Health inspection·July 11, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interview and record review the facility failed to answer call lights for residents needing assistance in a timely manner for 4 residents of 10 residents (R2, R5, R6, R8, R9) reviewed for call lights in a sample of 10. Findings include: 1. R5's Current Care Plan documents R5 has Self-Care Deficit as evidenced by: Needs assistance with ADL's (Activities of Daily Living), transfers, toileting r/t (related to) paralysis d/t (due to) gun shot. Date initiated 6/21/23. Interventions/Tasks include: Encourage the resident to use bell to call for assistance. On 7/5/2024 at 8:00pm, R5 who was alert to person, place and time said he requires the assistance of one staff to transfer and assist him with activities of daily living. R5 said the facility is very short of staff and often he has to wait 20 or 30 minutes for his call light to be answered. 2. R2's current Care Plan documents R2 has Self-Care Deficit as evidenced by: Needs assistance with ADL's, bed mobility, extensive transfer. Date initiated 8/17/23. Interventions/Tasks include: Encourage the resident to use bell to call for assistance. On 7/5/2024 at 8:15pm, R2 who was alert to person, place and time said she requires the use of a whole body lifting machine to transfer. R2 said the facility is very short of staff, but the staff that are working really hard. R2 said she has to wait for at least 30 to 45 minutes to get her call light answered. R2 said a lot of time a CNA will answer her light but says they have to go find help to transfer her and it takes an hour or more for the staff to came back and transfer her. 3. R9's Current Care Plan documents R9 has Self-Care Deficit as evidenced by: Needs (one) assistance with ADL's related to pain, weakness, unsteadiness on feet, abnormalities of gait and mobility, lack of coordination. Date initiated 3/1/23. Interventions/Tasks include: Encourage the resident to use bell to call for assistance. On 7/5/2024 at 8:55pm, R9 who was alert to person, place and time said she requires the assistance of one staff to get to the toilet safely. R9 said she puts on her call light and waits and waits. R9 said it often takes an hour for her call light to get answered due to the staff helping other residents. R9 said after she gets helped to the toilet, she then has to wait for the staff to come back and answer her light to assist her off the toilet. R9 said one time she had to wait about an hour for staff to come and assist her off the toilet. Page 1 of 4 146096 146096 07/11/2024 The Haven of Ridgeview 413 Ridge Lane Oblong, IL 62449

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 4. R8's Current Care Plan documents R8 has Self-Care Deficit as evidenced by: Needs extensive assistance with ADL's related to contracture, weakness, impaired mobility. Date initiated 2/15/22. Interventions/Tasks include: Encourage the resident to use bell to call for assistance. On 7/5/2024 at 8:20pm, R8 who was alert to person, place and time said she requires the assistance of one staff to transfer from her wheelchair to her bed and every night she has to wait about an hour for her call light to be answered. R8 said nightshift on the weekends have the most call light wait times. R8 said the facility is very short of staff and needs to hire some more. 5. R6's Current Care Plan documents R6 has Self-Care Deficit as evidenced by: Needs assistance with ADL's r/t hypotension, hemiplegic right side, dialysis. Date initiated 3/11/24. On 7/5/2024 at 8:35pm, R6 who was alert to person, place and time said she needs the assistance of one staff to transfer into and out of her bed. R6 said the facility is very short of staff and one nightshift there was only one CNA and one nurse. R6 said they tried hard and worked themselves to death, but she had to wait long periods of time for her call light to be answered to get staff assistance. On 7/5/2024 at 7:58pm, V5 and V6 (both Certified Nursing Assistants) were interviewed together. V5 and V6 said for the past month or so they have only had two CNAs on the night shift. V5 and V6 said this usually happens on the weekends and occasionally they will have three CNAs. V5 and V6 said about half of the residents who live here need a minimum of two staff to transfer and they spend all their time putting residents to bed and can not get the call lights answered very quickly. V5 and V6 said they try to get the call lights answered timely but a lot of times residents have to wait 30 to 45 minutes before we can get to them. On 7/5/2024 at 8:30pm, V1 (Administrator) said she knows the facility is short of care staff, but they try really hard to get more care staff in the facility to work. V1 said all their efforts have been unsuccessful. 146096 Page 2 of 4 146096 07/11/2024 The Haven of Ridgeview 413 Ridge Lane Oblong, IL 62449

