F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to implement appropriate infection control measures for
residents with signs and symptoms of a potentially communicable skin condition. The facility failed to
initiate/implement contact isolation precautions, failed to obtain a diagnosis and track the infection, and
failed to clarify physician orders through the infection preventionist for two (R2, R3) of six residents
reviewed for communicable diseases in a total sample of six residents. Findings include:The facility's
General Approaches to Infection Prevention and Control Standard and Transmission Based Precautions for
Communicable Diseases dated October 17th, 2022 documents contact precautions used in addition to
standard precautions are intended to prevent transmission of pathogens that are spread by direct person to
person or indirect contact with the resident or environment examples (C. diff, norovirus, and scabies) and
require the use of appropriate personal protective equipment (PPE) including gown and gloves before or
upon entering the room before making contact with the resident or residents environment the room or
cubicle period prior to leaving the residents room or cubicle the PPE is removed and hand hygiene is
performed. Contact precautions should also be used in situations when a resident is experiencing wound
drainage, fecal incontinence or diarrhea, or other discharges from the body that cannot be contained and
suggest an increased potential for excessive extensive environmental contamination and risk of
transmission of a pathogen. Even before a specific Organism has been identified.1.) R2's medication
administration record documents a new order dated 6/10/25 for Permethrin External Cream 5% (used to
treat certain conditions caused by tiny insects, such as scabies and head lice) to be applied to R2's entire
body except the face on night shift for one day, leave on for 8 hours then wash off for a rash.R2's Physician
Notes dated 6/10/25 documents rash becoming an issue, roommate with same issue, Permethrin cream
ordered.R2's record does not document that contact isolation precautions were implemented during
treatment, despite the use of a topical antiparasitic medication typically used for contagious skin
infestations.2.) R3's skin assessment dated [DATE] documented multiple scabs and scratches all over the
body, including bilateral lower extremities, abdominal area, trunk, and neck. The treatment in place at that
time was the use of cocoa butter, per V5 (Physician) order.R3's Physician Order dated 6/10/25, documents
Permethrin 5% cream, to be applied to the body (except face) and washed off after 8 hours. However, the
medical record does not indicate that contact isolation precautions were implemented during this treatment.
R3's Nurse Progress Note dated 6/17/25 documents R3's bilateral upper extremities (BUE) were reddened
and weeping fluid from scratched areas and there was increased scratching since Permethrin treatment on
6/11/25. Although the V5 (Physician) was notified, no new infection control measures or follow-up
assessment was documented. R3's Nurse Progress Note dated 6/19/25 documents that another
Permethrin treatment was applied the night before and washed off the following morning. The note further
documents observed the BUE to be scaly, bleeding, and weeping serous fluid. The symptoms were noted
to have worsened over the past 48 hours, and V5 was
Residents Affected - Few
(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:
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
08/05/2025
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
notified again. However, the record contains no documentation of additional precautions or medical
reevaluation, and no infection prevention documentation or review.On 8/5/25 at 12:30 PM, V2 (Director of
Nursing) stated she was unable to locate any documentation from the former Infection Preventionist (IP)
indicating that infection tracking was completed, or that follow-up with the physician occurred to clarify the
diagnosis or orders for R2 or R3. V2 stated she does not have any record that R2 and R3 were placed on
Contact Isolation Precautions. On 8/5/25 at 10:50 AM, V3 (Licensed Practical Nurse) stated she spoke with
V5 (R2 and R3's Physician) who ordered treatment for R3's rash, and although the physician did not
explicitly state it was for scabies, V5 treated the condition as such. V3 confirmed that R2 and R3's room
was not placed on contact isolation during the treatment. V3 further stated the nurses were concerned
when V5 ordered this treatment because it's normally ordered for treatment of scabies.On 8/5/25 at 2:00
PM, V1 (Administrator) stated the facility currently does not have an Infection Preventionist as of last week.
Event ID:
Facility ID:
145952
If continuation sheet
Page 2 of 2