Health inspection·September 1, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to properly supervise a resident requiring supervision during meals. This applies to 1 of 1 resident (R20) reviewed for supervision in a sample of 17. The findings include: On 08/29/2023 at 11:43 AM, R20 was in his room while the other residents and staff were in the dining room being served for lunch. Staff delivered R20's meal tray to his room. On 08/30/2023 at 12:11 PM, R20 was again observed with his meal tray in his room without any staff supervising him eating his meal. On 08/31/2023 at 8:41 AM, R20 was observed in his room with his meal tray without any supervision from staff. On 08/31/2023 at 10:38 AM, R20 had a straw in his beverage cup. The beverage cup had nectar thick written around the top rim of the cup. On 08/31/2023 at 10:43 AM, V11 (Certified Nurse Assistant/CNA) said R20 ate in his room and would take a long time to eat his food. V11 said he watches TV and gets distracted by the TV. V11 said she had not received any instructions on how R20 should be set up to eat. On 08/31/2023 at 12:17 PM, V10 (Registered Dietician) said R20 was on a nectar thick diet. V10 said R20 was supposed to have line of sight supervision with all meals and encouragement. V10 said R20 should be eating his meals in the dining room so that there is supervision for dysphagia and encouragement to eat meals. V10 said with the dysphagia diet, R20 was at an increased risk for choking. On 08/31/2023 at 12:31 PM, V13 (Director of Rehab Services) said R20 had aspiration precautions ordered for him. V13 said R20 was not supposed to use a straw and required line of sight supervision for intake. V13 said line of sight supervision meant staff should always be able to see the resident. On 08/31/2023 at 12:32 PM, V15 (CNA) delivered R20's meal tray to his room for lunch service. Staff did not provide supervision for R20. On 08/31/2023 at 12:42 PM, V2 (Director of Nursing) said line of sight supervision would mean the resident should be within view of the staff. V2 said if the resident had aspiration precautions, he or she should be observed during mealtimes. V2 said R20 should not be eating by himself in his room. Page 1 of 7 146183 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0689 On 08/31/2023 at 1:22 PM, R20 still had a straw in his nectar thick beverage cup. Level of Harm - Minimal harm or potential for actual harm On 08/31/2023 at 1:29 PM, V9 (Unit Manager/Scheduling and Staffing) said anyone who was on a nectar thick diet should not use straws. V9 said R20 should not have a straw in his beverages and if they were on aspiration precautions, they could choke using a straw. Residents Affected - Few On 08/31/2023 at 1:45 PM, V2 said if a resident was on aspiration precautions, they should not be using a straw. On 08/31/2023 at 2:09 PM, V2 said the facility did not have any policies on aspiration precautions or supervision with meals. V2 was unable to provide policies. R20's POS (Physician Order Sheet) showed an order for nectar thick consistency. R20's POS also shows directions for line of sight supervision during meals. R20's Nutrition assessment dated [DATE] showed R20 required line of sight supervision for eating. R20's progress note dated 07/11/2023 at 6:54 PM showed R20 requires supervision/line of sight at meals. R20's progress note dated 08/07/2023 at 10:15 AM showed R20 required supervision/line of sight at meals. 146183 Page 2 of 7 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to serve food at a safe temperature. This applies to 1 of 6 residents (R5) reviewed for pureed food temperatures in a sample of 17. Residents Affected - Few Findings include: On 8/30/23 at 11:17 AM, food temperatures were checked on the steam table in the facility's East pantry by V6 (Dietary Aide). The pureed potato measured 132 degrees F and the pureed vegetable measured 127 degrees F. At 11:25 AM, V6 said the pureed potato and pureed vegetable were not safe to serve, they must measure 135 degrees F. V6 then placed the pureed cornbread, pureed potato, pureed beef brisket, and pureed vegetable in the hot box. V6 said the hot box would reheat the foods placed inside. On 8/30/23 at 11:40 AM, V7 (Activity Aide) came into East pantry and asked V6 (Dietary Aide) for a pureed tray for R5. V6 then removed the pureed foods from the hot box and served pureed beef brisket, pureed vegetable, and pureed cornbread onto R5's plate. V6 then handed the plate to V7 and V7 turned to leave the pantry to bring the plate to R5. Surveyor then stopped V7 and asked V6 if he needed to recheck the temperatures. V6 said yes. V6 rechecked the temperatures with the following results: pureed beef-126 degrees F, pureed cornbread- 131 degrees F, and pureed vegetable- 128 degrees F. V6 said that plate was not safe to serve. On 8/31/23 at 11:08 AM, V8 (Dietary Supervisor) said foods on the steam table need to be held at 135 degrees or above. On 8/30/23 at 12:13 PM, V5 (Executive Chef) said the plate of pureed food should have been reheated prior to serving it to R5 to get rid of any risk of foodborne illness. The facility's policy titled, Flow of Hot Food from Preparation to Service revised 6/18 states, Policy: Hot food will be handled safely from preparation to resident service. Purpose: to reduce the risk of foodborne illness. Procedure: .3 .If hot food is below 135 degrees F it will be rapidly reheated to 165 degrees F . 