Health inspection·March 22, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** On 3/19/24 at 12:30 PM R329 was observed in a wheelchair eating lunch. The tray was placed on the overbed table in front of her. A canister half filled with urine was on top of the bedside table. R329 said that the canister was connected to her external female catheter overnights. R329 said that she used the catheter at night and took it off in the morning. The canister was not covered. On 3/20/24 at 11:00 AM the urine canister was observed on the bedside with a small amount of urine, the canister was not covered. R329 said that it is hit or miss if they empty the urine. Sometimes it is not emptied. On 3/20/24 at 12:04 AM V2 (Director of Nursing) said the urine collection should be covered. The urine should be emptied when the catheter is removed in the mornings. The Order Summary Report indicates catheter care every shift and as needed. The Care Plan indicates I have a female external catheter in place related to potential for incontinence episodes of bladder and skin issues on right medial thigh. Policy Urinary Catheter Care, Revision 2/14/19 12. Catheter drainage bags will be emptied one time on each shift or as needed, using a separate collecting container for each resident's drainage bag. Dignity, Revision 4/23/18 Maintaining a resident's dignity should include but is not limited to the following: Refraining from practices demeaning to residents such as leaving urinary catheter bags uncovered, refusing to comply with a resident's request for bathroom assistance during meal times, and restricting residents from the use of common areas open to the general public, such as lobbies and restrooms, unless they are on transmission-based isolation precautions or are restricted according to their care planned needs. Based on observation, interview and record review, the facility failed to provide privacy during blood sugar check for one (R59) of two residents reviewed for blood sugar monitoring. The facility Page 1 of 6 145877 145877 03/22/2024 Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few also failed to empty and cover a urinary collection canister for one resident (R329) of eight residents reviewed for dignity in a sample of 20 residents. Findings Include: During medication administration on 3/21/24 at 12:00pm with V4 (Registered Nurse) performed blood sugar check on R59 with a resident and family member sitting opposite R59 in the 400-hall dining area. R59's room was being cleaned at the time blood sugar check was due. On 3/21/24 at 12:30pm, V4 stated that the blood sugar check should have been done in a private area to provide privacy to R59. On 3/21/24 at 1:42pm, V2(Director of Nursing) stated that all patients should be provided privacy during blood sugar check. Review of records indicates R59 was admitted on [DATE] with diagnosis of type 2 Diabetes Mellitus with orders for Novolog Flex Pen Subcutaneous solution injector 100 unit/ml (Insulin Apart) 3units with meals and inject per sliding scale before meals. Care plan dated 5/12/22 indicates, I have Diabetes Mellitus. Facility unable to provide patient privacy policy for blood sugar monitoring. 145877 Page 2 of 6 145877 03/22/2024 Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 professional standards of care by failing to prime an insulin Flex pen prior to administering insulin to one resident (R59) of two residents reviewed for insulin administration in a sample of 20 residents. Residents Affected - Few Findings include: During medication administration on 3/21/24 at 12:20pm with V4 (Registered Nurse), V4 removed R59's flex pen from a plastic bag, turned it to 1 unit with no needle attached to the pen. V4 then proceeded to attach the needle to the pen and turned it to seven (units to be administered). V4 proceeded to administer seven units of Aspart insulin to R59 for a blood glucose of 277mg/dl. On 3/21/24 at 1:00pm, V4 stated that the Flex pen should have been primed before administering to R59. On 3/21/24 at 1:45pm, V2(Director of Nursing) stated that the Flex pen should have the needle attached to the pen before priming with 2units. Review of records indicates R59 was admitted on [DATE] with diagnosis of type 2 Diabetes Mellitus with orders for Novolog Flex Pen Subcutaneous solution injector 100 unit/ml (Insulin Aspart) 3units with meals and inject per sliding scale before meals. Care plan dated 5/12/22 indicates, I have Diabetes Mellitus. Facility policy updated 2/2024 indicates: Brand, Novolog U-100 Flex Pen, Generic; Aspart. Pen Priming Requirements: 2 units. 145877 Page 3 of 6 145877 03/22/2024 Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419

