CEDAR RIDGE HEALTH CARE CENTER I.D. NUMBER 0042838 1 Perryman St. Shannon, IL 62254 As a result of a survey conducted by representative(s) of the Department, it has been determined the following violations occurred. "A" VIOLATION(S) The facility shall provide a Resident Services Director who assigned responsibility for the coordination and monitoring of the resident's overall plan of care. The director of nurses or an individual on the professional staff of the facility may fill this assignment to assure that residents' plan of care are individualized, written in terms of short- and long-range goals, understandable and utilized; their needs are met through appropriate staff interventions and community resources; and residents are involved, whenever possible, in the preparations of their plan of care. 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 resident. 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. The DON/HSS shall oversee the nursing services of the facility. This person's duties shall include: Planning an up-to-date resident care plan for each resident based on the resident's individual needs and goals to be accomplished, physician's orders, and personal care and nursing needs. Personnel, representing other services such as nursing, activities, dietary, and such other modalities as are ordered by the physician, shall be involved in the preparation of the resident care plan. The plans shall be in writing and shall be reviewed and modified in keeping with the care needed as indicated by the resident's condition. The plan shall be reviewed at least every three months. All exterior 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. Based on record review, facility records, physician interviews, staff interviews, R1 eloped from the facility on 12/17/98 without the facility's knowledge. The facility failed to provide for R1's supervision, which placed the resident at risk for injury/harm. The facility also failed to ensure that all exit doors were properly alarmed/under constant direct visual control to alert staff if a resident attempted to exit the facility. Findings include: R1 is a 78-year-old resident admitted 8/97 with Alzheimer's disease, hypertension, dementia, Peripheral Vascular Ischemia Disease of both legs, anemia, etc. , and is total care. R1 is ambulatory with a fast shuffling gait, which puts R1 at risk for falls. Record review for R1 shows a general profile of a confused, incontinent, wanderer, at-risk for falls, short- and long-term memory loss, cognitive skills severely impaired, sometimes understands when given concrete requests, has medications that include Tenormin, Zoloft, Monopril, Buspar, Trental, Zyprexia. R1's progress note from a structured program dated 8/17/98 shows R1 Displayed episodes of attempting to leave the facility unattended, baseline 62 times in one month. R1 has a physician's order to leave the facility with power of attorney, and maintains Code Alert and security bracelet since 8/6/97. Interviews with staff and physician, Z4, reveals R1 is not able to function safely on his own in the community. Interview with Z1 reveals the official weather data on 12.17/98 was as follows: temperature 36 degrees, 32 dew point, some rain and ice pellets. R1 was last seen by E7 at approximately 7:15 a.m. - 7:20 a.m. at which time medications were given to R1. E6 states R1 was dressed by E6 the morning of 12/17/98 in jeans, undershirt, long-sleeve flannel shirt, blue tennis shoes, cap. R1 had not been noted missing from the facility until E8 was leaving the facility from the 11-7 shift. E8 states R1 was noted on the sidewalk on Belleville Street, had crossed Belleville Street to get to the sidewalk and was heading toward downtown Lebanon. E8 states as he was assisting R1 to E8's private car, Z2 came driving by, stopped as Z2 recognized R1 as Z2's grandfather. E2 explained the situation to Z2 who then continued on his way. E8 states he found R1 around 7:20 a.m. and R1 was dressed in shoes, socks, pants, long- sleeve flannel shirt, no hat/coat. E8 states it had been raining earlier that morning but was dry when R1 was found. R1 was dry, but cold. E8 took R1 back to the facility and staff put blankets on R1. E8 states that he went directly to the dining room where E7 was passing medications, reported the incident to E7 who came and assessed R1. No injuries were found. E8 states that R1 said nothing and came willingly back to the facility. R1's vital signs were as follows: temperature 97.8, pulse 88, respirations 24, blood pressure 128/72. Facility's investigation and staff interviews by surveyors failed to reveal which door R1 exited on 12/17/98. E4 states all door alarms and wanderguard bracelets were functional prior to 12/17/98 and also on 12/17/98. E4 had checked each door on 12/17/98 at 8:30 a.m. Staff were observed on 1/7/99 to respond promptly to door alarms and all alarms were functional as checked by E4 and surveyor on the morning of 1/7/99. The facility is located on a hill with uneven, steep terrain on all sides and is 2/10ths of a mile from Belleville Street, which is a main thoroughfare with considerable traffic. Facility records and staff interviews reveals no other elopements have occurred. Facility had no policy or procedures in place prior to 12/17/98, according to E1 interview. E1 states, and records show, policy/procedures were obtained from a sister facility on 12/17/98. All staff were inserviced on 12/17/98 by 11 a.m., and staff were all given a written examination on policy/procedures for elopements, and 15-minute checks were implemented for those who eloped.