Countryside Care Center

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure a resident's right to retain and use personal possessions by failing to maintain respect and dignity for the resident and their possessions and safeguard personal possessions for one resident (R4) out of a sample of four residents.

Inspectors wroteBased on interview and record review, the facility failed to document the steps taken to investigate a grievance, summarize the pertinent findings or conclusions and what corrective action was taken by the facility for one resident (R4) out of a sample of four residents.

Inspectors wroteBased on Observation, Interview and Record Review, the facility failed to ensure that direct resident care staffing was adequate to provide timely care and meet the needs of residents in the facility. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to post the Daily Staffing Report for 1/14/26 and failed to keep copies of the Daily Staffing Reports. This failure has the potential to affect all 44 residents residing within the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to maintain sanitary food storage and preparation, failed to label and date opened and prepared food items, failed to ensure food items were free from expiration, failed to wear gloves when checking food temperatures and handling resident meals, and failed to maintain safe holding temperatures for prepared foods on the steam table after reheating. These failures have the potential to affect all 44 residents residing in the facility. Findings Include:The facility's Refrigerators and Freezers policy dated 12/30/2024 documents, Policy Statement, the facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, and will observe food expiration guidelines. Policy interpretation and implementation, 6. All food shall be appropriately dated to ensure proper rotation. [...]

Inspectors wroteBased on interview and record review the facility failed to document the number of Registered Nurses/RNs, Licensed Practical Nurses/LPNs, and Certified Nursing Assistants/CNAs in the Facility Assessment needed to meet the needs of the residents. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on Interview and Record Review, the facility failed to record and track employee reported illnesses. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on Interview and Record Review, the facility failed to offer COVID-19 immunizations to its employees. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure Certified Nursing Assistants (CNAs) were provided and completed Dementia and Abuse training in a 12-month period. This failure has the potential to affect all 44 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide showers as scheduled for six (R4, R6, R7, R22, R23, and R42) of six residents reviewed for Activities of Daily Living (ADL) care in the sample list of 28.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure oxygen therapy equipment was maintained and labeled according to facility policy, and failed to ensure oxygen safety signage was posted for residents receiving oxygen therapy for five (R1, R6, R12, R17, and R34) of five residents reviewed for oxygen therapy in the sample list of 28.

Inspectors wroteBased on observation, interview, and record review the facility failed to clean and disinfect a resident's wheelchair that had brown fecal matter smeared on the seat daily for one of four residents (R34) reviewed for dignity in a sample of 28. Findings Include:The facility's Resident Rights policy dated 11/5/2019 documents, It is the policy of this facility to respect the rights of the resident by providing comprehensive care with an approach aimed at maintaining dignity while respecting the core rights of patients and residents as outlined by the State Department of Public Health, Centers for Medicare and Medicaid (CMS) and Joint Commission of Healthcare Organization (JCAHO). Recognizing that society is dynamic, and the rights of residents are continually evolving; [...]

Inspectors wroteBased on Interview and Record Review, the facility failed to ensure resident mail was delivered unopened for two of nine residents (R42, R47) reviewed for resident rights in the sample of 28.

Inspectors wroteBased on Interview and Record Review, the facility failed to implement their abuse policy when an allegation of staff to resident physical/sexual abuse was received for one of two residents (R12) reviewed for abuse in the sample of 28.

Inspectors wroteBased on Observation, Interview and Record Review, the facility failed to investigate and document an allegation of staff to resident physical/sexual abuse for one of two residents (R12) reviewed for abuse in the sample of 28.

Inspectors wroteBased on interview and record review the facility failed to provide the ombudsman an accurate notification of admission/discharges for one of two residents (R1) reviewed for discharge process in the sample of 28.

Inspectors wroteBased on Interview and Record Review, the facility failed to ensure a residents Minimum Data Set assessment (MDS) was completed accurately to reflect medications for one of three residents (R2) reviewed for Resident Assessment in the sample of 28.

