Inspection·July 2, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 routine shower/bed bath care for residents who require extensive assistance for activities of daily living (ADL) care. This applies to 2 of 3 residents (R1, R2) reviewed for ADL care in the sample of 3. Residents Affected - Few The findings include: 1. Face sheet shows R1 has multiple medical diagnoses which include acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, chronic kidney disease, chronic diastolic (congestive) heart failure, morbid (severe) obesity with alveolar hypoventilation, encounter for attention for tracheostomy, atelectasis, morbid (severe) obesity due to excess calories, type 2 diabetes mellitus without complications, other asthma, need for assistance with personal care, other lack of coordination, other reduced mobility, abnormal posture, chronic obstructive pulmonary disease. R1's Minimum Data Set (MDS) dated [DATE], shows R1 is alert and oriented and requires substantial/maximal assistance for shower or bathing. On July 1, 2024, at 12:09 PM, R1 stated he prefers to have a bed bath rather than a shower due to his tracheostomy. R1 received a bed bath on Tuesday (June 25), Wednesday (June 26), and on Friday (June 28). Prior to last week, his last bed bath was on a Monday (June 3), afterwards, R1 had not had bed bath from June 4 through June 24, 2024. R1's bed bath was scheduled on night shift or the 3rd shift. According to R1, the staff does not wake him to give him the shower or bed bath. On June 18, 2024, R1 stated he spoke with V2 (Director of Nursing/DON) requesting for his bed bath schedule to be change to evening shift. R1 did not receive a shower or bath from June 18 to June 24, 2024. On June 23rd, R1 requested at 6 AM a bed bath because his family was going to visit him at 11 AM. A staff member informed R1 she was waiting for someone to help her. R1 informed staff he could help by turning and repositioning himself on the bed during the process, however, he still did not receive a bed bath day. R1 was so upset he told the nurse he would call Public Health because of their failure to give him a bed bath. On July 1, 2024, at 1:05 PM, V2 (Director of Nursing/DON) stated she had a meeting with R1 requesting to change shift schedule from night to evening shift because R1 was still sleeping during the bed bath time. V2 recalled after meeting there were staff who were about to give R1 a bath. The facility staff documented in the shower sheet when they provided shower or bed bath. On July 1, 2024, at 3:28 PM, V3 (Assistant Director of Nursing/ADON) stated, The residents receive either shower or bed bath at least once a week and as needed. Some residents receive it every Monday, Wednesday, and Friday because that's how they wanted it. V3 said the facility follows resident's (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 3 Event ID: 146112 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 146112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arc at Bradley 650 North Kinzie Ave Bradley, IL 60915 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)