Health inspection·August 22, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to obtain treatment orders for a resident with pressure injury for 1 of 3 residents (R1) reviewed for pressure injury in the sample of 10.The findings include:R1's Electronic Face Sheet documents R1 was admitted to the facility on [DATE] with diagnosis of Alzheimer's dementia, depression, and anxiety. R1 was on hospice services due to Alzheimer's dementia.R1's Braden Scale (assessment use to predict pressure risks) show R1 was high risk to for pressure injury. R1's admission assessment under skin dated 4/2/25 by V15 (former Administrator/LPN) documents pressure to coccyx as non-staged. Under treatment: {Wound Company} notified, will see R1 on next visit due (4/8/25)R1's Wound Assessment and Plan with initial visit dated 4/15/25 by V17 (Wound MD) show: Wound Location-coccyx, Wound Type-Pressure Injury, Wound Measurements-1.5 centimeters (cm) x 1cm x 0.1 cm. Wound Order: Coccyx wound- cleanse with normal saline or sterile water apply Hydrocolloid to wound every 2 days and PRN.On 8/22/25 at 1PM. V2 (Director of Nursing-DON) said R1 was admitted with pressure injury. V2 (DON) said she thought R1 had wound treatment upon admit. R1 had dressings to coccyx when she checked R1's coccyx wound. V2 also said R1 was supposed to see V17 (Wound Md) on 4/8/25 to obtain treatments but R1 was not on the list to be seen at that time.R1's Electronic Treatment Sheet documents: coccyx wound- cleanse with normal saline or sterile water apply hydrocolloid to wound bed every two days and as needed. Start date 4/15/25 (approximately 13 days after admission).On 8/22/25 at 2:30 PM, V16 (Asst Director of Nursing) said wound treatment should be obtained as soon as the wound was discovered to promote wound healing.The Facility Policy on Skin Prevention, Assessment and Treatment dated 5/7/2024 show, to identify factors that place the residents at risk for the development of pressure ulcers, to promote a systematic approach and monitoring process for the care of residents with existing wounds and for those who are at risk for skin breakdown and to promote healing of existing pressure ulcers. Residents Affected - Few 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: 146123 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 146123 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lacon Rehab and Nursing 401 9th Street Lacon, IL 61540 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)