Inspectors wroteBased on record review and interview the facility failed to refer a resident to the PASRR (Preadmission Screening and Resident Review) State Agency to obtain a Level II PASRR after being diagnosed with Schizophrenia for one of five residents (R6) reviewed for Mental Illness in the sample of 28. Findings Include:The Pre-admission Screening and Resident review (PASRR) policy dated 2/2/24 documents This facility coordinates with the preadmission screening and resident review (PASRR) program to ensure that residents are appropriately placed in nursing homes for Long-Term Care. 4. Any level II resident who experiences a significant change in status will be referred promptly to the State mental health or intellectual disability authority for additional resident review. 5. [...]

Inspectors wroteBased on Interview and Record Review, the facility failed to ensure residents with Mental Illness diagnoses were provided the required level two PASARR (Pre-admission Screening and Resident Review) upon admission to the facility for two of five residents (R2, R43) reviewed with PASARR in the sample of 28.

Inspectors wroteBased on interview, and record review, the facility failed to ensure residents consistently received food that was palatable, properly prepared, and consistent with posted menus for three (R1, R2, and R3) of three residents reviewed for dietary services. This has the potential to affect all 47 residents residing in the building.

Inspectors wroteBased on interview and record review the Facility failed to monitor and treat acute medical conditions for two of seven Residents (R4 and R9) reviewed for quality of care in a sample of nine. This failure resulted in R4 and R9 requiring hospitalization.

Inspectors wroteBased on observation, interview, and record review the facility failed to prevent an injury for one of three residents (R1) reviewed for accidents in a sample of nine. This failure resulted in R1 receiving a large hematoma under both eyes and across the bridge of R1's nose causing R1 pain and requiring R1 be sent to the Emergency Room.

Inspectors wroteBased on interview and record review the Facility failed to identify, reconcile, document and investigate a missing controlled substance drug for one of seven Residents (R5) reviewed for controlled substances in a sample of nine.

Inspectors wroteBased on observation, interview, and record review the facility failed to prepare and serve palatable food. This failure has the potential to affect all 47 residents residing in the facility.

Inspectors wroteBased on record review and interview the facility failed to offer bedtime snacks daily. This failure has the potential to affect all 47 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure the kitchen ovens were maintained and in operating condition. This has the potential to affect all 47 residents residing in the facility.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure mechanical lift machines used to transfer dependent residents were safe and in good repair for five of five residents (R1, R4, R27, R38, and R39) reviewed for accidents in the sample of 38.

Inspectors wroteBased on observation, interview, and record review the facility failed to ensure medications were stored in their original packaging until administered for 18 of 18 residents (R1, R2, and R8-R23) reviewed for medication storage in the sample of 38.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement hand hygiene and apply new gloves between dirty to clean wound dressing changes and failed to apply pressure ulcer treatments as ordered by the physician for one of three residents (R1) reviewed for pressure ulcers in the sample of 38.

Inspectors wroteBased on observation, interview, and record review the facility failed to implement Enhanced Barrier Precautions (EBPs) and failed to change gloves and complete handwashing after performing catheter care for one of four residents (R1) reviewed for infection control practices in a sample of 38.

Inspectors wroteBased on record review and interview, the facility failed to check the temperature of a hot beverage before serving and failed to assist and supervise a resident dependent with eating for one of three residents (R1) reviewed for quality of care in the sample of three. These failures resulted in R1 spilling hot chocolate on herself and sustaining a second degree burn on her left hip/thigh causing R1 pain.

Inspectors wroteBased on interview and record review the facility failed to notify family, physician, and Illinois Department of Public Health/IDPH of an injury for one of three residents (R1) reviewed for quality of care in the sample of three.

Inspectors wroteBased on interview and record review the facility failed to correctly enter and follow a physician's order for one resident of three residents (R1) reviewed for steroid injections in the sample of three.

Inspectors wroteBased on record review, observation and interview, the facility failed to employ a Dietary Manager with the appropriate competencies and skill to carry out the functions of Food Service Director. This failure has the potential to affect all 46 residents currently residing in the facility.