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on interview and record review, the facility failed to provide a sufficient amount of staff to ensure residents care needs were being met. This failure has the potential to effect all 43 residents living at this facility. Findings include: On 7/5/2024 at 8:30pm, V1 (Administrator) said the facility has 43 residents. V1 said of the 43 residents 19 residents require a minimum of two staff to transfer. V1 said she knows the facility is short of care staff, but they try really hard to get more care staff in the facility to work. V1 said all their efforts have been unsuccessful. V1 said the care staff usually work 12 hours shifts, 6:00am-6:00pm is dayshift and 6:00pm-6:00am is nightshift. V1 said they did not have trouble with enough staff on the dayshift, but the trouble is with the nightshift. V1 said the nightshift should have five or six care staff, but she is lucky to have three and at times she only has two. On 7/5/2024 at 7:45pm, V4 (Licensed Practical Nurse) said she works 12 hours nightshift Thursday through Sunday, every weekend. V4 said she usually only has two CNAs (Certified Nursing Assistants) and herself for a total of three care staff for all 43 residents. On 7/5/2024 at 7:58pm, V5 and V6 (both CNA's) were interviewed together. V5 and V6 said for the past month or so they have only had two CNAs on the night shift. V5 and V6 said this usually happens on the weekends and occasionally they will have three CNAs. V5 and V6 said about half of the residents who live here need a minimum of two staff to transfer and they spend all their time putting residents to bed and can not get the call lights answered very quickly. V5 and V6 said they try to get the call lights answered timely but a lot of times residents have to wait 30 to 45 minutes before we can get to them. On 7/5/2024 at 8:00pm, R5 who was alert to person, place and time said he requires the assistance on one staff to transfer and assist him with activities of daily living. R5 said the facility is very short of staff and often he has to wait 20 or 30 minutes for his call light to be answered. On 7/5/2024 at 8:15pm, R2 who was alert to person, place and time said she requires the use of a whole body lifting machine to transfer. R2 said the facility is very short of staff, but the staff that are working try really hard. R2 said she has had to wait for at least 30 to 45 minutes to get her call light answered. R2 said a lot of time a CNA will answer her light but says they have to go find help to transfer her and it takes an hour or more for the staff to came back and transfer her. On 7/5/2024 at 8:30, R7 who was alert to person, place and time said he requires the assistance of one staff to safely transfer from his wheelchair. R7 said the facility is severely short staff on the nightshift and especially on the weekends. R7 said most of the time there is only 3 staff working, a nurse and two CNAs. R7 said he gets care provided but not very quickly at times. On 7/5/2024 at 8:55pm, R9 who was alert to person, place and time said she requires the assistance of one staff to get to the toilet safely. R9 said she puts on her call light and waits and waits. R9 said it often takes and hour for her call light to get answered due to the staff helping other residents. R9 said after she gets helped to the toilet, she then has to wait for the staff to come back and answer her light to assist her off the toilet. R9 said one time she had to wait about an hour 146096 Page 3 of 4 146096 07/11/2024 The Haven of Ridgeview 413 Ridge Lane Oblong, IL 62449

F 0725 for staff to come and assist her off the toilet. Level of Harm - Minimal harm or potential for actual harm On 7/5/2024 at 8:20pm, R8 who was alert to person, place and time said she requires the assistance of one staff to transfer from her wheelchair to her bed and every night she has to wait about an hour for her call light to be answered. R8 said nightshift on the weekends have the most call light wait times. R8 said the facility is very short of staff and needs to hire some more. Residents Affected - Many On 7/5/2024 at 8:35pm, R6 who was alert to person, place and time said she needs the assistance of one staff to transfer into and out of her bed. R6 said the facility is very short of staff and one nightshift their was only one CNA and one nurse. R6 said they tried hard and worked themselves to death, but she had to wait long periods of time for her call light to be answered to get staff assistance. A review of the facility's nursing staff for June 2024 revealed 17 night shifts with only two CNAs and one Nurse. (6/1, 6/2, 6/7-6/11, 6/14-6/16, 6/21-6/23, 6/27-6/30) This same schedule revealed only one CNA and one Nurse on the nightshift on 6/13/24. All other night shifts in June had three CNAs and one Nurse. A review of the facility's nursing staff for July 1st through July 12th, 2024 revealed three night shifts with two CNAs and one Nurse. (7/4, 7/6, 7/7) This same schedule revealed 8 nightshifts with three CNAs and one Nurse. (7/1-7/3, 7/5, 7/8-7/10 and 7/12). One night shift (7/11/24) had 4 CNAs and one nurse. A document titled Daily Census (undated) was provided by V1 (Administrator) and documents the facility has 19 residents who require a minimum of two staff to safely transfer, 16 residents require a minimum of one staff to safely transfer and 8 residents transfer independently. A review of the facility's census, dated 7/5/2024 documents 43 residents reside at this facility. 146096 Page 4 of 4