Inspection·March 28, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide complete incontinent care for 1 of 4 residents (R4) reviewed for incontinence, in the sample of 33. Findings include: On 3/27/2024 at 1:09 PM, during incontinent care, V15, Certified Nursing Assistant (CNA) washed hands with soap and water prior to donning gloves. V15, CNA, unfastened R4's incontinent brief. R4's incontinent brief wet as verified by both V15, CNA and V14, CNA. V15, CNA with washcloth sprayed no rinse peri wash and wiped down right groin, then gets a clean washcloth and swipes down R4's peri area , V15 then gets a clean wash cloth and cleaned R4's left groin. V14 only dried R4's right groin, prior to turning R4 to her right side facing the window. V15 cleansed R4's right buttock with clean washcloth with no rinse peri wash, then with clean washcloth cleansed left buttocks. V15, CNA cleansed R4's rectal area from front to back. V15 did dry R4's buttocks or rectal area prior to applying a clean incontinent brief. R4's Care plan, dated 2/23/2024, documened, (R4) has bladder incontinence related to history of Urinary tract infection (UTI) and bladder re-sectioning. R4's care plan documents INCONTINENT: Check R4 every 2 hours and as required for incontinence. Wash, rinse and dry perineum. R4's Minimum Data Set (MDS), dated [DATE], documented that R4 was dependent on staff for toileting and is frequently incontinent of urine. On 3/28/2024 V17, CNA, stated that when providing incontinent care to a female resident it is expected that the labia is separated and go from front to back . V17 also stated that all areas are to be dried after care is provided. The facility policy, Perineal policy and procedure dated 2015, documented, Female genitalia use gentle downward strokes from the front to the back of the perineum. It continues, Pat dry resident's perineal area with a dry towel. 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 7 Event ID: 146139 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 146139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Care 2120 West Washington Springfield, IL 62702 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)