146183 Page 3 of 7 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to properly label, date, seal, and store food items in the kitchen. This applies to all 44 residents that receive oral nutrition and foods prepared in the facility kitchen. Findings include: The Facility Resident Census and Condition of Residents (Form CMS-Centers for Medicare and Medicaid Services-672) dated 8/29/23 documents the total census was 44 residents. On 8/30/23 at 1:40 PM, V1 (Administrator) said there are no NPO (Nothing by Mouth) residents. V1 said all 44 residents eat from the facility kitchen. On 8/29/23 starting at 10:15 AM, the facility kitchen was toured in the presence of V5 (Executive Chef). On 8/29/23 at 10:27 AM in the dry storage room, 1 large cardboard box of lasagna noodles was found opened and not sealed with the date cut-off. The date showed /17/23, the month was not shown. On 8/29/23 at 10:36 AM, in the walk-in refrigerator, 1-large cardboard box labeled green leaf lettuce with a pack date of August 1st was found. The lettuce was browning and wilted. On 8/29/23 at 10:36 AM, V5 (Executive Chef) said all food should have a received by date so the kitchen staff know when to use the foods by and V5 said the lettuce should be thrown away. On 8/29/23 at 10:42 AM, in the walk-in refrigerator the following was found: 1 large cardboard box with 2 bunches of browning celery with a pack date of July 24th. 1 pint of cherry tomatoes, not dated with white fuzz growing on underside of container. 1 large cardboard box of bagged baby spinach not dated. 1 large full cardboard box of browning/wilted celery bunches not dated. 4 cantaloupes in cardboard box, not dated. The following day, on 8/30/23 at 9:31 AM, the walk-in refrigerator was again toured in the presence of V5 (Executive Chef). The wilted and browning celery and lettuce were still in the refrigerator as well as the pint of cherry tomatoes with white fuzz on it. The walk-in refrigerator also had 2 large cardboard boxes of 24 count cucumbers with no date on either box. At 9:34 AM, 2 large trays of not labeled, dated, or covered cut lemon cake were observed on racks in the refrigerator. On 8/30/23 at 9:26 AM, V5 said the vegetables that were observed the day before were still in the refrigerator, that he had not thrown them out yet. V5 said all food should have a label and date so the kitchen staff know when food should be thrown away to prevent foodborne illness. On 8/31/23 at 10:46 AM, V8 (Dietary Supervisor) said all foods should be labeled and dated to 146183 Page 4 of 7 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many prevent spoiled food from being given to the residents and making them sick. V8 said all foods need to be sealed to prevent contamination. On 8/31/23 at 11:53AM, V5 (Executive Chef) said according to the FDA (Food and Drug Administration) Food Keeper Application, celery is safe to store in the refrigerator and serve for 1-2 weeks and lettuce is safe to store in the refrigerator and serve for 3-7 days. The facility's policy titled, Labeling and Dating revised 7/23 states, Policy: Ready-to-eat time/temperature control for safety foods may be stored in the refrigerator .for 7 days. Purpose: To reduce the risk of food borne illness. Procedure: .4. Ready-to-eat PHF (Potentially Hazardous Food) may be kept for 7 days in the refrigerator .6 Based on the food item, which each have a different shelf life the facility will discard any food item that shows signs of spoilage. Facility will review USDA Food Keeper app to determine how long that food can be stored for. The facility's undated policy titled, Handling of Fresh Fruits & Vegetables states, Policy: fresh fruits and vegetables will be stored and handled to maintain healthful standards. Purpose: to reduce the risk of and the spread of infestation and food borne illness. Procedure: .2. Fruits and vegetables will have a delivery or packed date noted on container or package which serve as delivery date 7. Based on the fruit or vegetable, which each have a different shelf life the facility will