F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview and record review, the facility failed to ensure a call light was within reach
for one of five residents (R1) reviewed for call lights on the sample list of seven.
Residents Affected - Few
Findings Include:
R1's ongoing and undated Medical Diagnosis Listing documents the following diagnoses: Quadriplegia,
Multiple Sclerosis, Anxiety Disorder, and Neuromuscular Dysfunction of the Bladder.
On 4/15/24 at 9:15 am, R1 was sitting up in a motorized wheelchair in R1's room and stated, R1 was
needing R1's incontinence brief changed but that R1 can't even call them to tell them because R1's call
light is hanging on the wall {behind the bed} and R1 can't reach it. At this time, R1's call light was secured
to the wall, behind the head of R1's bed, out of reach and next to R1's bed was an end table, which
prevented R1 from getting close enough to the wall to reach the call light.
On 4/15/24 at 9:35 am, V4 CNA (Certified Nursing Assistant) and V7 RN (Registered Nurse) were in R1's
room, changing R1. At this time, V4 and V7 confirmed R1's call light was secured on the wall, out of R1's
reach. V4 explained that V5 CNA had made R1's bed earlier that morning and must have forgot to place the
call light back on the bed, where it should be.
The facility's Call Lights: Answering Policy dated July 2023 documents when a resident is in bed or confined
to a chair, ensure that the call light is within easy reach of the resident.
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:
146010
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
146010
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/16/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Accolade Healthcare of Pontiac
300 West Lowell
Pontiac, IL 61764
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 0690
Level of Harm - Minimal harm
or potential for actual harm
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
Based on observation and record review, the facility failed to prevent possible cross contamination during
incontinence care for one of four residents (R1) reviewed for toileting on the sample list of seven.
Residents Affected - Few
Findings Include:
On 4/15/24 at 9:35 am, V4 CNA (Certified Nursing Assistant) and V7 RN (Registered Nurse) were changing
R1's incontinence brief. R1 had been incontinent of urine and stool and R1's brief was saturated. V4
donned gloves and provided incontinence cares using disposable wipes, then proceeded to grab a clean
incontinence brief and placed it under R1 without removing the potentially contaminated gloves or
performing hand hygiene. R1 then urinated again, onto the new incontinence brief. V4 changed gloves at
this time but did not perform hand hygiene. V4 provided incontinence care again and upon rolling R1 to
R1's side, it was noted that R1 had also had another small bowel movement. V4 continued to provide
incontinence care, cleaning the bowel movement, then obtained another clean brief from the bed side table
and placed it under R1 without changing gloves or performing hand hygiene.
The facility's Hand Washing Policy dated March 2024 documents hand hygiene is the primary means to
prevent the spread of infections. All staff will properly wash hands after direct contact with any
contaminated substances, after direct resident care, and as instructed. Employees must wash their hands
for 15 to 20 seconds using antimicrobial or non-antimicrobial soap and water under the following conditions:
after contact with blood, body fluids, secretions, mucous membranes, or non-intact skin, after removing
gloves and after handling items potentially contaminated with blood, body fluids, or secretions.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146010
If continuation sheet
Page 2 of 2
