Health inspection·May 12, 2023

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to safely store respiratory care therapy tubing and masks after the therapy. Residents Affected - Some This applies to 5 of 5 residents (R27, R65, R67, R81, and R291) reviewed for respiratory equipment in a sample of 18. Findings include: 1. On 5/10/2023 at 10:01 AM, R81's nebulizer tubing and mouthpiece were observed uncovered and undated. The nebulizer tubing and mouthpiece were hanging from her nightstand and touching the floor. R81's uncovered oxygen tubing was observed on her wheelchair, uncovered and undated. R81's POS (Physician Order Sheet), dated 4/28/2023, showed an order for oxygen at two liters per minute to keep oxygen saturation above 92 percent. On 5/11/2023 at 10:25 AM, V2 (DON-Director of Nursing) stated all oxygen and nebulizer tubing and mouthpieces should be dated to reflect the date the tubings were changed. She said oxygen and nebulizer tubings and mouthpieces should be placed in a plastic bag when not in use for infection control. She said the oxygen and nebulizer tubings and mouthpieces should never be touching the floor. 2. On 5/9/23 at 2:45 PM, R65's oxygen cannula, nebulizer tubing, and mouthpiece were uncovered and undated. R65's face sheet shows a diagnosis of dyspnea, emphysema, obstructive sleep apnea, obstructive sleep apnea, atrial fibrillation, and anxiety. MDS (Minimum Data Set), dated 04/10/2023 shows R65 is cognitively intact. A review of R65's Physician Order Sheet, dated 04/22/2023 and 05/03/2023, showed R65 had orders for oxygen 2 liters per minute per nasal cannula as needed to maintain an oxygen saturation level at 92 percent or above, and an albuterol inhaler three milliliters twice daily and as every four hours as required respectively. Notified V3 (Registered Nurse) walking by in the hallway, and V3 said respiratory tubing and masks need to be stored properly.3. On 5/10/2023 at 9:01 AM, R67's nebulizer tubing and mouthpiece were on top of her nightstand, uncovered, and undated. R67's POS (Physician Order Sheet), dated 4/4/2023, shows an order for Ipratropium-Albuterol inhalation solution 0.5 - 2.5 milligram per 3 milliliters every six hours for shortness of breath. POS, Page 1 of 4 146192 146192 05/12/2023 Thrive of Lisle 2850 Ogden Avenue Lisle, IL 60532

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dated 4/10/2023, shows an order for oxygen at two liters per minute per nasal cannula to keep oxygen saturation above 92 percent. R67's EMR (Electronic Medical Record) showed R67 had a diagnosis of acute respiratory failure with hypoxia, pneumonia, and pleural effusion. 4. On 5/10/2023 at 9:25 AM, R27's oxygen tubing and nasal cannula was observed hanging on the oxygen regulator attached to the wall. The tubing and nasal cannula were uncovered and undated. R27's POS, dated 4/26/2023, shows an order for oxygen at 2 liters per minute per nasal cannula to keep oxygen saturation above 92 percent. 5. On 5/10/2023 at 10:29 AM, R291's oxygen tubing and nasal cannula was observed uncovered and undated on his nightstand. R291's POS, dated 5/5/2023, showed an order for oxygen at two liters per minute per nasal cannula to maintain oxygen saturation above 92 percent. Facility's Oxygen/Nebulizer/Bipap/Cpap Tubing Policy dated September 2022 stated . 1. Residents requiring nebulizer, oxygen and/or CPAP/BIPAP therapy will have tubing stored in a clean container and/or bag when not in use. 146192 Page 2 of 4 146192 05/12/2023 Thrive of Lisle 2850 Ogden Avenue Lisle, IL 60532

F 0761 Level of Harm - Minimal harm or potential for actual harm Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to safely store resident medications. Residents Affected - Few This applies to 3 of 3 residents (R29, R291, R284) reviewed for medication storage in a sample of 18. Findings include: 1. R29's Face sheet shows a diagnosis of dementia, and R29's MDS (Minimum Data Set) shows severely impaired cognition. R29's POS (Physician Order Sheet) states to apply antifungal powder to groin topically every 12 hours, 9am and 9pm, for rash. R29's Care Plan, dated 4/7/23, shows R29 has impaired safety awareness and staff should educate the resident and caregivers about safety reminders and anticipate and meet the resident's needs. On 5/9/23 at 10:17AM, 5/10/23 at 12:58PM, and 5/11/23 at 12:50PM, Miconazole nitrate 2% antifungal powder medication was observed in R29's room on his nightstand. On 5/11/23 at 12:52PM, V5, LPN (Licensed Practical Nurse), said R29 gets the antifungal powder for redness in his groin, but the medication has to be kept in the medication cart. V5 (LPN) said the medication should not be left at the bedside because R29 is confused, and might mistake the medication for something else. On 5/11/23 at 2:11PM, V2, DON (Director of Nursing), said R29 is absolutely not allowed to have medications at his bedside. V2 said R29 is cognitively impaired, and R29 could ingest the antifungal powder, causing harm to himself. 2. On 5/9/2023 at 11:33 AM, a bottle of Acetaminophen 500 mg was observed on R291's nightstand. He stated that medication was brought in by his daughter on 5/6/2023. The medication did not have resident's name on it. On 5/9/2023 at 12:22 PM, V8 (RN-Registered Nurse) stated R291 has no order for Acetaminophen 500 mg, and has no order for self-administration of medication. R291's POS (Physician Order Sheet) on 5/9/2023 at 12:30 PM did not show order for Acetaminophen 500 mg, and no order for Acetaminophen 500 mg to be self-administered and kept at bedside. R291's EMR (Electronic Medical Record) shows diagnosis of dislocated left shoulder and gout. 3. On 5/10/2023 at 11:20 PM, Fluticasone Furoate Inhalation Powder 200 mcg (micrograms) was observed on R284's bedside table. She said the nurse left it there after medication was administered. On 5/10/2023 at 11:25, V7 (RN) said the Fluticasone Furoate Inhalation Powder 200 mcg should be kept in the medication cart. She stated R284 did not have an order to keep the inhaler by the bedside and had no order to self-administer the inhaler. 146192 Page 3 of 4 146192 05/12/2023 Thrive of Lisle 2850 Ogden Avenue Lisle, IL 60532

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R291's POS reviewed, no order for Fluticasone Furoate Inhalation Powder 200 mcg to be kept at bedside. R284's EMR shows she diagnosis of asthma. On 5/10/2023 at 9:52 AM, interview with V2 (DON-Director of Nursing) stated all medication had to be stored in the medication cart or medication room. She stated there is only one resident in the facility with an order to keep medication by bedside and order to self-administer medication. She said she expects staff to be aware when family brings in medication from home and to take the medication, inform the physician and obtain order for the medication. Facility's Medication at Bedside Policy revised on 5/2023 stated . 2. Physicians must provide an order for medication to be kept at bedside. Facility's Medication Labeling and Storage Policy dated January 2020 did not show any information on medication storage. 146192 Page 4 of 4