Inspection·January 6, 2023

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to accurately label insulin with resident's name and date of opening for 6 (R3, R7, R11, R14, R16, R37) of 12 residents reviewed for medication labeling and storage in a sample of 26. Findings include: On [DATE] at 10:10AM, the medication cart serving rooms 100 through 308 was observed to have 1 Novolog Flexpen with no name or open date, 2 of R14's Humalog Kwikpens with no open date, 1 Levemir Flextouch with no name or open date, 1 Humalog Kwikpen with no name or open date, 1 of R11's Basaglar pens with no date, 1 Lantus vial with no name or date, and 1 of R14's Lantus vials with no open date. V4 (Registered Nurse/RN) said all the insulins should be labeled with the resident's name and date of opening. R7's face sheet documented an admission date of [DATE] and diagnoses including: hypertension, heart failure, major depressive disorder. R7's Physician Order Sheet (POS) documented an [DATE] order for Lantus 100 unit/ ml (milliliter) 25 units every morning. R11's face sheet documented an admission date of [DATE] and diagnoses including: hypertension, anxiety disorder, cerebral infarction, fatty liver. R11's POS documented a [DATE] order for Basaglar 100 unit/ ml 35 units at bedtime, an [DATE] order for Novolog 100 unit/ ml 8 units 3 times a day before meals, and a [DATE] order for Novolog 100 unit/ ml sliding scale three times a day. R14's face sheet documented an admission date of [DATE] and diagnoses including: anxiety disorder, type 2 diabetes mellitus, hypertension. R14's POS documented a [DATE] order for Lantus 100 unit/ ml 12 units twice a day, [DATE] order for Humalog 100 unit/ ml sliding scale twice a day. R37's face sheet documented an admission date of [DATE] and diagnoses including: anemia in chronic kidney disease, end stage renal failure, type 2 diabetes mellitus, hypertension. R37's POS documented a [DATE] order for Humalog 100 unit/ ml 3 units with meals three times daily, and a [DATE] order for Humalog 100 unit/ ml sliding scale twice a day. On [DATE] at 1:38PM, V2 (Director of Nursing/DON) said R7, R11, R14, and R37 were the only residents served from the 100 through 308 medication cart with orders for the types of undated insulins found. (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: 145890 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 145890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eldorado Rehab & Healthcare 1001 A Jefferson Street Eldorado, IL 62930 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)