Health inspection·December 12, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm Based on observation, interview and record review, the facility failed to obtain Physician Orders for a change of condition for 1 of 15 residents (R150) reviewed for quality of care in the sample of 41. This failure resulted in R150 being delayed treatment for mouth sores, nausea, and a sore throat. Residents Affected - Few Findings include: On 12/04/23 at 10:52 AM, R150 stated, They just put me on a new medicine, and it has been awful. I got canker sores all over my mouth. I couldn't figure out what was going on. On Friday (12/1/23) or Saturday (12/2/23) I told the nurses, and they looked in my mouth and said it was canker sores. Nothing from doctor yet but they are going to talk to him today. My throat is sore, and I have been very nauseous. It's a new medicine for arthritis. R150 is sitting in her room in her wheelchair. R150 appears to be in discomfort and is very pale. R150's Health Status Note, dated 12/3/2023 at 06:55 AM, documents, res (resident) noted to have canker sores to inner upper lip and inner bottom lip. c/o (complaint of) sore throat. nausea. vomiting. Vs (vital signs) - 186/76 (blood pressure) - 72 (pulse) - 98.2 (temperature) - 20 (respirations) - 95% RA (room air). Fax written and sent to MD (Medical Doctor). On 12/5/23 at 11:55 AM, V10, Nurse Practitioner, stated that she saw R150, and she does have stomatitis (condition that causes painful swelling and sores inside the mouth) in her mouth and that she has sores inside her mouth. V10 stated that today was the first time she had heard of it, and she has ordered her a mouth rinse for it. R150's Physician Order, dated 12/5/23, documents, Nystatin Mouth/Throat Suspension (Nystatin (Mouth-Throat)). Give 15 ml (milliliter)/hr (hour) by mouth after meals and at bedtime for oral stomatitis for 14 Days magic mouthwash with equal ratios of diphenhydramine12.5mg (milligram) elixir, Maalox susp (suspension). nystatin 100,00 unit/gram-swish 15ml for as long as tolerated, then spit out. On 12/11/23 at 2:30 PM, V1, Administrator, stated that there was a misplaced fax related to this, but she agreed the nurses should have followed up when they did not hear back from the doctor in a timely fashion. The policy Change in a Resident's Condition or Status, dated 2/2021, fails to document what to do if Physician fails to answer notice of change of condition. Page 1 of 11 146051 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to supervise to prevent injury while smoking and elopement for 2 of 17 residents (R46, R47) reviewed for supervision in the sample of 41. Finding include: 1. R46's admission Profile, dated 12/8/23, documents that R46 was admitted on [DATE] with a diagnosis of Dementia. R46's Minimum Data Set, (MDS), dated [DATE], documents that R46 is moderately cognitively impaired and independent with ambulation. R46's Elopement Assessment, dated 9/8/23, documents that R46 is a risk for elopement. R46's Health Status Note, dated 10/20/2023 at 3:36 PM, documents, resident was found walking on street near stop sign by property. resident was able to be redirected and brought back into facility by staff. (Resident monitoring device) bracelet replaced to ensure proper function. notified regional nurse of incident. On 12/7/23 at 1:20 PM, V1, Administrator, stated that R46 did not get to the stop sign on the side of the property. V1 said she made it to the one at the end of the drive. (There is no stop sign at the end of drive). V1 stated that she is not sure what happened or if the door alarm went off. V1 stated that there were people outside. V1 stated that she had the staff replace the (resident monitoring device) just in case it was faulty. On 12/7/23 at 1:25 PM, V1 stated that at that time there was not clear documentation that (resident monitoring device) were checked to see if they were working. The policy Wandering and Elopement policy, dated 3/2019, documents, The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. 2. R47's admission Profile, print date of 12/8/23, documents that R47 was admitted on [DATE] and has diagnoses of Bipolar Disorder, Major Depressive Disorder, Anxiety and Vascular Dementia. R47's MDS, dated [DATE], documents that R47 is cognitively intact and is independent with ambulation. R47's Care Plan, dated 7/10/23, documents, The resident is a smoker. Interventions: Resident is supervised while smoking. Smoking materials are kept secured by staff. Smoking per facility protocol. R47's Smoking Evaluation, dated 7/10/2023, documents that R47 is to be supervised while smoking. (There is no other Smoking Evaluation available for review). On 12/4/23 at 10:10 AM, R47 stated, I smoke 3 times a day. I take myself outside and smoke behind the building. I keep my cigarettes and lighter. 