Health inspection·May 18, 2023

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pain management for one of three residents (R34) reviewed for pain management in the sample of 27. This failure resulted in R34 experiencing severe pain and Physical Therapy shortening therapy with R34 on 5/15/23. Residents Affected - Few Findings include: The Facility Policy: Management of Pain dated 4/4/12, documents Our mission is to facilitate resident independence, promote resident comfort and preserve resident dignity. The purpose of this policy is to accomplish that mission through an effective pain management program, providing our residents the means to receive necessary comfort, exercise greater independence, and enhance dignity and life involvement. A standard format for assessing, monitoring, and documenting pain in both cognitively intact and cognitively impaired residents will be utilized. As part of a comprehensive approach to pain assessment and management, pain will be considered the fifth vital sign at the facility, along with temperature, pulse, respiration, and blood pressure. For the purpose of this policy, pain is defined as whatever the experiencing person says it is, existing whenever the experiencing person says it does. On 05/15/23 11:30 AM, R34 was sitting in her wheelchair with a frown on her face. (R34) stated (R34) was having severe pain in (R34's) side and is supposed to be getting Norco (Hydrocodone-Acetaminophen oral tab 5-325 milligrams/mg), but the facility does not have Norco. R34 also stated I know they have it (Norco) in a convenience box (C-Box), but they need authority to get in the box. I am hoping they will get it today but none so far. I have therapy every day, but I couldn't do it today because I hurt too bad. I was told it may be 8:00 PM before they get the medication. I took Tylenol earlier this morning, but it doesn't work as well as the Norco. On 5/15/23 at 11:35 AM, V3 (Licensed Practical Nurse) stated that V34's Norco was increased due to V34 having chronic pain. V34 ran out of the Norco last night (5/14/23). We asked V6 (R34's Primary Physician) to send an order to the pharmacy. Once the pharmacy gets the order, they will call us, and we can get the medication out of the Convenience Box. On 5/17/213 at 10:15 AM, V2 (Director of Nursing) stated that on 5/12/23 at 5:45 PM, R34's Norco order was changed from one tab to two tabs. The last Norco the facility had available for R34 was given to R34 on 5/15/23 at 12:15 AM. The facility policy is that the pharmacy must verify the order before we can pull it from the convenience box. There was Norco in the convenience box, but the facility was not allowed to take it from the C-Box without permission. The next time R34 got Norco was on 5/15/23 at 1:37 PM. V2 also stated We should have contacted (V6/R34's Primary Physician) sooner to get the medication here so (R34) would not have had pain. (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 5 Event ID: 145952 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 145952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beardstown Health & Rehab Ctr 8306 St Lukes Drive Beardstown, IL 62618 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)