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 Based on observation, interview, and record review the facility failed to provide grooming for three residents (R5, R25, and R57) of eight residents reviewed for activities of daily living in the sample of 20. Residents Affected - Few Findings include: On 3/19/24 at 11:45 AM R57 was observed in his room with untrimmed beard growth. R57 said they were supposed to shave me, but they never did. On 3/20/24 at 10:00 AM R57's beard growth had not been trimmed or shaved. R57 said (Certified Nursing Assistant unnamed) kept saying that she was going to shave me. Every time that I asked, she said that she would come back and do it. She never came back. On 3/19/24 at 11:48 AM R5 was observed with untrimmed beard growth. R5 said, I asked them to shave me, but it hasn't happened yet. On 3/20 24 at 10:05 AM R5's beard growth was unchanged. R5 said (Certified Nursing Assistant unnamed) said that she was going to shave me yesterday, but she never came back. On 3/19/24 at 11:50 AM R25 said I need a shave. R25's beard is untrimmed and overgrown. On 3/20/24 at 10:55 AM R25's beard growth remains unchanged. R25 said they never came back to shave me. She (Certified Nursing Assistant unnamed) said that she was coming back. On 3/20/24 at 12:04 PM V2 (Director of Nursing) stated the residents should be shaved the same day that they ask. Policy Activities of Daily Living reviewed 1/2023 Grooming: Maintaining personal hygiene, including planning the task and gathering supplies, combing and/or styling hair, face and hands, brushing teeth, shaving or applying makeup, oral hygiene, self-manicure (safety awareness with nail care), and/or application of deodorant or powder. 145877 Page 4 of 6 145877 03/22/2024 Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419

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 follow its infection control policy by failing to disinfect an intravenous tubing valve for 30 seconds for one (R330) of one resident reviewed for intravenous medication administration in a sample of 20 residents. Residents Affected - Few Findings include: During medication administration on 3/19/24 at 2:00pm, V3(Registered Nurse) was observed wiping the valve of an intravenous tubing. V4 did not disinfect the valve for 25 to 30 seconds. On 3/19/24 at 2:00pm, V3 stated that the valve should be cleaned for at least one minute to prevent the growth of bacteria. V3 stated that she should have waited a bit longer. On 3/20/24 at 1:45pm, V2(Director of Nursing) stated that the valve should be cleaned for 25 to 30 seconds. R330's face sheet indicates an admission date of 3/12/24 with a diagnosis of history of Diabetic Foot Ulcer, a physician order for Cefazolin Sodium Injection Solution with start date of 3/23/24 and end date of 4/18/24 to be given three times a day for DM (Diabetes Mellitus) foot ulcer. Care plan dated 3/13/24 indicates; I have a PICC (Peripheral Inserted Venous Catheter) line and have the potential risk for infection at the site. PICC line site will remain free from sing and symptoms of infection. Facility policy dated 12/2014 title; Administration Procedures: Intermittent Infusion Administration. 11. Disinfect valve with alcohol swab, . 145877 Page 5 of 6 145877 03/22/2024 Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to offer pneumococcal immunization to one resident (R57) of five residents reviewed for immunizations in the sample of 20. Residents Affected - Few Findings include: On 3/20/24 at 4:00 PM surveyor conducted a review of the immunizations for five residents. R57 did not have any documentation related to the pneumococcal immunization education, consent, or refusal. V2 (Director of Nurses/Infection Preventionist) stated that she did not know if R57 had a pneumococcal immunization. On 3/21/24 at 11:00 AM V2 said I don't know why R57 was missed for pneumonia. We have a clinic coming this month and he will be offered the pneumonia vaccine then. Policy: Influenza and Pneumococcal Immunizations revision 4/21/22 Pneumococcal Immunization: Before offering the pneumococcal immunization each resident or the resident's representative will be provided education regarding the benefits and potential side effects of the immunization. Each resident is offered a pneumococcal immunization per CDC (Center for Disease Control) recommendations (see CDC Pneumococcal Vaccine Timing for Adults reference table) unless the immunization is medically contraindicated, or the resident has already been immunized: A second pneumococcal vaccine will be offered only when necessary, according to CDC guidelines. The resident or the resident's representative has the opportunity to refuse immunization. The resident's medical record includes the documentation that indicates, at a minimum, the following: That the resident or resident's representative was provided education regarding the benefits and potential side effects of influenza immunization; and That the resident either received or did not receive the pneumococcal immunization due to medical contraindications or refusal. 145877 Page 6 of 6