Mount Vernon Countryside Manor

Inspectors wroteBased on observation, interview and record review the facility failed to ensure a medication cart was kept locked when out of staffs visual control. This has the potential to affect all 83 residents living at the facility.

Inspectors wroteBased on observation, interview and record review the facility failed to ensure the kitchen was clean and sanitary. This has the potential to affect all 83 residents residing in the facility. The Findings Include:During the lunch meal service on 3/24/26 at 11:30 AM the following observations were made: the cart that holds the clean plates for meal service was full of crumbs/old food debris, open shelves under preparation tables were dusty with food crumbs/dried drink spills, the top of the convection oven was dirty with food debris and grease buildup, the stationary cabinets underneath were littered with dropped dishes/paper trash/dirt, gnats were seen throughout the kitchen, underneath the juice machine was spilled dried juice, the floor appeared to be sticky and appeared to not have been mopped under the carts and stationary tables. [...]

Inspectors wroteBased on observation, interview and record review the facility failed to treat residents with dignity during mealtimes for 1 of 1 resident (R34) reviewed for dignity in a sample of 34.

Inspectors wroteBased on interview and record review, the facility failed to maintain a functional status of mobility for 1 (R34) of 1 residents reviewed for ADL (Activities of Daily Living) in the sample of 34.

Inspectors wroteBased on interview, observation, and record review the facility failed to ensure a resident with limited range of motion received appropriate treatment and services to prevent further decrease in range of motion for 1 (R46) of 18 residents reviewed for position and mobility in the sample of 34. The Findings Include: R46's face sheet documents R46 was recently readmitted to the facility on [DATE]. The diagnoses listed include displaced intertrochanteric fracture of left femur, dementia, conversion disorder with seizures, hypertensive chronic kidney disease, mixed hyperlipidemia, hypothyroidism, chronic obstructive pulmonary disease, and Parkinson's Disease. R46's current orders document on 09/03/2025 an order for restorative active range of motion to be completed 6-7 times a week every shift. [...]

Inspectors wroteBased on interview and record review, the facility failed to obtain daily weights per physicians orders for a resident with a history of weight loss for 1 of 4 residents (R5) reviewed for weight loss in the sample of 34.

Inspectors wroteBased on interview and record review, the facility failed to weigh a dialysis resident daily per physicians orders and to maintain regular communication with the dialysis center about post dialysis weights for one resident of one resident (R3) reviewed for dialysis in the sample of 34.

Inspectors wroteBased on observation, interview, and record review the facility failed to follow infection control practices for 2 (R10 and R96) of 6 residents reviewed for infection control in the sample of 34.

Inspectors wroteBased on interview, observation, and record review, the facility failed to properly secure a resident's wheelchair into the facility van for 1 of 3 residents (R1) reviewed for accidents in the sample of 3. This past non-compliance occurred between 9/19/25 and 9/20/25.

Inspectors wroteBased on observation, interview, and record review, the facility failed to utilize PPE (Personal Protective Equipment) per CDC (Centers for Disease Control) guidelines when coming in contact with Covid positive residents. This has the potential to affect all 74 residents living at the facility.

Inspectors wroteBased on interview and record review the facility failed to implement dietary supplements as ordered for 4 (R39, R44, R45 and R63) of 8 residents reviewed for nutrition in a sample of 36. This failure resulted in R63 experiencing a 7.88 percent weight loss within one month.

Inspectors wroteBased on observation, interview, and record review, the facility failed to provide the correct physician's ordered diet and dietary recommendations for 3 of 12 residents (R5, R26, R44) reviewed for therapeutic diets in the sample of 36.

Inspectors wroteBased on interview and record review the facility failed to maintain range of motion for 1 (R25) of 1 resident reviewed for decreased range of motion in the sample of 36. The findings Include: R25's Face Sheet documented R25 as a [AGE] year-old with an admission date of 08/02/2024 to the facility. Diagnoses listed are chronic respiratory failure, type 2 diabetes mellitus with diabetic neuropathy, morbid obesity, chronic obstructive pulmonary disease, venous insufficiency, chronic systolic congestive heart failure, obstructive sleep apnea, major depressive disorder, essential hypertension, non - pressure chronic ulcer of other part of right lower leg, and atherosclerosis of native arteries of right leg with ulceration of other part of lower leg. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure residents were free from unnecessary psychotropic medications for 1 (R25) of 5 residents reviewed for unnecessary medications in the sample of 36. The Findings Include: R25's Face Sheet documented R25 as a [AGE] year old with an admission date of 08/02/2024 to the facility. Diagnoses listed are chronic respiratory failure, type 2 diabetes mellitus with diabetic neuropathy, morbid obesity, chronic obstructive pulmonary disease, venous insufficiency, chronic systolic congestive heart failure, obstructive sleep apnea, major depressive disorder, essential hypertension, non - pressure chronic ulcer of other part of right lower leg, and atherosclerosis of native arteries of right leg with ulceration of other part of lower leg. [...]

Inspectors wroteBased on interview and record review the facility failed to use the appropriate size shower chair for 1 (R1) of 4 residents reviewed for accidents in the sample of 4. This failure resulted in R1 sliding down in the chair into the open part, causing an acute impacted fracture of the left femoral neck. This past non-compliance occurred between 07/10/2024 and 07/16/2024.

Inspectors wroteBased on interview and record review, the facility failed to report an allegation of abuse to the Illinois Department of Public Health (IDPH) for 1 of 4 residents (R1) reviewed for abuse in the sample of 6.

