Inspection·March 31, 2023

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. Based on observation, interview, and record review, the facility failed to provide catheter care to prevent potential urinary tract infection (UTI) by having the catheter bag touching the floor, not maintaining the catheter bag below bladder level, and not maintaining a closed system of the indwelling catheter. This applies to 1 of 2 residents (R18) reviewed for indwelling catheter care in a sample of 14. Findings include: On 03/28/23 at 10:36 AM, R18 was sitting in his bedroom chair with an indwelling catheter bag touching the floor and the tubing was noted with cloudy urine and sediment. On 3/28/23 at 10:40 AM, R18 stated that his catheter was leaking. On 3/28/23 at 10:57 AM, V3 (Registered Nurse/RN) stated, R18's incontinent brief is wet with urine, and the catheter is leaking. It was leaking yesterday, but the night nurse reported to me that there was no leak. I called the physician (MD) to relay R18's urine sensitivity result that came out on 3/27/23 at 4:00 AM. We tried to reach him, but MD never answered our call. Finally, I could reach him today (3/28/23) after 8:00 AM. On 3/28/23 at 1:44 PM, V2 (Director of Nursing/DON) stated, They should notify MD as soon as possible (ASAP) when they found out the indwelling catheter was leaking. They should have called the medical director if the attending was not answering. I will educate them on that issue. The urine sensitivity final result should have been relayed to the physician ASAP to start antibiotics to manage the UTI. Indwelling catheter bags shouldn't be on the floor. On 3/28/23 at 11:02 AM, V3 stated that MD ordered Cipro 500 milligrams (mg) twice daily x 7 days for UTI. On 3/28/23 at 10:50 AM, V5 (Certified Nursing Assistant) placed R18's urinary catheter bag on the bed while V3 tried changing the catheter tubing. On 3/30/23 at 11:00 AM, V2 (DON) stated, The indwelling catheter bag should be maintained below bladder level to prevent backflow. The facility presented a urinary catheter care policy (last approved on 01/2022) document: The urinary drainage bag must always be held or positioned lower than the bladder to prevent the (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: 146056 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 146056 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arc at Kankakee 901 North Entrance Avenue Kankakee, IL 60901 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)