Inspectors wroteBased on record review, observation and interview, the facility failed to ensure appropriate infection control practices were utilized in the Laundry Room, failed to ensure Legionella Risk Assessments were conducted annually and accurately with the designated team members, and failed to utilize Enhanced Barrier Precautions during a wound treatment for one (R1) of two residents reviewed for wound care in a sample of 24 residents. These failures have the potential to affect all residents who reside in the facility with a current census of 46 residents.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a resident ingested his medications for one resident (R2) of 24 residents reviewed during a routine medication pass observation. Findings Include: The Facility's Administering Medication policy dated 3/19/2020 documents the purpose of the policy and procedure is to ensure safe and effective administration of medication in accordance with physician orders and state/federal regulations. The Facility's Administering Medication policy also documents Medications will remain secured in a locked cabinet/cart unless in direct view of the individual administering the medication. Self administration of drugs is permitted when approved by the attending physician and the interdisciplinary care planning team. [...]

Inspectors wroteBased on record review and interview the facility failed to have a completed discharge summary for one (R48) of one resident reviewed for discharge in a total sample of twenty four. Findings Include: The Facility's Transfer/Discharge policy dated 11/05/2023 documents The interdisciplinary team and or physician, in consult with the resident or his/her Power of Attorney for healthcare, may recommend transfers or discharges. Information vital for discharges to home include: a. Interdisciplinary discharge summary. R48's Interdisciplinary Discharge Summary for resident dated 10/16/2024 is filled out for Nursing Service Summary. The following areas on the Interdisciplinary Discharge Summary are blank : medications, social service summary, dietary service summary, activity service summary and rehab service summary. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were transported to appointments as needed for one (R17) of three residents reviewed for transportation, failed to assess, document and provide appropriate treatment for a fungal infection for one (R8) of three residents reviewed for non-pressure skin impairments and failed to utilize a wheelchair positioning cushion for one (R8) of 14 residents reviewed for positioning in a total sample of twenty four. Findings Include: 1. The Transportation of Residents policy, dated 11/1/15, documented the facility will assist the resident in making transportation arrangements to and from the source of a service if the resident needs assistance. The Transportation calendar dated November 2024 documented R17 had a dental appointment on 11/19/24 at 11:15 AM. [...]

Inspectors wroteBased on record review and interview the facility failed to identify triggers for PTSD (Post Traumatic Stress Disorder) and develop and care plan interventions related to PTSD for one (R31) of two residents reviewed for PTSD in a total sample of twenty four. Findings Include: R31's current medical record includes a Trauma Informed Care Screen, dated 2/26/24, documents R31 answered Yes when asked if he has experienced traumatic events. This trauma screen also documents R31 answered Yes when asked if has had nightmares about the event(s) and if (he) has tried hard not to think about the event(s), and if R31 went out of (his) way to avoid situations that reminded (him) of the event(s). The section of R31's Trauma Informed Screen, titled Potential Trigger(s) that May Cause a Reaction from Trauma Event is left blank, with no potential triggers documented nor interventions for the triggers. [...]

Inspectors wroteBased on record review and interview, the facility failed to ensure the antibiotic stewardship program accurately monitored infections and antibiotic use per policy for three of three residents (R7, R17, R25) reviewed in a sample of 46 residents.

Inspectors wroteBased on interview and record review the facility failed to implement post fall interventions for one (R1) of three residents reviewed for falls in the sample list of four.

Inspectors wroteBased on interview and record review the facility failed to develop a plan of care for the use of an antipsycotic medication, implement behavioral interventions, and limit a prn (as needed) antipsychotic medication to 14 days. This failure had the potential to affect one (R1) of three residents reviewed for medications in the sample list of four.

Inspectors wroteBased on record review and interview the facility failed to ensure one of three residents (R1) reviewed for mechanically altered diets was served the Physician ordered diet. This failure resulted in R1 receiving the wrong texture of diet causing R1 choking on his food requiring back thrusts, the Heimlich maneuver and transfer to the local area hospital. This failure also put R1 at risk for death and/or brain damage from lack of oxygen due to choking. These failures resulted in an Immediate Jeopardy. Findings Include: The Immediate Jeopardy began on 6/23/24 at 5:50 PM when the facility failed to provide the proper mechanically soft diet with ground meat and gravy on all meats as ordered for R1. [...]

