Health inspection·April 23, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on interview and record review, facility staff failed to operate the facility van, with a resident aboard, in a safe manner to prevent an accident, for one of seven residents (R1), reviewed for accidents. Residents Affected - Few FINDINGS INCLUDE: The facility policy, Transportation, dated 8/2019 directs staff, Employees are required to use (facility) vehicles when transporting residents, running errands for the (facility) or attending workshops outside of the (facility). Any accident involving (facility) property or vehicles shall be reported immediately to the employee's supervisor. Employees are also required to notify law enforcement when appropriate. All traffic violations, citations and fines incurred when driving for work purposes are the sole responsibility of the authorized driver. The (facility) reserves the right to review both the drivers' license and motor vehicle record (MVR) of all authorized drivers, at any time. R1's Nursing Progress Notes, dated 4/2/24 at 2:06 P.M. document, (Hospital Social Worker) SW called and updated (facility staff) that (R1) will return today. (Hospital Social Worker) said (R1's) last IV (Intravenous Antibiotic) will be done at 3:00 PM. R1's Nursing Progress Notes, dated 4/2/24 at 3:45 P.M. document, Informed Power of Attorney (POA) of auto accident (R1) was in during transport back to our facility. (R1) states she is ok. This writer instructed our driver to have (R1) transported to ER (Emergency Room) for evaluation and treat (treatment). Physician notified. The Police Report dated 4/2/24 and signed by V6/Police Officer documents, 4/2/24 at 3:28 P.M., (V3/Certified Nursing Assistant) was driving the facility van to pick (R1) up from the hospital. (R1) was securely tethered in a wheelchair, in the van. (V3) was traveling east bound, went through the intersection, failing to yield to oncoming traffic. The second vehicle struck (V3's) (facility) van on the front, right passenger side. The second vehicle had an airbag deployment. After the first collision, (V3) struck a third vehicle, that was stopped at the stop sign. All three vehicles were towed (from the scene) due to damage. (V3) and (R1) were taken to the local emergency room (ER) and evaluated. No injuries were noted. V3 was issued a traffic citation for failure to yield, at an intersection. On 4/22/24 at 9:30 A.M., V1/Administrator stated, (V3/Certified Nursing Assistant/Transport Driver) had driven the facility van on 4/2/24 to pick (R1) up from the hospital, after a stay for an acute illness. (V3/Certified Nursing Assistant/Transport Driver) has been employed at the facility as a CNA (Certified Nursing Assistant) for the past couple of years and is also trained in transportation Page 1 of 2 145949 145949 04/23/2024 Hillcrest Home 14688 Illinois Highway 82 Geneseo, IL 61254

F 0689 Level of Harm - Minimal harm or potential for actual harm and driving the facility van. On this day, (V3) stated he stopped at a stop sign, looked both ways and proceeded through the intersection when (V3) collided with another vehicle. (V3) was given a ticket for failure to yield (at an intersection). Immediately after the accident, (V3) and (R1) went to the hospital for an evaluation with no injuries noted. Per company policy, (V3) was urine tested for drugs and alcohol, which was negative. (V3) was very upset about the incident and the potential for resident injury. Residents Affected - Few On 4/22/24 at 12:47 P.M., V7/Witness to accident confirmed the incident occurred when V3/Certified Nursing Assistant failed to yield at a stop and hit two other vehicles. On 4/22/24 at 2:54 P.M., V3/Certified Nursing Assistant/Transport Driver stated, I have been an employee of the facility for the past 12 years. I started driving about six or seven years ago. I took a class (Transportation) before I started driving. I rarely drive any more. I had never driven the (Transit) and I was not trained on how to do it. I was coming into work on that day (4/2/24) for second shift. It was windy and cold out and it was snowing. As I came in, (V4/Transportation Director) yelled at me and told me I was to go pick (R1) up at the hospital. The CNA (Certified Nursing Assistant) I was to relieve, had to stay over while I was gone, to cover for me. I can honestly say I wasn't happy about the situation. I hadn't been trained on that van and no one told me what to do. My (Mother-in-Law) (V8/Registered Nurse) came outside and showed me how to operate the lift and this van. (V8/Registered Nurse) also told me take clothing for (R1), blankets to cover her and (R1's) wheelchair. When I got to the hospital, I pulled in the ER (Emergency Room) lot, thinking (R1) would be there and ready to go. (R1) wasn't, so I had to park the van, lower the lift (took me 10 minutes to figure it out) and go upstairs to the second floor to get (R1). When I got there, (R1) was still in bed and not dressed. After they finally got (R1) dressed, I took (R1) out to the van and had to mess around with the lift for another 10 minutes to get it to engage. I was worried about (R1) because it was so cold outside, and I wanted to get back to the building so my co-worker could go home. I was about 5 blocks from the hospital and this weird intersection. I had a stop sign. There is a boulevard, so after I stopped, I had to get across two lanes of traffic. I did not even see the girl in the first car that I hit. Then the van hit another car that was stopped at a stop sign opposite of where I had stopped. I was very shaken up. I asked (R1) if she was okay and she said yes, but she was upset. (V5/Maintenance Director)) is also a volunteer on the city ambulance and fire department and he arrived on the scene. We put (R1) in an ambulance to go to the ER to get checked out and (V5) drove me to the hospital to be checked out. We were both okay, but I am still seeing a chiropractor for my right hip and back. The first car I hit; the impact was on the right front side. I know I don't want to ever drive again to transport residents. I'm still pretty shook up. On 4/23/24 at 8:26 A.M., V6/Police Officer stated, I was the responding officer to the scene of the accident. (V3) was very shook up. That intersection has been the scene of many accidents. You must drive through two lanes of traffic. The posted route from the hospital avoids that intersection. (V3) was issued a citation for failure to yield at an intersection, causing an accident, as (V3) caused the accident. All three vehicles had to be towed from the scene. 145949 Page 2 of 2