Health inspection·December 9, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview and record review, the facility failed to maintain resident rooms in a clean sanitary manner. This applies to 6 of 7 residents (R10, R11, R12, R13, R14 and R15) reviewed for homelike environment in a sample size of 15. Findings include: 1. On 12/7/23 at 11:00 AM, V14 (R10's daughter) stated, on 11/21/23, R10 used the bedside commode. The commode with urine & stool in it was left in the room for 3 days and it was cleaned on Monday, 11/24/23. On 12/7/23 at 11:00 AM, observed R10's walker was dirty and with cleanable stains. V14 stated, she asked the nursing staff and the housekeeping staff to clean it, and nobody did. 2. On 12/7/23 at 11:15 AM, observed R13's soiled clothing - a bedsheet, pajamas, shirt, socks and R13's sling used for mechanical lift, on the floor. 3. On 12/7/23 at 11:40 AM, R15 stated, on 12/5/23, R15 used her bedside commode. The commode with urine and stool in it was left in the room until 12/6/23, when it was cleaned. R15 stated, she asked the CNAs to clean it, yet nobody did. R15's MDS (Minimum Data Set) dated 11/22/23 showed R15 had intact cognition. 4. On 12/7/23 at 11:10 AM, R12 stated, there were dirty washcloths left in the sink most of the days, that is used for another resident and that R12 has to pick it up for her to use the sink. R12's MDS (Minimum Data Set) dated 10/5/23 showed R12 had intact cognition. 5. On 12/7/23 at 11:13 AM, R11 stated, used washcloths were left in her sink by the CNAs. R11 stated she can't use the sink to brush her teeth unless she picks it up. R11's MDS (Minimum Data Set) dated 11/6/23 showed R11 has intact cognition. 6. On 12/7/23 at 11:15 AM, R14 stated, soiled wash cloths are left in the sink after use for more than 24 hrs. R14 states CNAs don't clean up behind them. On 12/7/23 at 11:15 AM, V7 (RN) stated, the CNA who cared for R13 should have picked it up & discarded into the laundry basket. V7 stated, for infection control reasons, linen should not be on the floor. On 12/8/23 at 1:00 PM, V9 (CNA/Certified Nurse Aide) stated, she had seen soiled washcloths left in the sink and on the floor, in some resident's rooms. (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: 146067 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 146067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Geneva 1101 East State Street Geneva, IL 60134 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)