Health inspection·January 23, 2025

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 interview and record review the facility failed to provide doctor ordered wound care for 1 of 3 (R5) residents reviewed for wound care in a sample of 9. Residents Affected - Few Findings included: R5's admission Record documented an admission dated of 11/27/2024 with diagnoses in part of Type 1 Diabetes mellitus with diabetic kidney disease, end stage renal disease, muscle wasting and atrophy and acquired absences of left and right legs below the knee. R5's MDS (minimum data set) dated 12/26/2024 documented R5's BIMS (brief interview for mental status) score of 15 out of 15 total which indicates R5 is cognitively intact. The MDS documented R5 is dependent on staff for all toileting, bathing and dressing tasks and needs partial/moderate assistance with all personal hygiene tasks. On 1/21/2025 at 11:00pm, R5 said he has developed a wound on his penis and his doctor has ordered his wound treatment to be done twice per day since 1/8/25, but usually the nursing staff only performs his wound care one per day. R5 said he has spoken with the nursing staff about getting his treatment done twice per day, but it still doesn't get completed. R5 said his wound is getting better despite his treatment not being done twice per day. R5's POS (Physician's order sheet) dated 1/1/25 through 1/31/25 documents the following order: 1/8/25 Santyl ointment 30 grams, cleansed penis with wound cleanser, pat dry, apply Santyl BID (twice per day). R5's TAR (Treatment administration record) dated 1/8/25 through 1/31/25 documented R5 missed the following treatments: 1/12/25 (6p), 1/13/25 (6p), 1/14/25 (6a), 1/14/25 (6p), 1/18/25 (6p) and 1/19/25 (6p). No further documentation was noted on the TAR as to why R5's has missed these treatments. A review of R5's progress notes for January 2025 did not document R5 refusing care. On 1/21/2025 at 2:00pm, V6 (Licensed Practical Nurse/LPN) said R5 has not been getting his treatments twice per day. V6 said she did not know why he's not getting the treatments as ordered by his doctor. V6 said if R5 refused his treatment, the nurse is supposed to document the refusal on the back of the TAR. V6 said she has not seen R5 refused to get his wound care done. On 1/21/2025 at 10:45am, V5 (Certified Nursing Assistant) said R5 tells her he does not get his wound care provided twice per day because the nursing staff won't do it. On 1/23/2024 at 10:45am, V1 (Administrator/LPN) said R5 should have been receiving his wound care twice per day as ordered by his doctor and did not know why R5 has been missing his treatment. V1 said she suspects R5 has been refusing and the staff are not documenting the refusals correctly. V1 Page 1 of 2 145978 145978 01/23/2025 Axiom Healthcare of Harrisburg 1000 West Sloan Street Harrisburg, IL 62946

F 0684 said when residents refuse care staff should document the care refusal in the residents chart. V1 reviewed R5's chart and could not find any refusals of care documented for January 2025. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 145978 Page 2 of 2