Inspection·August 17, 2023

F 0686 said she has one now. Level of Harm - Minimal harm or potential for actual harm On 08/16/23 at 9:26 AM, V3 (DON/Director of Nursing) said the facility has been without a wound care nurse since the end of June, beginning of July. V3 said R17 was here and had to go back to hospital for surgery on her arm, she left on 8/9 and returned late on 8/10 and that is where the wound was identified as a stage 2 pressure ulcer. Residents Affected - Few On 8/16/2023 at 11:48 PM, V20 (RN) showed surveyor R17's sacral wound. The dressing was ordered to be changed every three days and was last changed on 8/15/2023. V20 didn't want to remove the dressing but was able to open the dressing so the wound could be visualized. The wound was approximately 7 cm x 8 cm. V20 said as a nurse she needs to document what she sees when there is a skin condition, notify the primary physician of the skin issue, carry out any orders given, and notify the wound care physician if the primary physician gave a referral. At 3:30 PM, V3 (DON) said when a resident develops a pressure ulcer, the nurse should measure, assess and describe the wound, call the resident's PCP (Primary Care Physician) and get an order for treatment and a referral to wound care. All this information should be documented in a progress note. Facility provided a policy dated March 2023 titled, Skin Assessment that showed the facility policy is to perform a full body skin assessment as part of our systemic approach to pressure injury prevention and management 1. A full body assessment, or head to toe, skin assessment will be conducted by a licensed or practical nurse on admission/readmission, daily for three days, and weekly thereafter. The assessment may also be performed after a change of condition or after a newly identified pressure ulcer. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 2 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0693 Level of Harm - Minimal harm or potential for actual harm Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation and interview the facility failed to ensure the correct placement of a gastrostomy tube before administering medication and fluids through it. Residents Affected - Few This applies to 1 of 1 (R58) resident reviewed for gastrostomy tubes. The findings include: R58 was admitted to the facility 11/17/2021 with diagnoses including Parkinson's disease, unspecified dementia severe, endocrine pancreatic insufficiency, spinal stenosis in cervical regions, dysphagia according to his face sheet. On 8/15/23 at 12:15 PM, V11 (LPN) R58's assigned nurse was observed during the scheduled medication pass and gastrostomy tube (G-tube) feeding bolus to R58. R58 was in his room sitting upright in his wheelchair, wearing a pullover-type shirt. V11 raised R58's shirt to expose the abdominal binder securing R58's G-tube in place. The access end of the G-tube was noted clamped shut. V11 spoke to R58 and opened the clamp and placed a 60 ml (milliliter) syringe into the G-tube and inserted 60 ml of water into the tube using the syringe plunger to assist the fluid into the G-tube. V11 continued the medication administration process using four 30 ml medication cups of individual medications and eight ounces of R58's prescribed nutritional supplement. In between the instillations of medications and before and after the nutritional supplement, V11 instilled water flushes into the G-tube. V11 commented during the process that the medications had a difficult time passing through the G-tube. It was noted that at no time did V11 check for bowel sounds or check for placement of the feeding tube before placing medications or the nutritional supplement into the G-tube. When asked by the surveyor what the protocol was for administering medication or fluids via a G-tube, V11 stated, I should have auscultated for air before I put anything into the tube. I forgot. I did not even bring my stethoscope in with me. On 08/15/23 at 1:05 PM, V3 (Director of Nursing) stated G-tube placement should be checked before administering medications or fluids into the G-tube and that there were two correct ways to check for proper placement of the G-tube. V3 stated the nurse should use a syringe and auscultate air and listen with a stethoscope. V12 (RN/ Nurse Case Manager) who was present, added that checking for a residual of stomach contents by aspirating the G-tube with the syringe was another process to ensure G-tube patency and in the correct placement. V3 stated it was her expectation that the nurse check for proper placement of the G-tube before administering anything into it. R58s care plan showed a focus problem which documented R58 had a G-Tube for enteral feeding due to oropharyngeal dysphagia (swallowing problems occurring with the mouth and or throat) and weight loss, and showed an intervention, Check abdomen for bowel sounds, distention and feeding tube placement. On 08/15/23 at 02:03 PM, R58's care plan showed a focus