entered the room and asked R131 to come with her and they left the dining area. On 11/14/23 at 12:32 PM, V8 (Memory Care Director) said R131 should have been re-directed and removed from the activity immediately the first time R131 hit R132. They should have been separated immediately and R131 should have been re-directed into a different activity or taken for a walk. 145872 Page 7 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 serve lunch on sanitized dishware. This has the potential to affect all 143 residents residing in the facility. Residents Affected - Many The findings include: The CMS 671 form dated 11/13/23 shows 143 residents residing in the facility. On 11/13/23 at 9:17 AM, V19 (Dietary Aide) and V18 (Dietary Aide) were doing dishes at the dish machine. V19 was on the dirty side, rinsing dishes, loading them into dish racks, and sending them into the dish machine. V18 was on the clean side, allowing the dishes to air dry. Once air dried, V18 placed the plates directly into the plate warmers, the silverware into the silverware rack, and the trays onto a cart. On 11/13/23 at 9:22 AM, V21 (Cook) placed a temperature test strip between the tines of a fork and sent it through the dish machine. V21 said the machine is a high temp sanitizing machine and it should reach 180°F to sanitize. When the test strip came out, the results were inconclusive. At 9:24 AM, V21 placed a new test strip onto a plate topper and ran it through the dish machine. This test strip did not change colors as intended, indicating 160°F was not reached. Direct observations from 9:44 AM until 9:49 AM showed the dish machine digital thermometer readout rinse temperature did not exceed 150°F. On 11/13/23 at 10:18 AM, V20 (Food Service Director) said after talking to someone, the dish machine had a chemical attached and that it might be okay that the machine is not reaching 160°F. At 10:21 AM, the chemical attached to the machine was a rinse additive and not a chemical sanitizer. On 11/13/23 at 10:22 AM, V20 placed a temperature test strip onto a plate, placed the plate onto a dish rack, and ran it through the dish machine. When the test strip came out, the test strip did not change colors as intended, indicating 160°F was not reached. At 10:27 AM, V20 placed another test strip onto a plate and ran it through the machine another time. When the test strip came out, the test strip did not change colors as intended, indicating 160°F was not reached. V18 and V19 continued to use the dish machine during this time and V18 continued to place the plates directly into the plate warmers, the silverware into the silverware rack, and the trays onto a cart. V20 did not instruct staff to stop using the dish machine or to use the three-compartment sink to sanitize the dishes. On 11/13/23 at 11:39 AM, V21 grabbed the plate warmer where the plates from breakfast were placed and began to plate lunch. V21 finished serving lunch at 12:27 PM. On 11/13/23 at 12:27 PM, V21 said the dishes used during lunch were the same dishes used during breakfast. V21 said when the dish machine is not working, they can use the three-compartment sink to wash and sanitize dishes or they can use disposable dishware to serve meals until the machine is fixed. V21 said the dishes from breakfast that were used to serve lunch had not been run through the three-compartment sink to be sanitized. On 11/13/23 at 12:44 PM, V20 said the dishes from breakfast should not have been used for lunch if 145872 Page 8 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0812 the machine did not reach sanitizing temperatures. Level of Harm - Minimal harm or potential for actual harm Facility Mechanical Washing Sanitation Testing policy dated 3/18 states, Dishmachine test strips will be used to verify the dishmachine sanitation system is working correctly. Purpose; to reduce the risk of food borne illness. 2. For temperature sanitizing machines: Attach a 160°F test strip to clean, dry, cool plate . If the test strip does not turn the correct color, the above procedure should be repeated. If the test strip does not turn the appropriate color on the second attempt, the dishmachine should be evaluated for proper functioning before the dishes are washed. Residents Affected - Many 145872 Page 9 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure residents were isolated and the scabies protocol was followed for 2 of 3 residents (R55 and R13) reviewed for infection control in the sample of 28. Residents Affected - Few The findings include: On 11/13/23 at 10:13 AM, R55 was sitting in the dining area. On 11/13/23 at 12:46 AM, R55 was in the dining area during lunch. She had her hands in her shirt scratching her chest. Her arms were noted to have red areas with raised scabbed bumps on them. She was also scratching under her shirt sleeve on both arms. On 11/13/23 at 1:07 PM, V24 (Registered Nurse/RN) was present in R55's room while she was itching so she put some lotion on her skin. R55's nursing progress notes show the following: 10/13/23 12:19 PM, Resident observed skin redness at the front, back and bilateral arms. Noted skin itchiness. Hospice nurse seen the patient today and gave order for permethrin cream (a cream used to treat scabies or lice) 5% topically one time a day every 14 days until asymptomatic. 11/1/23 at 7:27 PM, (FN- facility nurse- notified writer of scabies tx on floor spoke with MD and gave orders for Ivermectin (anti-parasitic drug used to treat scabies). 