Inspection·January 11, 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 interview, observation and record review, the facility failed to complete wound care as ordered and document wound descriptions/observations in 2 of 3 residents (R1, R2) reviewed for wound care in the sample of 3. Residents Affected - Few Findings include: 1. On 1/9/24 at 8:40 AM, R2 was observed in her room, up in the wheelchair. R2 had dressings in place to her bilateral lower extremities (BLE). The dressings were undated, both loose and the wounds were exposed. The dressings were soiled with yellow and bloody drainage. Areas to the BLE that were visible, were dry with scaly skin, red and swollen. R2 stated she has pain everywhere and her BLE itch. R2 stated she has seen a wound care doctor and wants to know what is causing the wounds. R2 stated they change her dressings every day but only once a day, regardless of if they are soiled or need changed. On 1/9/24 at 11:00 AM, R2's BLE were observed with V3, Assistant Director of Nurses, (ADON), and V6, Registered Nurse (RN), with the following noted: the old undated dressings were removed and had large amounts of yellow and red drainage on them. R2's BLE were red, inflamed, had several open bloody scratches and several fluid filled blister areas. R2's Face Sheet, undated, documents R2 has the following diagnoses: Lymphedema, Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes, Chronic Pain, Obesity, Hypertension (HTN), Peripheral Vascular Disease (PVD), Chronic Kidney Disease, Heart Failure, Hyperlipidemia and Hypothyroidism. R2's Minimum Data Set (MDS), dated [DATE], documents R2 is cognitively intact and has open lesions. R2's Care Plan, dated 9/27/23, documents R2 is at risk for skin impairment related to aging/disease process, decreased mobility, diabetes, diuretic therapy, edema, fragile skin, impaired mobility, incontinence, non-compliance with turning and repositioning, Lymphedema, non-compliance with showers and personal hygiene. R2 has interventions to keep skin clean and dry, complete preventative treatment as ordered and Lymphedema boots to BLE per therapy. R2's Physician Order Sheet (POS), documents the following order, dated 9/27/23, Triamcinolone Acetonide External Cream 0.1 %. Apply to BLE topically one time a day for preventative. R2's Treatment Administration Record (TAR), documents the following: the Triamcinolone was not administered 3 times in November 2023, 12 times in December 2023 and 1 time in January 2023. R2's Skin Reports, dated 12/14/23, 12/21/23, 12/28/23 and 1/4/24, fail to document a (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 3 Event ID: 145928 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 145928 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Jacksonville 1021 North Church Street Jacksonville, IL 62650 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)