Inspection·January 30, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to reorder scheduled medication to ensure availability for a resident and failed to pass medication timely, per physician orders. These failures applied to two (R1, R2) of three residents reviewed for medication administration. Findings include: R2 is a [AGE] year old female who originally admitted to the facility on [DATE] and continues to reside in the facility. R2 has multiple diagnoses including but not limited to the following: type II DM, HTN, depression, and anxiety. Per R2's physician orders, R2 receives Insulin Lantus Subcutaneous Solution (100 unit/ml) 37 units two times a day scheduled at 8:00AM and 8:00PM. R2 also receives Insulin Lispro Solution (0.5 unit dial) of 17 units three times a day scheduled at 8:00AM, 12:00PM, and 5:00PM. On 1/29/2025 at 10:33AM, V3 (Licensed Practical Nurse) was observed administering medications. V3 said it is 10:33AM and I am still passing my 9:00AM medication. V3 said there are times when we struggle to pass medication in the allotted time which is one hour before and after the scheduled medication time. At 10:45AM, R2 had said there are times where I do not receive my medication till way after the scheduled time. R2 said I receive rapid and long-acting insulin and they are scheduled a certain way to ensure that my blood sugars remain controlled. On 1/18/25, 1/19/25, and 1/23/25, my diabetic medication was given extremely late. I am also concerned about my psych medication when my medication is given late. I can feel myself having increase agitation and becoming irritable when I do not take it timely. Facility Medication Admin Audit Report shows on 1/18/25, R2's Insulin Lispro was scheduled for 5PM and given at 6:41PM and Insulin Lantus was scheduled for 8:00PM and given at 9:45PM. On 1/23/24, R2's Insulin Lispro and Lantus were scheduled for 8:00AM and given at 9:16AM. R2's Insulin Lispro was also scheduled on 1/23/25 for 5:00PM and was given at 8:53PM. At 11:05AM, V4 (Registered Nurse) said it is protocol that we have an hour before and an hour after medication time to adequately pass medications. V4 said I currently have 29 residents and this is very difficult to do. We also use agency nursing staff and there is not way that they are passing medications in the allotted time. (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 3 Event ID: 145994 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 145994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inverness Rehab 1800 W Colonial Parkway Inverness, IL 60067 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)