problem that (R58) had a G-tube for enteral feeding due to oropharyngeal dysphagia (swallowing problems occurring the mouth and or throat) and weight loss, and that (R58) .will have adequate nourishment and hydration via feeding tube. The documented intervention stated, Check abdomen for bowel signs, distention and feeding tube placement. The facility provided their policy, Enteral Nutrition - Verifying Placement of Feeding Tube (dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 3 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0693 Level of Harm - Minimal harm or potential for actual harm January 2023) which documented, Policy: To ensure proper placement of feeding tubes prior to beginning, flushing the tube, or before administering medications via feeding tube. Policy Explanation and Compliance Guidelines: 1. Before beginning a feeding, flushing the tube, or administering a medication via the feeding tube, proper placement and functioning will be verified. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 4 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0694 Provide for the safe, appropriate administration of IV fluids 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 Peripherally Inserted Central Catheter (PICC) care. This applies to 1 of 1 resident (R42) in the sample of 20. Residents Affected - Few The finding included: R42's EMR (Electronic Medical Record) showed R42 was admitted to the facility on [DATE] with diagnoses that included intervertebral disc disorders with myopathy lumbar region, unspecified open wound lower back and pelvis, and intraspinal abscess and granuloma. On 7/25/2023 R42 had an MRI (Magnetic Resonance Imaging) which showed a spinal abscess that required R42 be sent back to the hospital for medical treatment. R42 was to return to the facility and required IV (Intravenous) antibiotic. R42 returned to the facility on 8/3/2023 with a PICC to right upper arm. The PICC became dislodged on 8/5/2023 and was reinserted into the right arm. On 8/12/2023 the PICC became dislodged for a second time and was reinserted into the left arm. R42's MDS (Minimum Data Set) dated 7/9/2023 showed R42 was cognitively intact and required staff assistance for all activities of daily living. R42's care plan showed PICC Line for IV (Intravenous) antibiotic for lower back surgical incision. Interventions included assess and monitor infusion site and perform infusion care. On 8/14/2023 at 11:00 AM, R42 was sitting in his room receiving an IV antibiotic through a left arm PICC line. The infusion site was not visible since it was covered with a gauze dressing. There was a clear occlusive dressing over the gauze, dated with 8/12/2023 as the last dressing change. On 8/16/2023 at 8:40 AM, V20 (RN/Registered Nurse) prepared R42's IV (intravenous) medication for administration. V20 said the dressing gets changed every 7 days. On 8/16/23 12:57 PM DON (V3) said when a resident has PICC line the nurse needs to assess the site for inflammation, infection, need to redness, and make sure catheter is not coming out. Dressings can be changed every seven days, but if a resident comes from the hospital with gauze covering the insertion site, the dressing needs to be changed right away so site can be assessed. Facility provided their policy dated January 2023 and titled, PICC/Midline/CVAD Dressing Change. Policy showed 9. Inspect the catheter and hub for any defects such as cracks or splits 12. Use a sterile measuring tape to measure external length of the catheter from the hub to skin entry to ensure that is has not migrated 17. Apply a transparent semipermeable dressing to the insertion site. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 5 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

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 and interview the facility failed to ensure that oxygen was delivered to a resident at the rate prescribed by the physician. This applies to 1 of 1 (R23) resident reviewed for oxygen therapy. Residents Affected - Few The findings include: R23 was admitted to facility on 7/25/22 according to her face sheet. R23's admitting diagnoses included pulmonary fibrosis, heart failure, respiratory failure, and hypertension. R23's most recent minimum data set (MDS) assessment dated [DATE] documented she was cognitively intact and required extensive assistance of one staff for most activities of daily living (ADLs), except supervision for eating and personal hygiene. On 08/14/23 at 11:03 AM, R23 was noted in her private room seated in the recliner, wearing a nasal cannula which was connected to a stationary oxygen concentrator. The setting of the oxygen was noted at 2 Liters (2L) rate on the dial, and this was confirmed by V24 (Registered Nurse-RN). V24 then stated the Oxygen should be set to 4 Liters. On 08/15/23 at 10:45 AM R23 was seated in room in the wheelchair with a portable oxygen concentrator hung with a strap on the back of her wheelchair. R23's nasal cannula