ALDEN-LONG GROVE REHABILITATION and HEALTH CARE CENTER I.D. NUMBER 0040683 BOX 2308, RFD HICKS ROAD LONG GROVE, ILLINOIS 60047 As a result of a survey conducted by representative(s) of the Department, it has been determined the following violations occurred. "A" VIOLATION(S): Adequate and properly supervised nursing care and personal care shall be provided to each resident to meet the total nursing and personal care needs of the residents. All necessary precautions shall be taken to assure the safety of residents at all times, such as but not limited to: nonslip wax on floors, safe equipment, assistive devices properly maintained, and proper use of physical restraints and adaptive equipment. Maintain all electrical signaling, mechanical, water supply, heating, fire heating protection, and sewage disposal systems in safe, clean and functioning condition. This shall include regular inspections of these systems. All exteriors doors shall be equipped with a signal that will alert the staff if a resident leaves the building. Any exterior door that is supervised during certain periods may have a disconnect device for part-time use. If there is constant 24 hour a day supervision of the door, a signal is not required. An owner, licensee, administrator, employee or agent of a facility shall not abuse or neglect a resident. These requirements are not met as evidenced by: R1's record revealed a 77-year-old with a diagnoses of senile dementia, depression, and blindness. The resident has a history of being confused, wandering, and at times being combative to staff. The annual review dated 10/27/98 lists the resident as having poor decision making skills, vision limited to colors and shapes, and has wandering behaviors occurring four to six days out of the week. Communication is limited due to the residents decreased cognitive abilities and limited speaking and understanding of English, as the resident's primary language is Bulgarian. The care plan dated 10/30/98 was not specific for the residents problem of wandering. R1 also receives psychotropic and anti-anxiety medications regularly (Seroquel 50 mg at 5 p.m., and 25 mg at 9 a.m., Ativan .25 mg every a.m., and Ativan .5 mg prn). R1, who resides in a ground floor dementia unit, was found outside the building by staff on 1/23/99 at approximately 10:30 p.m. E1 and E2 reported that R1 was found lying on the ground by the driveway outside exit door 5. R1 was brought back into the facility by staff. Vital signs taken at the facility were recorded on the incident report and blood pressure unable to obtain, temperature 85, pulse 102 and respirations 22. When the Long Grove Fire Department paramedics responded, R1's rectal temperature was found to be 90 (F). Z2 informed surveyors, during interview on 2/4/99, that staff on the dementia unit stated the resident has been missing since 8:30 p.m. Hospital records were reviewed on 2/25/99. Records indicated the R1 arrived in the Emergency Room in Northwest Community Hospital in Arlington Heights at 11:32 p.m. on 1/23/99. According to Emergency Room assessment, R1's pupils were fixed and dilated and R1 had a core rectal temperature of 87.5 (F). Following stabilization by Emergency Room staff, R1 was transferred to the hospital's Intensive Care Unit in reportedly critical condition where she was monitored for a cardiac arrythmia and any further complications possibly arising from her diagnosis of hypothermia. Z4, when interviewed on 2/4/99 stated that the weather conditions for Chicago and the surrounding area from 8 p.m. through 10 p.m. on 1/23/99 was 34 (F), with a wind chill of 13 (F). Nurse's notes on 1/23/99 reveal that while searching for R1, "all doors were checked and found door #5 alarm not working." When interviewed E1, E2 and E6 all stated that the door alarm serving exterior doors #5 had malfunctioned on 1/23/99 and the alarm did not alert staff when R1 exited the building. Exit door #5 leads to a driveway at the back of the facility that continues along the south side of the facility and eventually exits onto Old Hicks Road. The area behind the facility is under development and the driveway borders a rough, uneven open field. Two large ponds were visible on the other side of the open field. All of the exterior door alarms in the dementia unit were tested and found to be operable during the complaint investigation of 2/3/99, however, the door alarms were not audible from the resident's bathroom farthest from the exit door. On 2/3/99 an exterior door between the ground floor and first floor stairwell was not provided with an alarm. The exterior door is accessible to residents from the ground floor and residents have access to the ground floor via elevators and via unalarmed stairwells. The exterior door leads to a courtyard that exits into the facility parking lot at the northwest side of the building. Interview of E1, E2 and E6 confirmed that the exterior door is not provided with an alarm. The exterior door was noted unsupervised during the complaint investigation.