Inspection·March 20, 2025

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 Based on observations, interviews and record reviews the facility failed to implement safety interventions and provide supervision to prevent a resident from injury when drinking hot liquids. This failure resulted in R1 sustaining 1st and 2nd degree burns to her chest. This applies to 1 of 3 residents (R1) reviewed for dependent assistance with feeding in a sample of 4. The findings include: R1's electronic health record showed that on 3/9/25, R1 was sent to the local community hospital for evaluation and treatment to burns on her chest. R1 has diagnoses including quadriplegia (loss of motor and sensory function in all four limbs), C5 - C7 complete. On 3/18/25 at 10:50 AM R1, who is alert and oriented, was in her bed with a picture of water and a large cup of ice coffee with extra-long flexible straws that reached R1's mouth. R1 said that on 3/9/25 she was alone drinking her hot cup of coffee. The cup of coffee did not have a lid on the cup, and she used a straw to drink it. R1 said coffee came out of the straw and burned her chest and she was sent to the emergency room for the burns. R1's 3/13/25 11:12 AM Nursing Progress Note showed that on 3/9/25 R1 was sent to the emergency room for burns to her chest due to coffee spillage. The progress note showed that R1 said that the coffee came out of the straw and on to her chest. R1's emergency report of 3/9/25 showed that the left side of R1's chest wall, and along the left side of the clavicle had 1st and 2nd degree burns with 2 areas of blistering. R1's 9/25/24 Fluoroscopic Swallowing Study recommendations showed, supervision 1:1, and liquid viscosity thin, no straws. R1's 3/9/26 MDS (Minimum Data Set) section GG showed that R1 is dependent on staff for eating. R1's 2/17/25 care plan showed R1 is at risk for aspiration with interventions of no straws and assess for residual food in mouth. R1's 3/10/25 Wound Notes showed that R1 had 15.2 cm x 16.8 cm burns to upper chest with a surface area of 255.36 cm, along with fluid filled blisters. The report showed an order for Silver (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 03/20/2025 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)