146051 Page 2 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0689 On 12/06/23 at 12:05 PM, V2, Registered Nurse, stated that R47 does go out to smoke by himself. Level of Harm - Minimal harm or potential for actual harm On 12/06/23 at 12:05 PM, V1, Administrator, stated that R47 needs be evaluated to see if he is safe to smoke by himself. Residents Affected - Few The Smoking Policy - Residents, dated 8/2022, documents, 8. A resident's ability to smoke safely is re-evaluated quarterly, upon a significant change (physical or cognitive) and as determined by the staff. it continues, 11. Any resident with smoking privileges requiring monitoring shall have the direct supervision of a staff member, family member, visitor or volunteer worker at all times while smoking. 146051 Page 3 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. 2. R101's Face Sheet dated 12/11/2023 documents in part that R101 has a diagnosis of Cerebral infarction with hemiplegia and hemiparesis affecting the dominant right side and aphasia following the cerebral infarction. R101's care plan dated 11/13/2023 documents R101 has an Activity of Daily Living (ADL) self-care performance deficit. R101's care plan documents that R101 is totally dependent on staff for toilet use. On 12/04/23 at 10:31AM, V15, R101's daughter, stated R101 was admitted to the facility from the hospital last Tuesday. V15 stated that R101 had a stroke. V15 stated R101 was not incontinent prior to her admission and R101 is wearing an adult diaper and is being told to go in the diaper. On 12/11/23 at 10:57 AM, V15 stated that she had spoken to the facility about her concern and was told the problem is the mechanical lift will not fit in the bathroom. On 12/11/23 at 11:04 AM, V2, Infection Preventionist/ Nurse Manager stated the expectation for a resident admitted to the facility who is incontinent of urine if the mechanical lift will not fit in the bathroom, a bedside commode should be offered instead of just having resident go in adult diaper. On 12/11/23 at 11:22 AM, V16, Certified Nursing Assistant (CNA) stated (R101) is a (full body mechanical lift) and all (full body mechanical lifts) use a bedpan because the (full body mechanical lift) won't fit in bathroom. When asked by surveyor if a bedside commode had been utilized, V16 stated she had not thought of using a bedside commode. The facility policy Activities of Daily Living (ADL), supporting dated, revised March 2018 documents residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out ADL. The policy documents residents will be provided care, treatment, and services to ensure their ADL's do not diminish. The facility policy Behavior programs and toileting plans for urinary incontinence dated, revised October 2010 documents to review the resident's care plan to assess for any special needs of the resident and to provide treatment and services to address factors that are potentially modifiable. For example, providing adaptive equipment for residents with mobility problems. Based on interview and record review, the facility failed to ensure that residents maintain current level of urinary continency and receive timely treatment for urinary tract infections (UTI) for 2 of 3 residents (R44, R101) reviewed for continency and urinary tract infections in the sample of 41. Findings include: 1. On 12/11/23 at 1:50 PM, V2, Infection Preventionist, stated that R44 did not receive an order for antibiotics to treat a urinary tract infection for 3 days. V2 stated that 3 days to receive an antibiotic is too long. V2, stated, The nurses should have followed up with (V10) for orders. R44's Health Status Note, dated 12/2/2023 10:15 AM, documents, UA (urinalysis) culture results available--e. coli (Escherichia coli), faxed to (V10's) office. 146051 Page 4 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R44's Physician Orders, dated December 2023, documents, Macrobid Oral Capsule 100 MG (Nitrofurantoin Monohyd Macro). Give 1 capsule by mouth two times a day for UTI (urinary tract infection) for 5 Days. Start Date of 12/5/2023 09:00 AM. On 12/11/23 at 3:00 PM, V6, Director of Nurses, stated that the nurses should continue to reach out to the Doctor for orders until they receive one. The policy Change in a Resident's Condition or Status, dated 2/2021, fails to document what to do if Physician fails to answer notice of change of condition. 146051 Page 5 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5. During Resident Council Meeting on 12/5/2023 at 10:24AM, R35, R24, R37 and R27 all stated the facility does not have enough staff to provide care. R35, R24, R37, and R27 all stated it takes too long for call lights to be answered due to lack of staff. R24's Minimum Data Set (MDS) dated [DATE] documents that R24 is cognitively intact. R24's Care plan dated 10/16/2019 documents R24 requires supervision and set up for bathing. R27's MDS dated [DATE] documents R27 is cognitively intact. R35's MDS dated [DATE] documents R35 has moderate cognitive impairment. The facility's Resident Council Minutes dated 11/28/2023 documents under old business kids are brought to work. New business documents not enough staff to serve meals. Call lights are taking too long 30 minutes. Resident council minutes dated August 2023 documents it takes a long time to get call lights answered because there is not enough staff. On 12/11/23 at 03:51 PM V6, Director of Nursing (DON) stated the facility has 2 nurses on days and 2 nurses on nights as the nurse's work 12-hour shifts. 4 CNAs on days 3 on nights with an additional CNA coming in from 6-10PM. V6 stated the facility has enough staff if they are being utilized right. V6 stated she would expect that call lights be answered in 15-20 minutes. V6 stated she expects call lights to be answered timely and residents to get their showers. The facility did not provide a staffing policy. The Facility's CMS 671, Long Facility Application For Medicare and Medicaid, dated 12/5/2023, documents facility census at 52. Based on observation, interview and record review the facility failed to provide sufficient staffing to meet the needs of the residents at the facility by providing care and assistance for Activities of Daily Living. This failure has the potential to affect all 52 residents at the facility. Findings include: 1. On 12/4/23 at 10:30 AM, R29 had a very shaky voice and tears coming down her face during an interview related to staff On 12/04/23 10:27 AM, R29 stated, Our girls are good. It might take them a bit, but they are good. Agency staffing is horrible. They just don't care about us. They are here for a paycheck. Last week I had my light on and he came in and asked what I needed. I told him I had to go to the bathroom. He told me that I had an (incontinent brief) on and to just go in my brief. It will take agency staff over 30 minutes to answer a light. They just make me feel worthless. R29 stated that she did tell the nurses and they told her that she is ok. R29 stated that they walk around and talk on their phones with those things they put in their ears instead of working. 146051 Page 6 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many R29's admission Profile, print date of 12/8/23, documents that R29 was admitted on [DATE] and has diagnoses Hemiplegia and hemiparesis following a stroke and Heart Failure. 2. On 12/04/23 at 09:48 AM, R45 stated, I don't think they have enough staff. They bring in agency and it takes them forever to get things done. I have waited for a half an hour for my call light. I get one shower a week and I don't think that is enough. I took a shower every other day at home, and they just don't have enough staff to do that here. 3. On 12/04/23 at 10:10 AM, R25 stated that he doesn't think there is enough staff. It takes about 30 minutes or more for them to come and answer the light. Over the weekend it took them an hour and a half to come and put me in my recliner from my wheelchair. I only get one shower a week and that is not enough my hair starts itching. I have talked to the Care Plan person in our meeting about this, but they don't have enough staff. R25's admission Profile, print date of 12/11/23, documents that R25 was admitted on [DATE] with diagnoses of Dementia and Type 2 Diabetes. R25's Care Plan, dated 10/2/20, documents, I enjoy participating in scheduled activities. Interventions: I prefer a shower 2 times per week at morning time of day. 4. On 12/04/23 at 9:36 AM, R42's call light was on. R42 stated that she has had her light on for awhile. R42 