discard any fresh fruits or vegetables that show signs of spoilage. Facility will review FDA (Food and Drug Administration) Food Keeper app to determine how long fresh fruit or vegetable can be used for. 146183 Page 5 of 7 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to utilize an appropriate standardized tool/system to justify or warrant the necessity of an antibiotic. This applies to 8 of 8 residents (R1, R4, R11, R12, R13, R17, R26, R27) reviewed for antibiotic stewardship in a sample of 17 and has the potential to affect all residents. Residents Affected - Many The findings include: 1. R1's face sheet documents an admission date of 7/15/20. R1's POS (Physician Order Sheet) for May 2023 documents orders of the following antibiotics: Cefuroxime Axetil Oral Tablet 500 MG (Milligrams): Give 1 tablet by mouth two times a day for UTI (Urinary Tract Infection) for 7 days. Diflucan Oral Tablet 100 MG (Fluconazole): Give 1 tablet by mouth one time a day for Vaginal Discharge for 7 days. R1's Lab Results Reports for urine cultures for 5/11/23 and 5/14/23 shows positive for Klebsiella oxytoca. 2. R4's face sheet documents an admission date of 12/15/22. R4's POS for June 2023 shows an order of Amoxicillin-Potassium Clavulanate Tablet 500-125 MG: Give 1 tablet by mouth two times a day for UTI for 5 days. R4's Lab Results Reports for urine culture for 6/9/23 shows positive for Enterococcus. 3. R11's face sheet documents an admission date of 4/12/29. R11's POS for April 2023 shows an order of Ciprofloxacin HCL Ophthalmic Solution 0.3%: Instill 1 drop in left eye every 6 hours for Conjunctivitis for 5 days. 4. R12's face sheet documents an admission date of 6/8/23. R12's POS for July 2023 shows an order for Levaquin Tablet 500 MG (Levofloxacin): Give 1 tablet by mouth one time a day for UTI for 7 days. R12's Lab Results Reports for urine culture for 7/14/23 shows positive for Escherichia. 5. R13's face sheet documents an admission date of 11/17/21. R13's POS for August 2023 shows an order for Levaquin 500 MG: Give 1 tablet by mouth one time a day for infection for 10 days order. 6. R17's face sheet documents an admission date of 4/26/23. R17's POS for August 2023 shows an order of Doxycycline Hyclate Oral Capsule 100 MG: Give 1 capsule by mouth two times a day for left heel wound for 14 days. R17's Lab Results Report for the wound culture many gram-positive cocci---Streptococcus Agalactiae 146183 Page 6 of 7 146183 09/01/2023 Alden Courts of Shorewood 700 West Black Road Shorewood, IL 60404

F 0881 (Group B). Level of Harm - Minimal harm or potential for actual harm 7. R26's face sheet documents an admission date of 1/18/21. Residents Affected - Many R26's POS for August 2023 documents an order of Macrobid Oral Capsule 100 MG (Nitrofurantoin Monohyd Macro): Give 1 capsule by mouth two times a day for UTI for 3 days. R26's Lab Results Reports for urine culture for 7/28/23 shows positive for Enterococcus. 8. R27's face sheet documents an admission date of 6/2/21. R27's POS for March 2023 documents an order for Amoxicillin-Potassium Clavulanate Tablet 500-125 MG. Give 1 tablet by mouth one time a day for UTI for 5 days. R27's urine culture report for 3/2/23 shows positive for Klebsiella. Review of R1, R4, R11, R12, R13, R17, R26, and R27's electronic medical record and facility's infection control binder did not contain a standardized tool, such as McGreer's critieria to justify the necessity of the antibiotics. On 8/30/23 at 1:41 PM, V2 (Director of Nursing/Infection Preventionist) stated I don't have McGreer's criteria for these residents. Yes, there should be one. I didn't get time to start the McGreer's criteria on all the residents who were put on antibiotics in August. We don't have a policy regarding McGreer's criteria. I don't have an ADON (Assistant Director of Nursing) to help me. The facility was unable to provide a specific policy regarding a standardized screening tool, such as the McGreer's tool, to track antibiotics and appropriately treat infections. Facility's Policy titled Infection Prevention and Control Program (4/2021) documents: It is the policy that the facility's Infection Prevention and Control Program (IPCP), is based upon information from the Facility Assessment and follows national standards and guidelines to prevent, recognize, and control the onset and spread of infection whenever possible. The infection Prevention and Control Program includes: 3. An antibiotic stewardship program that uses antibiotic protocols and a system to monitor antibiotic use. Antibiotic Stewardship and review include reviewing data to monitor the appropriate use of antibiotics in the resident population. F. Monitor antibiotic use to help determine if appropriate. 146183 Page 7 of 7