11/1/23 8:11 PM, New orders received for Ivermectin 3 mg (milligrams) for a total dose of 9 milligrams. On 11/14/23 at V3 (Infection Preventionist) said she was not made aware by the hospice nurse or the facility nurses of R55's orders for scabies treatment in November. V3 said the facility had an outbreak of scabies several months ago but she was not aware of a recent concern that R55 had scabies. V3 said the protocol for potential scabies is for Permethrin cream and sometimes Ivermectin oral medication. She said the facility should have also bagged up all clothing and personal items that could not be laundered for 7 days, and launder all clothes in addition to a deep cleaning of her room and that was not done. V3 said that both R55 and her roommate R13 should have been on isolation until 24 hours after treatment and were not, and R13 should have also been treated for scabies when R55 was in Oct/Nov. and was not. R55 and R13's Physician Order Summaries (POS) shows there were no orders for isolation on 10/31-11/2/23. R55 and R13's progress notes have no documented isolation, deep cleaning or laundering of items due to potential scabies for either resident. The facility provided Scabies policy dated 9/2020 shows if a resident is suspected of having scabies contact precautions should continue for 24 hours post treatment. The roommate of a resident suspected and treated for scabies should also be isolated and treated. The policy also shows all linens and clothes should be laundered on high heat, and items that cannot be laundered need to be closed in a plastic bag for 7 days. Treatment of choice is Permethrin cream to be applied and left on 8-14 hours and if a rash persists past 1 week repeat treatment. Residents rooms should be thoroughly cleaned. 145872 Page 10 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to offer both pneumonia vaccines (pneumococcal conjugate vaccine [PCV15 or PCV20] and Pneumococcal polysaccharide vaccine [PPSV23]) for 2 of 5 residents (R63, R131) reviewed for pneumococcal vaccinations in the sample of 28. Residents Affected - Few The findings include: 1. R63's face sheet shows he is a [AGE] year old male admitted to the facility on [DATE]. R63's Immunization Report dated 11/14/23 documents pneumovax dose 2 was administered in 2018. As historical. The report does not identify what pneumococcal vaccine he received. 2. R131's face sheet shows she is a [AGE] year old female admitted to the facility on [DATE]. R131's Immunization Report dated 11/14/23 documents she received Pneumovax 23 dated 10/15/22 and does not show a second series was given. On 11/14/23 at 12:57 PM, V3 (ADON/ICP) said she was not sure which pneumo vaccine should be administered after a resident received a first dose and would check with their policy. She said she was not aware of the updated pnuemonia vaccine guidance from the CDC (Centers for Disease Control and Prevention). She confirmed that residents should receive two series of the pneumo vaccine if they have received PPSV23. The facility's Influenza and Pneumococcal Vaccinations Policy dated 9/21 states, In order to minimize the risk of residents acquiring, transmitting, or experiencing complications from influenza and pnuemococcal pneumonia, it is the policy of the facility to offer influenza and pneumonoccal vaccinations to all residents .Pneumococcal vaccine. Adults aged >65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive the a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 12 months after a dose of PCV13 .Previous vaccination with PPSV23. Adults aged >65 years who have previously received >1 dose of PPSV23 also should receive a dose of PCV13, if they have not received it. A dose of PCV13 should be given >1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 12 months after PCV 13 and >5 years after the most recent dose of PPSV23 . The facility's policy does not include the CDC recommendations including the PCV15 or PCV20. The Center for Disease Control and Prevention (CDC) website updated January 2022 states, Vaccination of Adults 65 Years or Older Routine Recommendation CDC recommends routine administration of pneumococcal conjugate vaccine (PCV15 or PCV20) for all adults 65 years or older who have never received any pneumococcal conjugate vaccine or whose previous vaccination history is unknown: If PCV15 is used, this should be followed by a dose of PPSV23 one year later. The minimum interval is 8 weeks and can be considered in adults with an immunocompromising condition +, cochlear implant, or cerebrospinal fluid leak. 145872 Page 11 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0883 If PCV20 is used, a dose of PPSV23 is NOT indicated. Level of Harm - Minimal harm or potential for actual harm Adults 65 Years or Older Never Received Any Pneumococcal Vaccine Residents Affected - Few For older adults who don ' t have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak: Give 1 dose of PCV15 or PCV20. When PCV15 is used, it should be followed by a dose of PPSV23 at least 1 year later. Their vaccines will then be complete. When PCV20 is used, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete. For older adults who have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak: Give 1 dose of PCV15 or PCV20. When PCV15 is used, it should be followed by a dose of PPSV23 at least 8 weeks later. Their vaccines will then be complete. When PCV20 is used, it does not need to be followed by a dose of PPSV23. Their vaccines are then complete. Also applies to people who received PCV7 at any age and no other pneumococcal vaccines. Only Received PPSV23 Give 1 dose of PCV15 or PCV20 at least 1 year after the most recent PPSV23 vaccination. Regardless of vaccine given, an additional dose of PPSV23 is not recommended since they already received it. Their vaccines are then complete. Only Received PCV13 For older adults who don ' t have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak: Give 1 dose of PCV20 or PPSV23 at least 1 year after PCV13. Regardless of vaccine used, their vaccines are then complete. For older adults who have an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak: Give 1 dose of PCV20 or PPSV23. Regardless of vaccine used, their vaccines are then complete. 145872 Page 12 of 13 145872 11/15/2023 Alden Long Grove Rehab &hc Ctr 2308 Old Hicks Road Long Grove, IL 60047

F 0883 The PCV20 dose should be given at least 1 year after PCV13. Level of Harm - Minimal harm or potential for actual harm The PPSV23 dose should be given at least 8 weeks after PCV13. Residents Affected - Few 145872 Page 13 of 13