Inspection·September 10, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide supervision to a cognitively impaired resident, while outdoors, to prevent prolonged sun exposure that resulted in burns to the skin. This applies to 1 of 3 (R1) residents reviewed for improper nursing care. This failure resulted in R1 obtaining full thickness burns to the upper back and posterior neck due to prolonged sun exposure. The findings include: R1 was identified by the facility with a skin condition incident report dated July 28, 2024, and identified on the facility wound report as a resident with full thickness skin injury. R1's New Skin Condition report, dated July 28, 2024, written by V9 (RN) showed R1 was noted with blisters left shoulder to mid back. The report also showed R1 required a cream be applied to R1's face and arms. On September 9, 2024, at 2:43 PM, V9 stated that she recalls R1's face and arms were also discolored and required treatment and stated the skin injuries were determined to be caused by sunburn. R1's Initial Wound Evaluation and Management Summary dated July 29, 2024, documented by V3 (Wound Physician) identified a burn wound to the left upper back full thickness that measured 5.3 x 14.3 x 0.1 cm (centimeters) that required debridement and identified a second wound burn wound to the posterior neck full thickness that measured 2.1 x 1.5 x 0.1 cm. On September 9, 2024, at 3:05 PM, V3 stated the cause of R1's wounds were from sunburn due to prolonged sun exposure. V3 identified R1 as having dementia and stated to prevent sunburn, facility staff should know how long R1 was exposed to the sun especially since R1 was cognitively impaired. V3 stated R1's dementia had also resulted in delayed wound healing due to R1's behavior of removing the wound dressing and not eating resulting in weight loss. R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], with multiple diagnoses including chronic obstructive pulmonary disease, Alzheimer's disease unspecified, fibromyalgia, basal cell carcinoma of the skin overlapping sites, chronic pain syndrome, and adjustment disorder with mixed anxiety and depressed mood. R1's MDS (Minimum Data Set) dated June 25, 2024, showed R1 was severely cognitively impaired, and (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 2 Event ID: 146172 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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)