Health inspection·December 5, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview and record review, the facility failed to maintain the shower room on the South Hall in a clean and sanitary condition. This has the potential to affect 23 residents residing on the South Hall. Findings include: On 12/02/24 at 10:19am, the shower room B on the South hall was observed to have an area in the corner behind the toilet where there was a significant buildup of an unknown black substance. On 12/02/24 at 10:32am, R2 who was alert to person, place, and time, stated that the shower rooms could be cleaner at times. On 12/02/24 at 10:53am, R13 who was alert to person, place, and time, stated the facility was pretty dingy before they started painting around here and the bathrooms are often dirty and damp. On 12/02/24 at 11:02am, R11 who was alert to person and place, stated the bathrooms could use a good cleaning. On 12/02/24 at 11:43am, V3 (Housekeeping) took a rag that was damp with cleaner and attempted to wipe an area of black buildup in the corner by the toilet of shower room B on the South hall, it did not wipe off after multiple swipes. It appeared that some of it was under a layer of clear sealant. On 12/04/24 at 10:00am, The buildup in the corner of shower room B was clean, there was no longer any clear sealant observed on the wall. On 12/04/24 at 12:00pm, V8 (Certified Nursing Assistant/CNA) stated everyone on this end of the South hallway uses shower room B. V8 stated it has a toilet and a shower and there is no one bed bound on the hallway, so it is possible that they all could use it at one time or another. On 12/04/24 at 12:00pm, V8 (CNA) confirmed that there were 23 residents on this end of the South hallway. On 12/04/24 at 1:40pm, V1 (Administrator) was asked about the spot in the corner of shower room B, she stated she did not know anything about it but assumed that housekeeping would have cleaned it. A review of the facility floor plan and census dated 12/03/24, documents there are 23 residents that reside in zone 3 of the south hallway where shower room B is located. Page 1 of 2 146121 146121 12/05/2024 Benton Rehabilitation and Health Care Center 1409 North Main Street Benton, IL 62812

F 0584 Level of Harm - Minimal harm or potential for actual harm A review of facility policy titled Physical Plant and Environmental Policy and Guidelines documents under the section titled Housekeeping that routine and daily cleaning and monthly schedules deep cleaning is to be performed in shower rooms. Residents Affected - Some 146121 Page 2 of 2