Pearl of Joliet, The

In the surveyor’s words

From the most serious findings on record at Pearl of Joliet, The, in the surveyor’s own words.

• Actual harm, isolatedF686Apr 30, 2026

  Based on record review and interview, the facility failed to ensure a resident who was admitted with an unstageable pressure ulcer was seen by a wound care physician or nurse practitioner in a timely manner and failed to follow recommended wound treatment. This failure resulted in a resident (R1) to develop an infection in the wound and require surgical debridement.This applies to 1 of 3 residents (R1) reviewed for wound care in the sample of 3.The findings include:R1's electronic medical record (EMR) showed R1 was admitted to the facility on [DATE]. […]

• Actual harm, isolatedF684Apr 17, 2025

  Based on observation, interview, and record review, the facility failed to complete a wound or skin event in risk management when a skin abnormality was found on a resident, failed to seek medical attention for a resident who developed rash-like skin redness, failed to monitor the skin rash/redness for improvement or worsening, failed to implement wound nurse practitioner's recommendations to keep the area clean and dry, and failed to implement wound nurse practitioner's recommendations for treatment of the rash. […]

• Actual harm, isolatedF686Dec 27, 2024

  Based on observation, interview, and record review, the facility failed to identify a resident's skin breakdown. As a result of this failure, R7 developed a Stage 3 pressure ulcer. This applies to 1 of 1 resident (R7) reviewed for pressure ulcers in a sample of 10. The findings include: The EMR (Electronic Medical Record) shows R7 was admitted to the facility on [DATE], with diagnoses of hemiplegia and hemiparesis, bacteremia, dependence on respiratory status, hypertension, gastrostomy status, and tracheostomy status. […]

• Actual harm, isolatedF686Oct 4, 2024

  Based on observation, interview, and record review, the facility failed to report a new skin alteration for a resident (R3) with a known history of a right hip pressure injury. This failure resulted in R3's right distal hip stage 3, and right proximal hip stage 2, new facility-acquired pressure injuries not being assessed and treated once identified. This applies to 1 of 3 residents (R3) reviewed for pressure wounds. The findings include: R3's EMR (Electronic Medical Record) showed R3 had multiple diagnoses including a history of pressure injuries, sequelae of cerebral infarction, traumatic subarachnoid hemorrhage, peripheral vascular disease, major depressive disorder, anxiety, dementia, neuropathy, cervical disc degeneration, hypertension, dysphagia, right eye blindness, and… […]

• Actual harm, isolatedF684May 30, 2024

  Based on observation, interview, and record review, the facility failed to monitor and check glucose blood sugar levels for a resident with a known history of Diabetic Ketoacidosis and elevated blood sugars. This failure resulted in R1 needing hospitalization for Diabetic Ketoacidosis (grossly elevated blood sugars). This applies to 1 of 3 residents (R1) review for Diabetes and blood glucose monitoring in the sample of 4. The findings include: Face sheet shows R1 is [AGE] years-old who has multiple diagnoses which include acute embolism and thrombosis of deep veins of upper extremity, bilateral, type 2 diabetes mellitus with ketoacidosis without coma, cardiac arrest due to other underlying condition, cardiac arrest, cause unspecified, diabetes mellitus due to underlying condition with… […]