was noted in place. R23's assigned nurse V11 (Licensed Practical Nurse/LPN) stated the concentrator shows setting 2 and stated she thinks that is 2 Liters, but that she was not sure, and added that she (V11) is not used to that type of concentrator. On 08/15/23 at 11:05 AM, V3 (Director of Nursing/DON) was asked by surveyor to confirm what setting R23's portable concentrator was on. V3 stated Setting 2 and stated that she was unsure of what rate that setting was. V3 stated that R23's oxygen was ordered at the rate of 4 Liters of oxygen. V3 then called V17 (Central Supply Clerk) to clarify the settings on the portable concentrator. V17 arrived promptly, viewed the reading on concentrator, stated it was Setting 2 and stated he believed that meant it was the equivalent of 2 Liters rate. V17 reported the supplier provided an in-service to staff regarding this oxygen concentrator, but V17 was not sure of the setting. On 08/16/23 at 10:35 AM, V17 and V4 (Registered Nurse/Infection Preventionist) clarified the portable oxygen concentrator setting. V17 explained that setting 2 is equivalent to 2 Liters of oxygen according to the local supplier of the concentrator and confirmed that the setting 2 means 2L of oxygen. V17 stated, We called (the company) and they confirmed that's the equivalency. V17 provided a 17-page printout titled, A Guide to Portable Oxygen Concentrators (produced by the American Association for Respiratory Care, attached) and highlighted section on page 16 and stated this clarified that the setting 4 is the correct setting for a prescribed 4 Liters rate. V4 explained that the expectation when the physician orders 4 Liters of oxygen, the concentrator should be set at Setting 4 on the concentrator. On 8/16/23 at 1:05 PM, V3 (DON) provided R23's physician's order sheet. V3 confirmed physician's order was changed to 2L by the primary care physician (PCP) earlier in the shift when the PCP was notified of the variance in the oxygen delivery from the original order. V3 stated the oxygen rate was previously ordered at 4 Liters by PCP. The facility assignment sheets for the first two days of the survey showed information for staff for R23, 4L (oxygen)- on concentrator when in room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 6 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to label and date medications after it was opened to determine expiration dates. This applies to 4 of 6 residents (R15, R57, R58, R59) reviewed for labeling and storage of medications. The findings include: On 8/16/23 at 10:03 AM, an inspection on the F/J/H medication cart was conducted with V24 (Nurse) and the following medications were observed and reviewed along with the pharmacy guidelines: 1. R58's Dimesylate-Latanaprost Ophthalmic Solution was noted to be opened on 4/6/23. The pharmacy guideline showed to discard medication 6 weeks after it was opened which would have been 5/18/2023. 2. R57's Albuterol SO4 90 mcg per actuation was noted to be opened and not dated. The pharmacy guideline showed to discard medication 12 months after it was opened. 3. R15's Budesonide Glycopyrrolate and Formoterol Fumarate 160mcg/9mcg/4.8 mcg per inhale was opened and not dated. The pharmacy guideline showed to discard medication 3 months after it was opened. 4. R59's Fluticasone Propionate/ Salmeterol Diskus 500mcg/50mcg inhaler and Blink Tears 0.25% eye solution both medications were opened and not dated. The pharmacy guideline showed to discard Fluticasone Propionate/Salmeterol Diskus one month after it was opened while the artificial tears is to be discarded 90 days after it was opened. 5. A Fluticasone Propionate 100 mcg/50 mcg inhaler which was opened and not dated was in the active medication drawer. This medication belonged to a resident that had been discharged and was no longer in the facility. On 8/16/23 at 3:02 PM, V4 (Infection Control Nurse) stated that the staff should put the date on the medication once the seal is broken, because the clock starts ticking for the expiration date. On 8/17/23 at 12:56 PM, V34 (Pharmacist) stated that some medications should be discarded after a specific amount of time after it was opened. The staff should follow pharmacy recommendations on medication expiration guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 7 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review the facility failed to serve pureed diet with the consistency as per policy guidance. This applies to 2 of 2 residents (R224 and R225) reviewed for pureed diets in the sample of 20. The findings include: On 08/14/23 at 01:03 PM, during the lunch meal service in the [NAME] Leaf wing, R224 and R225 received pureed chicken and pureed vegetables from a hot holder served by V14 (Cook). The pureed chicken was noted to have small black colored seed like items in it. These items when removed and tested in between the fingers, remained hard and unable to be mashed up. V14 stated that since the pureed meals were already plated in