Health inspection·September 27, 2024

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 a portable oxygen tank that was full for a resident. This applies to 1 of 3 residents (R1) reviewed for oxygen in a sample of 3. Residents Affected - Few The findings include: On 9/27/24 at 10:15 AM, surveyor and V2 (DON-Director of Nursing) went to R1's room. R1 was sitting in her wheelchair. At the back of her wheelchair, R1 had a portable oxygen tank that was connected to her nasal cannula. The dial was turned to 3 liters but it read empty. V2 removed the nasal cannula as instructed by the surveyor and put the nasal prongs near her wrist. Then, she passed it to surveyor who did the same thing. Both V2 and surveyor confirmed no air was able to be felt. R1 was asked if she felt any air and she said No! Surveyor asked R1 if she had any problems breathing or if she was in any type of distress. She stated no she was not. R1's oxygen saturation rate was 91%. On 9/27/24 at 10:18 AM, V2 stated that the tank should have been full or changed out. V2 also confirmed that when R1 was brought back to her room from the dining room, she should have been connected to her concentrator. On 9/27/24 at 10:21 AM, V4 (CNA-Certified Nursing Assistant) stated, I'm (R1)'s CNA today. She was on her concentrator last night. Then, I switched her to the portable oxygen tank and took her to the dining room so she can eat her breakfast. It was not empty then. Then I brought her back to her room. The oxygen tank was on yellow. I'm sorry. I should have changed it out. Did they bring a new oxygen tank for her? On 9/27/24 at 10:29 AM, V2 stated, (V3-Hospice Nurse) brought it to my attention that my staff wasn't using the portable oxygen concentrator that was provided by hospice for (R1) when she is in the dining room. Instead, they were using the portable oxygen tank. I inserviced my staff and made sure this was communicated to all the staff. I talked to V5 (LPN/Licensed Practical Nurse) and she told me the portable oxygen concentrator is charging, but it's not turning on. I told (V3) this but she said our staff is not charging it at night. We checked it today and it's not turning on. So, I have to tell hospice again to send a new one. On 9/24/24 at 1:48 PM, telephone interview was done with V3 (Hospice Nurse). V3 stated, The staff there are not using the portable oxygen concentrator when they are taking (R1) to the dining room. Instead, they are using the portable oxygen tank. Today and a couple of days ago, I saw the tank was turned off. I told them they have to get a new tank or (R1) is going to die. She is on hospice and has COPD. They are having problems keeping the tank full. (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 09/27/2024 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)