Inspection·August 13, 2024

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 assess and obtain treatment orders for a resident with a known surgical wound. Residents Affected - Few This applies to 1 of 3 residents (R1) reviewed for quality of care. The findings include: R1's EMR (Electronic Medical Record) showed a readmission date of 8/05/2024. R1's EMR showed R1 had multiple diagnoses including left gluteal abscess, urinary tract infection, right arm deep vein thrombosis, metabolic encephalopathy, vascular dementia, morbid obesity, and malnutrition. R1's MDS (Minimum Data Set) dated 7/03/2024 showed R1 was incontinent of bowel and bladder and required substantial to maximal staff assistance with toileting hygiene. On 8/09/2024 at 12:30 PM, V10 (Certified Nurse Assistant/CNA) and V11 (Restorative Aide) were providing care to R1 and were asked to check R1's skin. V10 said R1 was readmitted with a wound to her left inner groin area that was not covered. R1 had an exposed open tunneling wound to her left inner gluteal fold area. R1's wound bed had 100% granular tissue with serosanguineous drainage. Then V9 (Wound Care Nurse/WCN) came to assist with R1's skin check. V9 said she was notified on 8/06/2024 that R1 was readmitted on [DATE] with an abscess wound to her left inner groin area that was surgically drained at the hospital. V9 said R1 had a dressing covering the wound during her readmission which was not removed. V9 continued to say R1's wound had not yet been assessed and R1 did not have treatment orders in place. V9 proceeded to clean R1's wound with wound cleanser then packed the wound with an iodoform packing strip dressing and covered it with a dry dressing. On 8/09/2024 at 2:47 PM, V7 (Nursing Unit Manager) said the facility was informed by the hospital of R1's left groin abscess wound during her readmission. V7 said she performed a skin check on R1 on 8/05/2024 and noticed a dressing in R1's left groin area. V7 said she did not assess nor contact R1's physician to obtain treatment orders for R1's wound. V7 said she notified V9 (WCN) of R1's surgical wound dressing on 8/06/2024. R1's hospital document titled Report of Inpatient Wound Care Consultation dated 8/05/2024 showed R1 had a left gluteal fold abscess wound that was surgically drained on 8/01/2024. The report showed R1's wound was assessed and measured 1 cm (centimeter) in length, 0.5 cm in width, 1 cm in depth, and had tunneling at 12 o'clock which measured 2.2 cm. The report said R1's wound was a full-thickness wound with pink and red granular tissue that had moderate serosanguineous drainage. The report continued to show R1 had discharge wound care orders to cleanse the wound with saline and pack with iodoform packing strip then cover with a foam dressing daily and as needed. (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 2 Event ID: 145874 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 145874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowbrook Manor - Naperville 720 Raymond Drive Naperville, IL 60563 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)