Arcadia Care Aledo

F 0550 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

V6/Registered Nurse (RN) to assist her on the bedpan as she had to urinate. States V6/RN told Resident R6 all staff were busy assisting other residents. Resident R6 states V6 swore at Resident R6 and told her she would get someone to help Resident R6 when they could. V7/LPN states that Resident R6 told her a couple of hours later, no staff had responded to assist her on the bedpan and Resident R6 was finally able to get herself closer to her bedside stand, grab an emesis basis, place it under herself and pee. V7 states Resident R6 was very upset about having to use the emesis basin, that it hurt to use the emesis basin and not a bedpan and that Resident R6 stated she was humiliated due to using

the emesis basin to urinate in. At that time, V7/LPN states Resident R6 told her she did not want V6/RN to ever take care of her again.On 11/25/25 at 1:05 P.M., V1/Administrator In Training stated V6/Registered Nurse should have assisted Resident R6 to the toilet when she requested, and she considers Resident R6 being forced to urinate in an emesis basin as unacceptable and a violation of Resident R6's resident's rights.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Arcadia Care Aledo

304 S.W. 12th Street Aledo, IL 61231

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

11/23/25 documents, Physical Abuse, employee to resident. On 11/23/25 at approximately 5;30 P.M., Resident R8 reported that agency staff (V10/Certified Nursing Assistant/CNA) was rough with cares. V10/CNA immediately suspended. Resident R8 assessed immediately. Appropriate notifications made.On 11/24/25 at 11:17 A.M., Resident R8 was alert, oriented, and seated in an easy chair in her room, reading her bible. Resident R8 was able to recall the incident of 11/23/25. Resident R8 states the tall, black man that took care of me yesterday (11/23/25) was rough with me and hurt my wrist during cares. States she was sitting in her chair in her room, reading her bible when V10/Agency CNA entered the room, roughly took her bible out of her lap and grabbed her right wrist and pulled on it, telling her she was wet (incontinent) and needed to get up and go to the bathroom. Resident R8 states she told V10 she would as soon as she finished the passage she was reading, but V10 was insistent and kept pulling on her wrist. Resident R8 states she told V10 he hurt her and to leave her alone. Resident R8 states her wrist feels okay now but was painful yesterday.The facility form, Staff Statement, dated 11/23/25 and signed by V11/Certified Nursing Assistant documents, While in the dining room passing medications this nurse overheard (Resident R8) telling her table (mates) at supper that the male CNA hurt her wrist. As I approached (Resident R8) she stated that she did not want that male CNA take care of her again, he hurt her wrist. (Resident R8) states (V10) came in her room, grabbed her bible out of her hands and told her to get up and go to the bathroom and he grabbed her wrist and hurt it. No injuries noted. V2/Director of Nurses and V1/Administrator notified.

On 12/1/25 the surveyor confirmed through interview and record review that the facility took the following actions to remove the Immediate Jeopardy:1. All residents with a BIMS 12 and greater currently in-house had abuse interview completed to ensure no other residents had been harmed and they feel safe in the facility completed by V24/Dietary Manager by 11/26/25.2. All residents with a BIMS 11 and below and skin assessments completed to ensure no other residents had been harmed and they feel safe in the facility completed by V2/Director of Nurses and V17/Wound Nurse by 11/26/25.3. Family members/POAs of those residents with a BIMS of 11 and below currently in-house had abuse interviews completed to ensure no other residents had been harmed and they feel that their loved one is safe in the facility. Initiated by V22/Business Office Manager on 11.26.25. 38 of these families answered the phone and were interviewed.

A message to return the phone call has been completed with the remaining 13 families. Facility will continue to make daily calls until 100% compliance. Administrator to monitor for compliance. 4. All residents currently in-house had an abuse/neglect screening completed with care plans updated to reflect level of at risk for abuse as indicated. Completed by V23/Social Services Director on 11/26/25.5. Abuse in-servicing for all staff. Completed by V1/Administrator in Training and V2/Director of Nursing, on 11.26.25. Abuse Training will remain ongoing with all new hires, all agency staff, and current staff. All staff in serviced before their next scheduled shift. 6. Facility Administrator or Designee will interview 5 residents per week for 12 weeks to ensure residents feel safe and have no concerns with abuse. Facility will utilize the abuse Allegation Interview questions for residents. Completed on 11/26/25 by V1/Administrator in Training.7.

Facility Administrator or Designee will interview 5 staff members per week x 12 weeks to ensure staff know reporting requirements. Facility will utilize an audit tool related to Abuse/Abuse Reporting/Abuse investigation. Facility Administrator or designee will monitor for completion. Completed by V1/Administrator

in Training on 11/26/25.8. Administrator In Training in-serviced on abuse by V12/Regional Nursing Consultant on 11/26/25.9. All residents have the potential to be affected by V6(RN) alleged abuse. V6 (RN) is no longer employed as of 11/12/25.10. Resident R6 had the potential to be affected by V6 (RN) alleged abuse. Resident R6 discharged on 10/8/25. Psych services are available to all residents by Psychiatric vendor. Completion date 11/26/25

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Arcadia Care Aledo

304 S.W. 12th Street Aledo, IL 61231

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Time Cards documents that V6 continued to work at the facility from 9/19/25 through 11/12/25. 2. The facility form, Final Abuse Investigation Report, dated (initial) 11/13/25 and (final) 11/19/25 documents, Resident: (Resident R7) and Staff: (V6/Registered Nurse-RN). Staff to resident verbal altercation. Facts determined:

On 11/12/25 at approximately 7:40 A.M., Resident R7 told V6/RN that he needed to use the restroom. V6/RN asked Resident R7 if he could wait due to staff being busy and her having to stay in the dining room. Resident R7 stated that he needed to go and he was not waiting. V6/RN took Resident R7 down the hallway where the CNAs (Certified Nursing Assistants) were assisting another resident. V6 returned to the dining room. No psychosocial needs noted.

Proper notifications made. V6/RN suspended immediately. Abuse Coordinator immediately initiated investigation. Facility leadership reviewed the medical record of Resident R7. Employees who were knowledgeable of

the allegation were interviewed by the Abuse Coordinator. Based on the results of the investigation the facility has found the following: IDT (Intradisciplinary Team) met to discuss the investigation. Also discussed appropriate interventions for resident. Care plan reviewed and updated accordingly. SSD (Social Services Director) will follow up with resident for any psychosocial needs that arise.Resident R7's Abuse Allegation Interview, dated as 11/12/25 and signed by V1/Administrator In Training documents, Can you tell me what happened? I needed to pee. so I didn't wet myself. (V6/RN) yelled at me and pushed me in my wheelchair down the hall. What was said? (V6/RN) was cussing and saying I already went.The facility form, Staff Statement, dated 11/12/25 and signed by V8/Certified Nursing Assistant/CNA documents, I was in (another resident's room) with (V9/CNA). V6/RN was shouting at (Resident R7) because he needed to use the bathroom. V6 then pushed Resident R7 down the long hall and said, 'See all these call lights' and told Resident R7 he needed to wait and let Resident R7 down the hall. During V6's shouting, V6 mentioned the F word, saying, 'FXXX this' and 'You need to FXXX wait.'On 11/25/25 at 11:54 A,M, V2/Director of Nurses stated the 11/12/25 incident between V6/RN and Resident R7 was also investigated by herself and V1/Administrator. V2/DON states she would consider the incident to be verbal abuse as the resident and two different staff members over heard V6/RN cussing and yelling at Resident R7 V2 states V12, V13 and V14 (Corporate Staff) made the decision to call the incident Misconduct: Unsatisfactory job performance and place V6 on a ‘Final Warning.' V2 states when she and V1 called Resident R6 to discuss the incident and advise her of the final warning and tell V6 to return to work on November 21, 2025, V6 stated she was terminating her employment with the facility. On 11/25/25 at 1:05 P.M., V1/Administrator

In Training stated there was a second incident on 11/12/25 involving V6/Registered Nurse and Resident R7 where V6 was overheard cussing and yelling at Resident R7 when Resident R7 requested to use the bathroom while in the facility dining room as he didn't want to urinate on himself. V1 states during her investigation it was determined that V6 refused to provide toileting assistance for Resident R7, pushed Resident R7's wheelchair out of the dining room and down the hall, opposite direction from his room and placed him outside of another resident's room where V8 and V9/CNAS were providing care to another resident. V1 stated the incident was discussed with corporate staff (V12, V13 and V14) and the decision was made, at the Corporate level, to call the incident, ‘Misconduct' and to place V6/RN on a final warning. When V6 was called on 11/20/25 and informed of the decision to place her on a final warning status and to inform V6 to return to work on 11/21/25, V6 chose to terminate her employment with the facility. V1/Administrator also stated she would consider the incident to be verbal abuse, and no changes were made to prevent future occurrences of abuse.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Arcadia Care Aledo

304 S.W. 12th Street Aledo, IL 61231

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

sitting in the hallway. States he did not hear the nurse ask any staff to assist him and when the CNAs did assist him, he had urinated on himself. States he was humiliated by the situation and doesn't want (V6/RN) to come near him any longer.On 11/25/25 at 1:05 P.M., V1/Administrator In Training stated there was a second incident on 11/12/25 involving V6/Registered Nurse and Resident R7 when Resident R7 requested to use the bathroom while in the facility dining room as he didn't want to urinate on himself. V1 states during her investigation it was determined that V6 refused to provide toileting assistance for Resident R7, pushed Resident R7's wheelchair out of the dining room and down the hall, opposite direction from his room and placed him outside of another resident's room where V8 and V9/CNAS were providing care to another resident. At that time, V1 verified that V6/RN should have assisted Resident R7 with his toileting needs.

Event ID:

Facility ID:

If continuation sheet