Goldwater Pontiac Nursing Home

facility affirms the resident's right to be free from misappropriation of property, which means the deliberate misplacement, exploitation, or wrongful use of a resident's belongings or money without the resident's consent.

This policy documents the administrator, or designee will initiate an incident investigation, and will at a minimum attempt to interview the person who reported the incident, anyone likely to have knowledge of the incident, the resident, and any employees with whom the accused has regularly worked with.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

08/20/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Goldwater Pontiac Nursing Home

1225 South Ewing Drive Pontiac, IL 61764

SUMMARY STATEMENT OF DEFICIENCIES

Provide safe and appropriate respiratory care for a resident when needed.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to obtain physician orders for the use and care of a CPAP (continuous positive airway pressure) for one of two residents (R6) reviewed for respiratory care on the sample list of 38. On 8/18/2025 at 10:08 AM there was a CPAP machine on R6's desk in R6's room.

R6 stated R6 is suppose to use it, but has had problems getting parts for it. R6 removed the filter from the machine to show the filter was dirty, covered in gray debris/dust. R6 stated R6 has talked to facility staff about needing parts for the machine. R6's Minimum Data Set, dated [DATE] documents R6 has severe cognitive impairment. R6's active physician orders and active care plan do not document the use or care of R6's CPAP machine as of 8/18/25. On 8/18/2025 at 3:54 PM V6 Licensed Practical Nurse stated R6 sleeps in her recliner and uses the CPAP machine, at least for the last five months that V6 has worked in the facility. V6 stated there should be physician's orders for use and care that would prompt to document on the Treatment Administration Record (TAR). V6 confirmed R6 did not have any physician's orders regarding the use of the CPAP. On 8/19/25 at 4:54 PM V21 Registered Nurse stated V21 works night shift and R6 has used a CPAP for about 5-6 months, R6 applies and cares for the machine herself. On 8/19/2025 at 12:08 PM V2 Director of Nursing stated CPAPs should be rinsed/washed on Mondays, and need filled with distilled water. V2 stated there should be physicians orders for use and documented on the TAR. V2 stated V2 would have to look at the facility's policy regarding changing filters on CPAPs. V2 stated V2 just found out about R6's CPAP yesterday and obtained orders for use/care. V2 stated it probably isn't care planned since we just found out about it yesterday.

The facility's undated CPAP Therapy policy documents to verify physician orders, if ordered connect humidifier to CPAP unit, fill humidifier with distilled sterile water, and adjust the ramp to prescribed time if ordered.

This policy documents to use a soft cloth and gently wash th3 mask or pillows with a solution of warm water and mild detergent, rings, and allow to air dry; wash/rinse/dry tubing as necessary; clean and inspect all components regularly.

This policy documents that disposable filters should be replaced according to manufacturer's instructions, and reusable filters should be rinsed of dust and allowed to air dry.

The User Manual dated 2021 for R6's CPAP machine, documents the device should only be used as instructed by a physician, including correct pressure settings, device configurations, and accessories.

This user manual documents the device uses a reusable blue pollen filter that can be rinsed and includes an automatic reminder every 30 days to check and replace filters as directed.

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