Health inspection·April 20, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide assistance with bathing, grooming, and hygiene to dependent residents for 6 of 7 residents (R2, R3, R4, R5, R6, R8) observed for activities of daily living (ADLs) in the sample of 7. Residents Affected - Some Findings include: 1. R2's Electronic Medical Record, documents R2's diagnoses as Gastrointestinal (GI) Hemorrhage, Urinary Tract Infection (UTI), Dysphagia, Anemia, Cognitive communication deficit, COVID-19, Malignant neoplasm of upper lobe lung, Chronic Obstructive Pulmonary Disease (COPD), Hypertension (HTN), left femur fracture. R2's Care Plan, dated 8/10/22, documents (R2) has a self-care deficit. Interventions: Assist with ambulation, transfers, and locomotion as needed, assist with dressing/undressing, assist with oral/dental hygiene, encourage resident to perform self-care if able. It continues (R2) has Excoriation. Interventions: Provide prompt attention to incontinent episodes, assess wound healing weekly, full skin evaluation with bath/shower, assess skin daily with routine care, perform skin care with attention to keeping skin folds clean and dry. R2's Minimum Data Set (MDS), dated [DATE], documents that R2 is cognitively intact and requires total dependence on one staff member for bathing, total dependence of two staff members for toileting, limited assistance from one staff member for personal hygiene, extensive assistance from one staff member for dressing. R2's MDS documents R2 is frequently incontinent of urine and always continent of bowel. On 4/18/23 at 2:05 PM, R2 was sitting in wheelchair and hair messy. On 4/18/23 at 2:10 PM, R2 stated I only get one shower a week. They have too many residents and not enough helpers. I would prefer to have two a week because it's relaxing. No one helps me with oral care on me. I only have four teeth left and no one ever offers to brush those teeth or even rinse my mouth out. I will sometimes use a washcloth to wipe out my mouth. On 4/19/23 at 8:40 AM, R2 stated I did not get cleaned up since Tuesday (4/18/23). I sometimes just ask for a washcloth to at least wash my face because I have to wait a week to get a shower. R2's Electronic Medical Record, Resident Care Tasks, documents that R2 is scheduled for a bath on Tuesdays and Fridays. (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 6 Event ID: 146052 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 146052 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alhambra Rehab & Healthcare 417 East Main Street, Box 310 Alhambra, IL 62001 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)