Health inspection·September 20, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to test all staff that were in close contact with a COVID-19 positive resident and failed to post isolation signage immediately on an isolation room after the resident testing positive for COVID-19. This failure has the potential to affect all 68 residents residing in the facility. Residents Affected - Many Findings include: The facility's SARS-CoV-2 (COVID-19) Policy and Procedure: Testing Plan and Response policy with a revised date of 5/25/23 documents, It is the policy of this facility to minimize exposure to respiratory pathogens, promptly identify residents or healthcare personnel with signs or symptoms of COVID-19 and implement interventions based upon Federal and State/Local recommendations (to include admissions, visitation, standard and transmission-based precautions, hand hygiene, universal source control, PPE (Personal Protective Equipment) use, resident placement, etc. {etcetera}) to prevent and/or mitigate the spread of COVID-19. PROCEDURE: Asymptomatic residents and HCP (Healthcare Personnel) with a close contact or higher-risk exposure with someone with SARS-CoV-2 infection are recommend(ed) to have a series of three viral tests for SARS-CoV-2 infections unless they have recovered from COVID-19 in the prior 30 days. Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. On 9/20/23 at 8:46 AM, V1 Administrator stated here are five residents that tested positive for COVID-19 and are currently in isolation. On 9/20/23 at 9:01 AM, there were five resident rooms with Contact, Droplet and Enhanced Barrier precautions signs posted outside the rooms. On 9/20/23 at 10:45 AM, V3 Infection Preventionist stated the outbreak started on a Sunday with one resident having congestion symptoms. The nurse completed a COVID-19 test that came back positive. V3 stated the nurse (V4 Licensed Practical Nurse) tested the roommate and the roommate was negative. V3 stated they started isolation the next day when management arrived at the facility. On 9/20/23 at 11:00 AM, V2 Director of Nursing stated the facility started isolation on Sunday. V2 stated that the nurse hung isolation supplies on the door but did not post isolation signage outside of the room until the next day because housekeeping is responsible and they had already left for the day. On 9/20/23 at 11:14 AM, V4 Licensed Practical Nurse stated the resident started to have a cough and lethargy so V4 performed a COVID-19 test. V4 stated V4 completed a second test on the resident after the first one was positive just to be sure. V4 stated V4 then contacted V1 and V2. V4 stated that V4 hung isolation supplies on the resident's door but did not hang isolation signs until the next (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: 146030 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 146030 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heartland Senior Living 101 Trowbridge Road Neoga, IL 62447 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)