Inspectors wroteBased on interview and record review, the facility failed to initiate and conduct a thorough investigation of an allegation of abuse for 1 of 4 residents (R1) reviewed for abuse in a sample 6.

Inspectors wroteBased on interview and record review, the facility failed to provide timely physician notification of symptoms of a urinary infection and timely collection of specimens for 1 (R22) of 1 resident reviewed for Urinary Tract Infections in the sample of 60. This failure resulted in R22 experiencing untimely treatment of a Urinary Tract Infections with symptoms of pain and burning expressed by R22 beginning on 2/15/24, with antibiotic treatment not initiated until 2/28/24. Findings Include: R22's face sheet documents an admission date of 12/29/17 to the facility and includes the following diagnoses: major depressive disorder, need for assistance with personal care, and disorder of kidney and ureter. R22's most recent completed MDS (Minimum Data Set) dated 11/7/23 Section C documents a BIMS (Brief Interview of Mental Status) score of 15, indicating that R22 is cognitively intact. [...]

Inspectors wroteBased interview and record review the facility failed to ensure the Activity Director had the appropriate qualification to conduct the activity program of the facility. This has the potential to affect all 87 residents living in the facility.

Inspectors wroteBased on observation, interview and record review the facility failed to properly store and label food items, failed to maintain the ice machine in a safe and sanitary manner and failed to prevent potential cross contamination of food and food contact areas by staff not wearing hair restraints. This has the potential to affect all 87 residents that reside in the facility. The Findings Include: During the initial tour of kitchen on 2/27/24 at 8:30 AM the following concerns were observed: 1. A package of waffles were found in the walk in cooler not dated and open to air not sealed back up. 2. Margarine spread buckets were open/partially used and not dated or labeled. 3. Yellow shredded cheese was open, and half used not dated or labeled. 4. Lunch meat and cheese slices were wrapped in plastic wrap in smaller packages not in original packaging not dated and not labeled. 5. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure quarterly assessments were completed timely for 4 of 4 (R5, R32, R38 and R43) residents reviewed for quarterly assessments in a sample of 60. The Findings Include: 1. R32's face sheet documents an admission date of 9/20/18 and includes the following diagnosis: unspecified dementia, protein calorie malnutrition, and contracture. On 2/28/24 2:03 PM, V8 (Medicare Coordinator) stated that R32's quarterly MDS had a target due date of 1/10/24 and transmitted and accepted on 2/28/24. A final validation report provided by V1 documents that R30's annual MDS had a target/due date of 1/10/24. This document had a warning message 'record submitted late'. 2. R5's face sheet documents an admit date of 7/12/23 and includes the following diagnosis: muscle weakness, repeated falls, lack of coordination and hypertension. [...]

Inspectors wroteBased on interview and record review, the facility failed to complete a PASARR (Preadmission Screening and Resident Review) Level II Screening for 4 (R73, R45, R20, R50) of 4 residents reviewed for PASARR Screening in the sample of 60. Findings Include: 1. R20's Face Sheet documented an initial admission date to the facility as 1/31/24. Diagnoses listed on this form included but were not limited to: Major Depressive Disorder and Bipolar Disorder. R20's Notice of PASRR Level I Screen Outcome dated 1/31/24 documented No Level II Required - No SMI (Serious Mental Illness) . 2. R45's Face Sheet documented an initial admission date to the facility as 5/19/23. Diagnoses listed on this form included but were not limited to: Major Depressive Disorder, Delusional Disorder, Anxiety Disorder, Post-Traumatic Stress Disorder, Auditory Hallucinations . [...]

Inspectors wroteBased on observation, interview, and record review the facility failed to date insulin pens when opened for use and ensure discontinued medications were disposed of per current standards of practice for 4 of 35 residents (R40, R33, R24, and R71) reviewed for medication storage in the sample of 60.

Inspectors wroteBased on interview and record review the facility failed to ensure comprehensive assessments were completed timely for 1 of 1 (R30) resident reviewed for comprehensive assessments in a sample of 60. The Findings Include: R30's face sheet documents an admission date of 11/29/17 and includes the following diagnosis: morbid obesity, history of falling and muscle weakness. A final validation report provided by V1 (Administrator) documents that R30's annual MDS (Minimum Data Set) had a target/due date of 1/17/24. This document had a warning message 'record submitted late'. On 2/28/24 2:03 PM, V8 stated that R30's annual MDS had a target due date of 1/17/24 and it was transmitted and accepted on 2/28/24, which was past the due date.

Inspectors wroteBased on interview and record review the facility failed to ensure residents who are transferred with a patient whole body lift machine are transferred safely and in accordance with the facility's lift machine policy for 1 of 3 (R1) residents reviewed for accidents in a sample of 9. This failure resulted in R1 falling while being transferred with the patient lift machine and sustaining moderate to large volume left scalp hematoma, acute minimally displaced fracture of C7 vertebral body, acute mildly displaced fracture of T1 vertebral body, and non-displaced fracture of the right posterior first rib. This past non-compliance occurred from 12/16/2023 to 12/18/2023.

Inspectors wroteBased on interview and record review the facility failed to prevent abuse for 1 of 6 residents (R2) reviewed for abuse in a sample of 9.

Inspectors wroteBased on interview, observation, and record review, the facility failed to provide sufficient staffing levels to provide care by considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment. This has the potential to affect all 73 residents residing in the facility.

Inspectors wroteBased on interview, observation, and record review, the facility failed to provide timely ADL (Activities of Daily Living) care for dependent residents for 3 of 8 residents (R1, R2, and R3) reviewed for ADL care in the sample of 8.