Casey Rehab And Nursing

F 0697

Provide safe, appropriate pain management for a resident who requires such services.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review the facility failed to provide adequate pain control for one (Resident R2) of three residents reviewed for pain on the sample list of seven.Findings Include: Resident R2's Physician Order Sheet (POS) dated August 2025 documents Resident R2 was admitted to the facility on [DATE REDACTED]. Resident R2 is diagnosed with Type II Diabetes Mellitus with Diabetic Polyneuropathy and Muscle Weakness among other medical diagnoses. Resident R2's POS documents a physician order on 7/4/25 for Acetaminophen tablets 650 milligrams by mouth every six hours as needed for mild pain. If more than three doses given in 48 hours- staff are to notify the physician or advanced practice provider. Resident R2's POS documents a physician order on 7/14/25 for Tramadol 50 milligrams by mouth as needed for pain. Resident R2's Medication Administration Record (MAR) dated July 2025 documents Resident R2 received more than three doses of Acetaminophen in 48 hours' time on 7/7/25, 7/8/25, 7/9/25, 7/10/25, 7/11/25, and 7/12/25. There is no documentation that a physician or advanced practice provider were notified of Resident R2's frequent use of the as needed Acetaminophen. The MAR documents Resident R2 rated her pain at an eight or higher for eleven of the fourteen Acetaminophen doses administered from 7/7/25 to 7/12/25. Resident R2's Progress Note dated 7/11/25 at 8:40 PM documents Resident R2 complained of right shoulder pain and V2 Director of Nurses requested a more effective pain medication and was waiting on response from the advance practice nurse. Resident R2's Progress Note dated 7/12/25 at 2:57 AM documents V15 Medical Director was notified of Resident R2's increased pain and request for better pain control. V15 ordered Tramadol 50 milligrams every eight hours as needed for pain. However, V15 could not send the new script to the pharmacy because V15 was not in his office. On 8/13/25 at 3:05 PM V2 Director of Nurses confirmed Resident R2 often complained of pain during her stay in the facility. V2 confirmed Resident R2 was given Acetaminophen more than three times in 48 hours on multiple occasions throughout her stay. V2 confirmed nursing should have notified a physician concerning the continued use of acetaminophen per the order. V2 confirmed on the evening of 7/11/25 Resident R2's pain was unbearable for her, and she requested a stronger pain medication than Acetaminophen. Resident R2 stated she reached out the to the Nurse Practitioner on-call however did not hear back so the nurse on duty overnight (V9 Registered Nurse) reached out to V15 Medical Director (MD) for a different pain medication order. V2 stated V15 ordered Tramadol however could not send the new script to

the pharmacy so the nurses could not get the medication out of the medication dispensing machine. V2 confirmed Resident R2 was not able to receive the new Tramadol medication until 7/12/25 at 3:16 PM. V2 stated Resident R2 was tearful and uncomfortable throughout the night. V2 stated staff repositioned her and tried to keep her as comfortable as possible but there was a delay in getting her the pain medication that should not have happened. V2 stated Resident R2's pain did improve some with the administration of the Acetaminophen however

she did still require an increase in pain relief (Tramadol) and should not have had to wait 18 hours for the medication to be available. V2 acknowledged a change in procedure is required to make sure medications are available when needed for residents even after hours or on weekends.

Residents Affected - Few

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

Event ID:

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Casey Rehab and Nursing

100 N.E. 15th Casey, IL 62420

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)

F 0744

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to provide appropriate services for a resident with a diagnosis of dementia for one resident (Resident R7) of three residents reviewed for dementia services on a sample list of seven.Findings include: Resident R7's Physician Orders Sheet (POS) dated August 2025, documents Resident R7's diagnosis as: Dementia, mild, with agitation and anxiety disorder.Resident R7's Wandering/Elopement Risk assessment dated [DATE REDACTED], documents Resident R7 is high risk for elopement.On 8/13/25 at approximately 10:30 AM,

a personal alarm was sounding. V7 Certified Nursing Assistant (CNA) ran out the front door towards Resident R7 who was seen walking towards the parking lot. V7 CNA assisted Resident R7 back into the building to the Business Office with V12 Business Office Manager (BOM). On 8/13/25 at approximately 12:10 PM, a personal alarm was sounding. V2 Director of Nursing (DON) ran out the front door towards Resident R7 who was seen walking towards the parking lot. V2 DON assisted Resident R7 back into the building. On 8/13/25 at 12:14 PM, V2 DON stated Resident R7 is very agitated today. V2 stated Resident R7 worries about going to the bank, worried about Resident R7's jeweler, and paying Resident R7's bills. V2 stated Resident R7 is progressively declining. V2 stated staff should be doing 15-minute checks on Resident R7 and making sure Resident R7's needs are being met. V2 stated V12 BOM has not had dementia training and may not know what to do with/for Resident R7. V2 stated dementia training should be completed immediately after starting (working). On 8/13/25 at 12:57 PM, V1 Administrator stated Resident R7 was put on 1:1 with staff after the last time Resident R7 tried to escape. V1 stated just in the last two to three days Resident R7 has been going to the door. V1 stated Resident R7 does have an alarm bracelet on, Resident R7 was given a calendar to show when rent is due, and staff has been letting Resident R7 go out into the courtyard. V1 stated dementia training should be done with onboarding and before starting work at the facility. On 8/13/25 at 1:18 PM, V7 CNA stated V7 took Resident R7 to the business office because Resident R7 always wonders about paying Resident R7's rent. V7 stated Resident R7 does exit seek because Resident R7 is always wants to go to the bank and wondering about rent. On 8/13/25 at 1:45 PM, V2 DON stated Resident R7 was exit seeking a few weeks ago but it has been more frequent this week, so we are moving Resident R7 to the south hall (locked unit). V2 also stated the nurses should be documenting the follow up from Resident R7 getting out of the facility and what interventions were used.Resident R7's Nursing Progress Notes written by V5 LPN, dated 8/8/25 at 1:26 PM, documents exit seeking x 2, continues to think he needs to go to the bank to make arrangements to pay the rent, re-education unsuccessful due to cognition. Resident R7's Nursing Progress Notes written by V5 LPN, dated 8/11/25 at 1:46 PM, documents exit seeking x 3 out the front door, staff had to assist back inside.On 8/13/25 at 1:52 PM, V5 Licensed Practical Nurse (LPN) stated V5 continued to remind Resident R7 his bank account is not here, and someone takes care of Resident R7's business. V5 stated

the only other options we have are to follow Resident R7 around or walk with Resident R7 and keep trying to explain this to him to help Resident R7 remember, keep repeating things to him. V5 stated this man (Resident R7) goes out the door about every day and it has been going on for the last week and a half on a daily basis. On 8/13/25 at 2:55 PM, V6 Registered Nurse (RN) stated she does not know where the elopement logbook is and can't say V6 was ever showed that.On 8/13/25 at 3:00 PM, V14 RN, stated V14 is still kind of new so V14 is not sure where

the elopement logbook is.The facility's Wandering and Elopement Assessment and Prevention Policy dated Revised 6/4/24, documents all residents shall be assessed for risk of elopement/unsafe wandering, to ensure their safety and prevention from elopement. This same policy documents all departments shall be made aware of the elopement log and the location. This policy also documents the facility uses a multi-faceted approach to prevent elopement including staff education regarding understanding wandering, responsibility to identify, report, and intervene for wandering/elopement risk for residents.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet