Health inspection·September 8, 2023

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent or determine how an injury of unknown origin occurred. This affected one of three residents (R6) reviewed injury of unknown origin. This failure resulted in R6 sustaining an injury to the right knee receiving seven sutures at the local hospital. Findings Include: R6 is a [AGE] year old with the following diagnosis: chronic venous hypertension with ulcer of the left lower extremity, venous, insufficiency, chronic obstructive pulmonary disease, congestive heart failure, and Alzheimer's disease. R6's Care Plan, dated 8/23/23, documents R6 has a potential for impairment of skin integrity related to fragile skin, impaired mobility, and incontinence. The Change of Condition Evaluation, dated 8/27/23, documents R6 had a change in condition of a skin wound and this occurred in the afternoon. R6 had no changes in mental status observed. There were no other changes of condition documented besides a skin tear to the right knee. The Hospital Records, dated 8/27/23, documents R6 was sent to the hospital when staff noted a linear laceration to the right knee. R6 does not have any pain and does not recall how this occurred. Staff denied any falls or witnesses to the injury. R6 was alert and oriented times two. The laceration to the right knee was 2.5 cm horizontally. R6 received seven sutures to the right knee during a laceration repair. On 9/6/23 at 5:35PM, V9 (Wound Nurse Practitioner) stated the older a resident becomes the more fragile skin becomes. V9 endorsed if a resident has a disease related to lack of circulation then wounds can develop easier than residents who don't have circulation issues. V1 stated the facility should be monitoring residents as best as they can to prevent any wounds. On 9/7/23 at 1:48PM, V2 (Director of Nursing/DON) stated when V14 (CNA) got R6 in bed, a skin tear was found to R6's right knee. V2 endorsed R6 was not able to say what happened. V2 reported assuming R6 bumped R6's leg, but was not able to confidentially say how the wound occurred. V1 stated the skin tear was about one to two inches long. V2 reported R6 was sent the hospital because of the skin tear and increased confusion. Per the documentation, R6 did not have any changes in mental status. V2 stated seeing a blood stain on R6's pants once R6 was in bed but was not able to see the blood stain before due to R6 having dark pants. Page 1 of 3 145913 145913 09/08/2023 Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459

F 0600 Level of Harm - Actual harm On 9/7/23 at 2:29PM, V14 stated V14 put R6 in the bed and started to undress R6. V14 endorsed when V14 pulled on R6's pants, a cut was found to the top of the right knee. V14 stated when V14 asked R6 what happened, R6 couldn't say. V14 denied any falls and denied R6 hitting any part of R6's body when getting into bed. Residents Affected - Few On 9/8/23 at 12:42PM, V1 (Administrator) stated R6 was sent to the hospital after obtaining a new skin tear in the facility. When asked what an injury of unknown origin is, V1 replied, It's an injury that can't be explained how it happened by the resident or staff. V1 denied R6 being able to explain how the skin tear happened. The policy titled, Abuse, Neglect and Misappropriation of Resident Property, that has no date documents, .Purpose: This policy's purpose is to ensure that resident rights are protected by providing a method for investigation and reporting of allegations of mistreatment, neglect, abuse, including injuries of unknown source, unusual occurrences and misappropriation of resident property .Policy Interpretation and Implementation: . 8. The facility will ensure that all allegations of mistreatment, neglect or abuse, including injuries of unknown source, are reported immediately to the Administrator of the facility. The Administrator and/or other officials shall notify ISDH in accordance with ISDH Guidelines. 145913 Page 2 of 3 145913 09/08/2023 Aperion Care Burbank 5701 West 79th Street Burbank, IL 60459

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their abuse policy by not reporting an injury of unknown origin to the regulatory agency. This affected one of three (R6) residents reviewed for abuse policy reporting. Findings Include: R6 is a [AGE] year old with the following diagnosis: chronic venous hypertension with ulcer of the left lower extremity, venous, insufficiency, chronic obstructive pulmonary disease, congestive heart failure, and Alzheimer's disease. The Change of Condition Evaluation, dated 8/27/23, documents R6 had a change in condition of a skin wound and this occurred in the afternoon. There were no other changes of condition documented besides a skin tear to the right knee. The Hospital Records, dated 8/27/23, documents R6 was sent to the hospital when staff noted a linear laceration to the right knee. R6 does not have any pain and does not recall how this occurred. Staff denied any falls or witnesses to the injury. The laceration to the right knee was 2.5 cm horizontally. R6 received seven sutures to the right knee during a laceration repair. On 9/7/23 at 1:48PM, V2 (Director of Nursing/DON) stated when V14 (CNA) got R6 in bed, a skin tear was found to R6's right knee. V2 endorsed R6 was not able to say what happened. V2 reported R6 was sent the hospital because of the skin tear. V2 stated, I reported it to the doctor and the Administrator. It didn't need to be reported to IDPH (Illinois Department of Public Health) because it wasn't a fall. On 9/8/23 at 12:42PM, V1 (Administrator) stated R6 was sent to the hospital after obtaining a new skin tear in the facility. When asked what an injury of unknown origin is, V1 replied, It's an injury that can't be explained how it happened by the resident or staff. V1 endorsed a risk management investigation is completed within the facility, but is not sent to IDPH. V1 stated, We didn't need to send an incident report to IDPH because it was a skin tear. Skin tears do not need to be reported. You might not know how a skin tear happened so it doesn't need to be reported. V1 denied R6 being able to explain how the skin tear happened. There is no documentation the facility notified the IDPH Regional Office of the injury of unknown origin for R6. The policy titled, Abuse, Neglect and Misappropriation of Resident Property, that has no date documents, .Purpose: This policy's purpose is to ensure that resident rights are protected by providing a method for investigation and reporting of allegations of mistreatment, neglect, abuse, including injuries of unknown source, unusual occurrences and misappropriation of resident property .Policy Interpretation and Implementation: . 8. The facility will ensure that all allegations of mistreatment, neglect or abuse, including injuries of unknown source, are reported immediately to the Administrator of the facility. The Administrator and/or other officials shall notify ISDH in accordance with ISDH Guidelines. 145913 Page 3 of 3