the facility kitchen, she does not know what these black items were. V15 (Dining Service Manager) who was present in the vicinity, also tested these black items and agreed that they were hard and unable to be mashed up. V15 was notified that the pureed chicken was not safe to serve with the unidentified black items in it. V15 stated that she will check with the kitchen to find out what they were. V15 reported back at a later time that these black colored items were sesame seeds. On 08/16/23 at 9:44 AM, V16 (Dietitian) stated that pureed items are supposed to have a blenderized smooth texture. Facility policy and procedure titled Pureed Program (Policy #C224, revised 02/19) included as follows: Policy: Provide Standardized recipes for all pureed requiring texture modification to meet pureed guidelines and to ensure palatability, flavor, texture and nutritional value. Procedure: Foods requiring modification will have a uniform mashed -potato like texture. Puree Guidelines: 1. Pureed foods should be to texture/consistency of smooth mashed potatoes. 2. a. Do not garnish with additional ingredients that are not part of the original recipe. Recipe for Puree Chicken (121562, revised 6/8/2023) 1. Make chicken broth per recipe and reserve warm. 2. Roast chicken breast to 165 degrees internal. 3. Cut the chicken into pieces and place in food processor. Run for one minute. Add Shape n Serve and run while adding the warm chicken broth. Run until you achieve a very smooth cake batter consistency. The base menu for Monday 8/14/23 included Parmesan Peppercorn Chicken Sandwich. Diet order Report printed on 08/14/23 showed that R224 and R225 were on pureed consistency diets. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 8 of 9 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 146110 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Smith Crossing 10501 Emilie Lane Orland Park, IL 60467 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to follow standard infection control practices regarding hand hygiene and changing of gloves during provisions of peri-care. This applies to 4 of 20 residents (R12, R32, R57, R67) reviewed for infection control in the sample of 20. Residents Affected - Some 1. On 8/14/23 at 1:38 PM, V26 (Certified Nursing Assistant/CNA) rendered peri-care to R57. V26 cleaned R57's perineum from front to back and applied a new incontinence brief while wearing the same gloves. Afterwards, V26 changed her gloves without hand hygiene. She assisted to reposition R57 and R57's indwelling urinary catheter, then placed a blanket on top of R57. 2. On 8/15/23 at 1:04 PM, V27 and V28 (Both CNAs) rendered incontinence care to R12 who was wet with urine and had a bowel movement. V27 cleaned R12's peri-area from front to back, she applied barrier cream, and applied a new incontinence brief while wearing the same gloves. V27 changed her gloves without hand hygiene. V27 and V28 transferred R12 to the recliner via a mechanical lift. V27 put the incontinence pad in the garbage, and she put away the container of the wet wipes on R12's bedside table. With the same gloves, V27 picked the garbage bag with soiled pads and brief, removed the gloves, and left the room without hand hygiene. 3. On 8/15/23 at 2:00 PM, V26 (CNA) rendered incontinence care to R32 who was wet with urine. V26 wiped R32 from front to back, then V26 placed a new incontinence brief underneath R32's buttocks. While wearing the same soiled gloves, V26 dipped her soiled gloved fingers in the Vaseline jar and applied Vaseline to R32's buttocks, then she closed the incontinence brief. 4. On 8/16/23 at 11:05 AM, V30 (Nurse) and V31 (wound CNA) rendered wound care to R67. After completing the wound care, V31 cleaned R67's perineum from front to back, applied a new incontinence brief, repositioned R67 and touched other clean surfaces while wearing the same soiled gloves. On 8/16/23 at 2:33 PM, V4 (Infection Control Nurse) stated that staff must wash hands before entering and exiting a resident's bedroom, after touching something contaminated, regardless of whether staff is wearing gloves or not. They should change gloves and perform hand hygiene from dirty to clean task. This is to prevent spread of infection and cross contamination. Facility's Hand Hygiene Policy and Procedure dated August 2015 indicates: Policy: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. 6. Additional considerations: a. The use of gloves does not replace hand hygiene. If you task requires gloves, perform hand hygiene prior to donning gloves, immediately after removing gloves. Hand Hygiene Table indicates to perform hand hygiene: - Before applying and after removing personal protective equipment (PPE). - After handling items potentially contaminated with blood, body fluids, secretions, or excretions. - When, during resident care, moving from a contaminated site to a clean body site. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146110 If continuation sheet Page 9 of 9