Health inspection·July 10, 2025

F 0880 Provide and implement an infection prevention and control program. 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 ensure three residents (R1, R2, and R5) were properly placed on enhanced barrier precautions, staff were adequately informed of isolation procedures and failed to follow their infection precaution guideline procedure. This failure has the potential to affect all 14 residents currently residing on the South-2 Unit.Findings include:Per facility census dated 7/9/2025 shows 14 residents residing in the South-2 Unit.R1 is a [AGE] year-old female who originally admitted to the facility on [DATE] and continues to reside in the facility. R1 has multiple diagnoses including but not limited to the following: acute myelitis in demyelinating disease of central nervous system, dementia, altered mental status, multiple contractures, need for assistance with personal care, urinary tract infection, ESBL (Extended-Spectrum Beta-Lactamase), quadriplegia, COPD (Chronic obstructive pulmonary disease), and anxiety. It is to be noted that R1 has multiple wounds and a urinary catheter. R2 is a [AGE] year-old male who originally admitted to the facility on [DATE] and continues to reside in the facility. R2 has multiple diagnoses including but not limited to the following: ESRD (End-Stage Renal Disease) dependent on dialysis, type II DM (Diabetes Mellitus), lack of coordination, pneumonia, sepsis, muscle wasting, difficulty in walking, abnormal posture, and prostate cancer. It is to be noted that R2 has a dialysis port, a central venous catheter, and multiple wounds.R4 is a [AGE] year-old male who originally admitted to the facility on [DATE] and continues to reside in the facility. R4 has multiple diagnoses including but not limited to the following: CKD (Chronic Kidney Disease), CHF (Congestive Heart Failure), type II DM, and repeated falls. It is to be noted that R4 has a VRE (Vancomycin-Resistant Enterococci) infection in his wound.R5 is a [AGE] year-old male who originally admitted to the facility on and continues to reside in the facility. R5 has multiple diagnoses including but not limited to the following: quadriplegia, depression, MRSA (Methicillin-Resistant Staphylococcus aureus), UTI (Urinary Tract Infection), anxiety, seizures, cachexia, obstructive uropathy, and psychotic disorder.It is to be noted that R5 has a urinary catheter and an active pressure ulcer.Order Listing Report dated 7/8/2025 shows R5 on Enhanced Barrier Precautions due to suprapubic catheter and wounds. R4 is on Contact Isolation for VRE of the wound. It is to be noted that R1 or R2 are not on the Enhanced Barrier Precautions list.On 7/8/2025 at 11:20AM, observed R2 and R5's room to have no enhanced barrier sign on door or isolation bin outside of door. At 11:30AM, observed V7 (Certified Nursing Assistant) changing linens to R1's bed. V7 was wearing gloves, however no gown or mask was worn. At 11:45, V6 (Certified Nursing Assistant) was asked about enhanced barrier precautions and contact isolation. V6 was noted to be confused and unable to accurately describe the differences between isolations and the expectations of CNA's regarding infection control when dealing with residents on various types of isolations.At 11:55AM, V7 (Certified Nursing Assistant) was also asked about enhanced barrier precautions and contact isolation. V7 was also unable to accurately describe the differences between isolations and the expectations of CNA's regarding infection control Residents Affected - Some (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: 145877 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 145877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Dolton 14325 South Blackstone Dolton, IL 60419 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)