ARDEN COURTS MANORCARE HEALTH SERVICES
Facility I.D. Number 0042606
3240 Milwaukee Ave.
Northbook, IL 60062
Date of Survey 05/25/00
Incident Report Investigation
Every facility shall have an effective plan for housekeeping including sufficient staff, appropriate equipment and adequate supplies. Each facility shall:
Keep the building in a clean, safe, and orderly condition. This includes all rooms, corridors, attics, basements, and storage areas.
All cleaning compounds, insecticides, and all other potentially hazardous compounds or agents shall be stored in locked cabinets or rooms.
These REQUIREMENTS are not met as evidenced by:
Based on observation, interview, facility incident investigation, resident record review, and product content for Ecotemp Ultra Kleen (cleanser used in dish machine) the facility failed to maintain a safe environment, failed to store a hazardous compound in a locked cabinet or room, and failed to utilize a safety device in a dangerous area.
Per E1, on 5/7/00, E2 was assisting another resident. It is believed that R1 was sitting in an arm chair down the hall. R1 walked down the hall to the kitchen. In the cabinet beneath the sink is where the dish machine cleanser (Ecotemp Ultra Kleen) is kept. R1 opened the unlocked cabinet, poured this cleanser into a cup and drank it. R1 yelled, E2 ran to see what R1 was yelling about and saw R1 spitting saliva into the sink. E2 questioned R1 as to what he was doing. R1 state, "I drank milk ." R1 had a glass with liquid in it and he was holding a bottle of dish washing detergent. E1 gave surveyor the product content for the detergent R1 drank. The product content for the Econtemp Ultra Kleen states..under hazardous compounds..sodium hydroxide-a caustic soda...conditions to avoid-do not mix with anything but water-reacts vigorously with acids...Health Hazard Data-IF SWALLOWED HARMFUL OR FATAL-causes chemical burns of mouth, throat and stomach...if swallowed...Immediately rinse mouth at once, then drink 1-2 large glasses of water..If Swallowed Immediately call Emergency #1-800-328-0026, a poison control center or a physician. Per incident investigation report, E3 wrote R1's lips and edges of tongue were red. E1 stated the facility did not know how long the cabinet containing the Ecotemp Ultra Kleen (dish machine cleanser) had been unlocked.
Per R1's record review, R1 was sent to Lutheran General Hospital. R1's diagnoses at the facility was Heart Disease, Dementia, Alzheimer's Disease, Congestive heart Failure, Hypertension, Atrial Fibrillation, Post Nasal Drip and Depression. As of 5/24/00, R1 still had not returned to the facility.
Incident report follow up, on 5/8/00, a call was made to Lutheran General Hospital inquiring about R1. R1 was now in the medical intensive care unit. Z1 stated that R1's lips, tongue and upper mouth were swollen. Z1 stated they were unable to do any further investigation, but later may do a GI.