stated, You can't judge them on the one here today. It always takes her a long time. I want to get up and get out of bed. 146051 Page 7 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, the facility failed to ensure medications are under direct supervision of nurse for 2 of 24 residents (R24, R45) reviewed for medication storage in the sample of 41. Findings include: 1. On 12/04/23 at 09:43 AM, V3, Licensed Practical Nurse (LPN) took a full medication up into R45's room. At 09:45 AM, V3 was observed leaving the room. On 12/04/23 at 09:48 AM, R45's room was entered. R45's bedside table had a medication cup full of pills on it. On 12/04/23 at 09:48 AM, R45 was questioned what pills those in the cup were. R45 stated, Well I woke up late. So, she (V3) just got them to me. 2. On 12/4/23 at 10:25 AM, R24 was standing next to her dresser in her room, and she had two 1-ounce medication cups sitting on her bedside table. One of the medication cups contained one tablet that R24 identified as her Tums, and the other cup contained several tablets and capsules. R24 stated, That is my morning medication that (V4, LPN) gave me a little while ago. I will take it sometime before I go to lunch pretty soon. R24 stated she has a good roommate but stated she, (R17) is not in her right mind and can't remember what she did or said five minutes after it happens. R24's Minimum Data Set (MDS) dated [DATE] documents she is alert and oriented. R17 propelled herself out of the bathroom in her and R24's room and rolled past R24's bedside table that still had R24's medications unsecured in medication cups. R17 sat in her chair for a couple minutes listening to R24 talk. R24's medications were within easy reach for R17. R17's MDS dated [DATE] documents R17 is severely cognitively impaired. On 12/4/23 at 10:30 AM, V4, was standing by her medication cart in the hall a few doors down from R24's and R17's room. V4 stated, I thought (R24) was going to take her medications right away after I left them sit there for her. She already had breakfast which is what she usually waits for before taking her medications. I will go in right away and make sure she takes her medicine now. I know I am supposed to stay with the resident until they actually take their medications. I screwed up there. The facility's policy, Administering Medications, revised, April 2019, documents, Medications are administered in a safe and timely manner and as prescribed. Under Policy Interpretation and Implementation the policy documents: #4. Medications are administered in accordance with prescriber orders, including any required time frame. #20. For residents not in their rooms or otherwise unavailable to receive medication on the pass, the MAR (Medication Administration Record) may be flagged. After completing the medication pass, the nurse will return to the missed resident to administer the medications. 146051 Page 8 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to securely seal, date and label refrigerated and frozen food. This failure has the ability to affect all 52 residents residing in the facility. Residents Affected - Many Finding include: On 12/4/23 at 8:40 AM, the kitchen was entered. 1. The freezer had a pan covered in aluminum foil. The foil had holes in it, it was not labeled or dated as to what food and when the food was prepared. 2. The refrigerator had a pan of left-over roast beef that was dated 11/19/23, unknown if made date or expiration date. 3. The refrigerator had a large stainless pan that was covered with aluminum foil that was not labeled of what it was, when made or when it expires. On 12/4/23 at 9:00 AM, V11, Dietary Manager, stated that all foods should be labeled with expiration date, the date prepared, name of the food and all foods should be sealed tightly. At the time of exit the facility was unable to provide a facility policy on how to store refrigerated or frozen food items. The Long-Term Care Facility Application for Medicare and Medicaid dated 12/5/23, documents that 52 residents reside in the facility. 