Health inspection·April 30, 2025

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Observation, Interview and Record Review, the facility failed to document a diagnosis and identify target behaviors to warrant the use of an antipsychotic medication and provide appropriate justification for a failed gradual dose reduction of Risperdal (antipsychotic) for one of one resident (R2) reviewed for antipsychotic medications in the sample of 34. Findings include: The facility's Psychopharmacologic Drug Usage Procedure policy, dated 10/18/17, documents A Psychopharmacologic Drug is any medication used for managing behavior, stabilizing mood, or treating psychiatric disorders. This includes the following types of drugs: antipsychotic, antidepressants, anti-anxiety medications, and sedatives/hypnotics. This policy also documents, Use of psychopharmacological medications requires assessment by the attending physician, and specific orders must be written by the attending physician with supporting diagnosis. Documentation of behaviors and conditions requiring the use of these medications must be done on a routine basis, as well as medication response and adverse consequences. Response to medication reduction must be clearly documented on a routine basis. Unsuccessful reduction of medication must be substantiated by documentation, including rationale from the physician as to why the medication cannot be reduced further. The ultimate goal of successful gradual dose reduction is to discontinue the medication necessary for the benefit of the resident and to minimize adverse consequences. On 4/29/25 at 12:45 PM, R2 was sitting in the dining room eating lunch. R2 denied concerns and was pleasantly confused with conversation. R2 was not displaying any behaviors. R2's discontinued Physician Order sheet, dated 4/29/25, documents R2's order for Risperidone (Risperdal, antipsychotic medication) 0.25 milligrams (mg) at bedtime was discontinued on 3/7/25. R2's current Physician Order Sheet, dated 3/10/25, documents R2 has an order for Risperidone 0.25 mg by mouth at bedtime for a diagnosis of Vascular Dementia, unspecified severity, with other behavioral disturbance. R2's current Care Plan, dated 4/27/25, documents R2 was admitted to the facility on [DATE] and has a diagnosis of Vascular Dementia. This same care plan documents a plan of care dated 4/2/24, for Psychotropic drug use (R2) has depression and vascular dementia with other behavioral disturbance. Interventions: Administer medication as ordered, Risperidone 0.25 mg, one tablet by mouth at bedtime. Monitor for side effects, including boxed warnings. Review medication during behavior committee meeting for gradual dose reduction. (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 9 Event ID: 146083 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 146083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manor Court of Princeton 140 North Sixth Street Princeton, IL 61356 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)