Health inspection·April 1, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to perform hand hygiene and glove changes during pressure ulcer treatments. The facility also failed to ensure pressure ulcer treatments were completed as ordered. These failures effect three of three residents (R2, R3, R4) reviewed for pressure ulcers in a sample of four. Residents Affected - Few Findings include: The facility's undated Wound Care policy documents Purpose: To provide guidelines for the care of wounds and soiled dressings to decrease the potential for nosocomial infections. Steps in the Procedure: 1. Wash your hands thoroughly before beginning the procedure. 11. Put on exam glove. Loosen tape and remove dressing. 12. Pull glove over dressing and discard into appropriate receptacle. Wash hands. 13. Put on disposable gloves. 14. Use no-touch technique. Use tongue blades and applicators to remove ointments and creams from their containers. 15. Pour liquid solutions directly on gauze sponges. 17. Cleanse wound with solution. 20. Dress wound. [NAME] tape with initials, time, and date and apply to dressing. 21. Pick up soiled items. Discard into designated container. Remove gloves and discard into trash bag/container. Wash hands. The facility's undated Using Gloves policy documents Purpose: To provide guidelines for the use of gloves. Objectives: 1. To prevent the spread of infection and disease to residents and employees; 2. To protect wounds from contamination. Miscellaneous: 1. When gloves are indicated, disposable single-use gloves should be worn .4. Nonsterile gloves should be used primarily to prevent the contamination of the employees' hands when providing treatment or services to the resident and when cleaning contaminated surfaces. 5. Wash hands after removing gloves. Gloves do not replace handwashing. The facility's undated Handwashing policy documents When to Wash Hands: 6. After handling used dressings, specimen containers, contaminated tissues, linen, etc. 8. After handling items or work surfaces potentially contaminated with a resident's blood, excretions, or secretions. 12. Upon completion of duty. The facility's undated Treatment of Pressure Ulcers (Bedsores) policy documents Purpose: The purpose of this procedure is to provide guidelines for the treatment of pressure ulcers to facilitate healing. This policy includes to 19. Dress the pressure sore with the prescribed dressing. The facility's undated Physician's Order Policy documents Purpose: The purpose of this policy is to establish guidelines for the ordering, processing, and management of physician orders in a long-term care facility, ensuring compliance with State and Federal regulations, and promoting the health and safety of residents. Procedures: 3. Order Implementation - All medications and treatments shall be administered as per the orders, with documentation in the resident's medical record. (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 6 Event ID: 146098 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 146098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sharon Health Care Elms 3611 North Rochelle Peoria, IL 61604 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)