146051 Page 9 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview, observation and record review, the facility failed to have a system in place to assess for efficacy of antibiotic use. This failure has the potential to affect all 52 residents living in the facility. Residents Affected - Many Findings include: 1.On 12/11/23 at 2:00 PM, V2, Infection Preventionist, stated that she does not have enough time to devote to the infection control program as she once did so there are pieces missing in her infection control tracking. V2 stated, I really don't understand all of the infection control stuff. I used to have an infection control program on the computer that would generate all my tracking and infections but apparently it is not here anymore. On 12/11/23 at 3:10 PM, V6, Director of Nurses, was questioned if the facility has updated infection control and antibiotic stewardship policies, V6 stated, I just pulled off the policies from Medpass. 2. On 12/11/23 at 1:35 PM, V2 stated that if the nurse enters the antibiotic correctly when it is ordered the computer system will automatically generate a McGreer's report for a suspected urinary tract infection. V2 was questioned if R23 had a McGreer's report available for review. V2 stated that R23 did not. V2 stated V10, Nurse Practitioner, started R23 on Keflex (an antibiotic) before the urine culture report was available for review and then the antibiotic was changed to Fosfomycin. R23's Health Status Note, dated 12/3/2023 2:27 PM, documents, N.O. (new order) received on 11/28/23 from (V10) 1. Notify office if bleeding continues 2. Collect Straight cath (catheter) UA (urinalysis) - send to(Lab) Dx (diagnosis): Hematuria, suprapubic tenderness. 3. Follow-up 1 week. R23's Health Status Note, dated 12/7/2023 11:33 AM , documents, Progress note from (V10). Stop Keflex. urine culture grew e coli ESBL (Escherichia coli extended spectrum beta-lactamase), contact isolation. treat with Fosfomycin 3 G packet (mixed with 4 oz (ounce) cold water) x1 dose. repeat urine culture (only) 7 days after receiving Fosfomycin. R23's Medication Administration Record (MAR), dated December 2023, documents that R23 received 1 dose of Fosfomycin on 12/7/23 and 5 doses of Keflex from 12/5/23 until 12/6/23. The facility is unable to provide the urine culture at this time. 3. On 12/11/23 at 1:40 PM, V2 stated that R6 does not have a McGreer's report for a suspected upper respiratory infection and that R6 did not receive a chest Xray. V2 stated, (R6) started with upper respiratory symptoms and was put on an Azithromycin. R6's MAR, dated November 2023, documents R6 received Azithromycin from 11/18/23 until 11/22/23. 4. On 12/11/23 at 1:50 PM, V2 stated that R44 did not have a McGreer's report completed for a suspected urinary tract infection and that 3 days to receive an antibiotic is too long. V2, stated, The nurses should have followed up with (V10) for orders. R44's Health Status Note, dated 12/2/2023 10:15 AM, documents, UA culture results available--e. 146051 Page 10 of 11 146051 12/12/2023 Barry Healthcare & Sr Living 1313 Pratt Street Barry, IL 62312

F 0881 coli, faxed to (V10's) office. Level of Harm - Minimal harm or potential for actual harm R44's Physician Orders, dated December 2023, documents, Macrobid Oral Capsule 100 MG (Nitrofurantoin Monohyd Macro). Give 1 capsule by mouth two times a day for uti for 5 Days. Start Date of 12/5/2023 09:00 AM. Residents Affected - Many The facility is unable to provide the urine culture at this time. The policy Surveillance for Infections, dated 9/2017, documents, The infection preventionist will conduct ongoing surveillance for healthcare - associated infections and other epidemiologically significant infections that have substantial impact on potential resident outcome and that may require transmission - based precautions and other preventative interventions. The Antibiotic Stewardship Order for Antibiotics, dated 12/2016, documents, Antibiotics will be prescribed and administered to residents under the guidance of the facility's antibiotic stewardship program and in conjunction with the facility's general policy for medication utilization and prescribing. This policy fails to document what clinical criteria are met for a clinical definition of an active infection or suspected sepsis.' The Antibiotic Stewardship - Orders for Antibiotics, dated 12/2016, documents, Antibiotic usage and outcome date will be collected and documented using a facility approved antibiotic surveillance tracking form. This data will be used to guide decisions for improvement of individual resident antibiotic prescribing practices and facility wide antibiotic stewardship. The Long - Term Care Facility Application for Medicare and Medicaid, dated 12/5/23, documents that 52 residents reside in the facility. 146051 Page 11 of 11