Inspectors wroteBased on interview and record review the facility failed train dietary staff on safe food handling or any other type of dietary specific training. This failure has the potential to affect all 49 residents who reside in the facility. Findings Include: The Facility's Diet Aid job description dated 10/2016 documents diet aids must have passed the Food Protection Manager exam or be willing to take the course approved by the facility is in. and Must receive food handler training within 30 days of employment. The Facility's Dietary Staff Schedule lists the following people work in the kitchen V4 (Dietary Manager), V11 (Day Cook), V14 (Day Cook), V15 (Evening Cook), 16 (Evening Aide), V5 (Day Aide), V12 (dishwasher), and V13 (Evening Aide). On 7/24/24 at 11:00 AM V5 (Dietary Aide) stated I have not been trained on anything in the kitchen. [...]

Inspectors wroteBased on interview and record review the facility failed to have adequate staffing in their dietary department. This failure has the potential to affect all 49 residents who reside at the facility. Findings Include: On 7/24/24 at 10:00 AM V4 (Dietary Manager) stated she took the dietary manager position over on July 1, 2024, after V7(Previous Dietary Manager) was terminated. V4 stated that she had been a dietary aide since June 2023. V4 reports that the schedules were usually done on paper and then thrown away. V4 stated there was no consistency to anyone's schedule, a lot of times people had to work alone and that wasn't right. It's too much to do with just one person. On 7/24/24 at 1:00 PM V5 (Dietary Aid) stated I have had no training and prior to (V4/Dietary Manager) taking over, I worked by myself most nights, so meals were always late. I had no idea what I was doing. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to accurately administer physician ordered GlucaGen (injectable medication to increase blood sugar) according to the physician order for a resident with Type II Diabetes Mellitus and already elevated blood glucose (sugar) levels, for one of three residents (R1) reviewed for Medications in the sample of three. This failure resulted in R1's hyperglycemia worsening and requiring R1 to be transferred to the emergency room for treatment to lower her blood glucose. Findings Include: The facility's Adverse Drug Reactions and Medication Discrepancy policy, dated 10/2006, documents A medication discrepancy/error has been made when one of the following occurs: [...]

Inspectors wroteBased on interview and record review the facility failed to prevent misappropriation of property for 1 resident (R1) of 3 residents reviewed for misappropriation of property in the sample of 4.

Inspectors wroteBased on observation, interview, and record review, the facility failed to administer pain medication as ordered and assess pain on a daily basis following a fall that resulted in a fracture for one of one resident (R30) reviewed for pain in the sample of 23. These failures resulted in R30 having intractable pain related to a new rib fracture.

Inspectors wroteBased on observation, interview, and record review, the facility failed to perform and document the food cooling process of a hazardous food. This failure had the potential to affect all 40 residents residing in the facility.

Inspectors wroteBased on interview, observation and record review, the facility failed to label, and date opened food items in the kitchen, monitor food temperatures, monitor the sanitizer levels of the dishwasher prior to washing dishes, and monitor refrigerator freezer temperatures. This has the potential to affect all 40 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure Certified Nursing Assistants were provided with Dementia training yearly. This failure has the potential to affect all 40 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to prevent resident to resident physical abuse for two of two residents (R20, R25) reviewed for abuse in the sample of 23.

Inspectors wroteBased on interview and record review, the facility failed to report an incident of physical abuse to the State Agency for two of two residents (R20, R25) reviewed for abuse in the sample of 23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a comprehensive care plan for the use of an anticoagulant, use of insulin, a UTI (Urinary Tract Infection), and a new fracture/pain for two of 13 residents (R6, R30) reviewed for care plans in the sample of 23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement new interventions following a fall with a fracture for one of three residents (R30) reviewed for falls in the sample of 23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to document justification for the increase of an antipsychotic, and document behaviors to warrant the use of an antipsychotic for one of five residents (R30) reviewed for psychotropics in the sample of 23.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure dental services were provided to a resident for one of one resident (R30) reviewed for dental services in the sample of 23.