Inspection·July 23, 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 Based on observation, interview, and record review the facility failed to provide the necessary care and treatment to residents with nonpressure wounds for 2 of 3 residents (R2, R3) reviewed for nonpressure wounds in the sample of 4. Residents Affected - Few The findings include: 1. R2's admission skin and nursing assessments dated 7/14/24 showed R2 was admitted to the facility, from a local hospital, with diagnoses of infectious wounds to her right and left buttock related to a diagnosis of necrotizing fascitis (flesh eating bacterial infection) to both areas. Clusters of wounds were also noted to R2's right and left posterior lower legs. These assessments showed R2 was cognitively intact. R2's wound care notes dated 7/21/24 showed R2's wounds as the following: 1. A left buttock infectious wound measuring 6.5 cm (centimeters) x 16 cm x 0.3 cm. 2. A right buttock infectious wound measuring 10 cm x 28 cm x unknown. 3. A cluster of vascular wounds to R2's left lower leg measuring 15 cm x 17 cm x 0.3 cm. 4. A cluster of venous wounds to R2's right lower leg measuring 22 cm x 20 cm x 0.3 cm. R2's left and right buttock physician treatment orders dated 7/17/24 showed, Cleanse with 1/2 Dakins (wound cleanser), pat dry, pack wound with moist Kerlix (gauze dressing) every day. R2's left and right lower leg physician treatment orders dated 7/14/24 showed, Cleanse with 1/2 Dakins, pat dry, apply Neosporin (antibacterial ointment), Xeroform (petroleum gauze dressing), and wrap wound with gauze, secure with tape, every day. On 7/23/24 at 8:49 AM, R2 was in bed, lying flat on her stomach. A large, linear, open, weeping wound was noted to R2's right buttock. No dressing was noted to the wound. A large amount of serous drainage was noted to the bed sheet lying on top of R2's right buttock wound. A smaller linear wound was noted to R2's left buttock. No drainage was noted from the wound. No dressing was noted to the wound. Gauze dressings, dated 7/21/24, were noted around both of R2's ankles, leaving the wounds to R2's posterior right and left lower legs exposed. Large reddened, clusters of open wounds were noted to both of R2's posterior lower legs. When R2 was asked when her wound dressing were last changed, R2 stated, A couple of days ago. (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: 145936 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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)