Randolph County Care Center

we get report information from the nurse, we don't have time to go through the care plans.

She (R1) has not had a mat nor been on 15-minute checks.2.R2's admission Record, print date of 10/23/25, documented R2 has diagnoses including disorientation, osteoarthritis, hyperlipidemia, anxiety disorder, hypertension, and depression. R2's MDS, dated [DATE], documented R2 is moderately cognitively impaired although at time of interview R2 was severely cognitively impaired.

This MDS also documented R2 requires substantial to maximal assistance with transfers. R2's Care Plan Report, undated, documented R2 is high risk for falls related to gait/balance problems, incontinence, and unaware of safety needs.

Interventions include ensure resident is wearing appropriate footwear when ambulating or mobilizing in wheelchair.R2's Incident Report, dated 10/20/25, documented this nurse was notified by CNA that this resident was on the floor in her room.

Upon entering resident's room noted resident lying on her left side against the wall in front of her WC (wheelchair).

Immediate action taken: Assessed for injuries.

Noted hematoma to center of forehead and to the left side of her forehead.

Scant bleeding from her left cheek.

Very small scrape to left cheek.

Cleansed with NS (normal saline) and LOTA (left open to air).

Sat resident up on her buttocks. No c/o pain other than a headache.

Assisted resident off the floor x2 assist and into her WC.

Noted that resident's glasses were broken on the left side. VS (vital signs) obtained.

Noted elevation in resident's BPs. On call doctor notified.

Order given to sent to ER for evaluation to rule out a brain bleed. On 10/23/25 at 12:13 PM R2 was observed in the dining room in her wheelchair. R2 was observed with bilateral black eyes and R2 was wearing plain white socks. No non-skid material was on the bottom of R2's socks.On 10/27/25 at 12:08 PM V2 DON (Director of Nursing) stated she expects fall interventions to be in place per the care plan. V2 stated (R2) is supposed to have non-skid socks or shoes on at all times when she is up in her wheelchair.

V2 stated she was not aware (R1) did not have her interventions in place on 10/23/25.The facility's Fall Policy, review date of 6/14/23, documented Mission Statement - to identify residents at risk for falls and provide guidelines for prevention and treatment post fall.

All residents upon admission shall be assessed by the licensed nurse using the Fall Risk Assessment Form.

This form will be updated quarterly, annual, significant change, or post fall episode. It continues, Post Fall - resident is assessed by the licensed nurse for potential injury and obtain treatment as necessary with MD guidance, responsible party is also notified.

All falls are investigated to determine cause (avoidable or unavoidable), correction and prevention.

Vital signs and condition are monitored by licensed nurse, care plan adjusted as needed to prevent additional falls.

Care plan interventions reviewed with POA (Power of Attorney) and residents as needed.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/19/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Randolph County Care Center

312 West Belmont Sparta, IL 62286

SUMMARY STATEMENT OF DEFICIENCIES