Health inspection·August 3, 2023

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure a resident receiving a transdermal medication patch, only had one medication patch in place during transdermal medication administration. This failure affects one of three residents (R1) reviewed for transdermal medication use on the sample list of six. Residents Affected - Few Findings include: R1's face sheet (8/1/23) documents R1's diagnoses including Parkinson's Disease, Dementia, Anxiety Disorder, and Adult Failure to Thrive. R1's current Physician Order Sheet (POS) documents R1's orders including Exelon (Rivastigmine) (reversible cholinesterase inhibitor) transdermal patch 24-hour 4.6 milligram (mg), apply one patch transdermal at a time related to Dementia. On 8/1/23 at 10:58 AM, V5 (R1's husband) was wheeling R1 back to her room. V5 stated he had concerns with R1's Exelon transdermal patch. V5 stated on 7/2/23 and 7/26/23, R1 had two of the Exelon transdermal patches on her. V5 stated R1 is supposed to have only one patch on her at a time. On 8/1/23 at 3:36 PM, V11 (LPN- Licensed Practical Nurse) stated on 7/2/23, V11 took an Exelon transdermal patch off R1's back before applying a new patch on the other side of R1's back. V11 stated later that day, V5, R1's husband showed V11 that R1 had another patch on R1's arm and R1 had two patches on R1's body. V11 stated she did not see the second patch prior to V5 showing her the patch on R1's arm. V11 stated it did not occur to her to check if R1 had more patches on R1. On 8/1/23 at 4:02 PM, V12 (Agency LPN) stated on 7/26/23, V12 took an Exelon transdermal patch off R1 prior to applying a new patch. V12 stated V12 placed the new patch on R1's right chest. V12 stated V4, R1's daughter showed V12 that R1 had another patch to R1's right back, later after V12 had already removed a patch prior to placing a new patch. R1 had two Exelon transdermal patches on at the same time. On 8/2/23 at 9:37 AM, V2 (DON-Director of Nursing) stated R1 had two Exelon transdermal patches on her on two separate days: on 7/2/23 and 7/26/23. V2 stated R1's family informed V11 and V12 of the multiple patches. V2 also stated there should only be one Exelon patch on R1 per physician order because it can lead to adverse effects of the medication. On 8/2/23 at 9:13 AM, V13 (Pharmacist) stated R1 should have one patch on at a time. V13 stated the downside to having two patches on is that there could be augmentation of the adverse effects of the medication; some of the adverse effects includes increased tremors, increased sedation, upset (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: 146173 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 146173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Springs at Monarch Landing, The 2308 North Route 59 Naperville, IL 60563 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)