Loft Rehab Of Decatur

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Let each resident or the resident's legal representative access or purchase copies of all the resident's records.

Based on interview and record review the facility failed to provide a copy of resident's medical records in a timely fashion following a request by resident's Power of Attorney for one of three residents (Resident R1) reviewed for medical records requests on the sample list of five.Findings Include:Resident R1's electronic medical record documents Resident R1 resided at the facility from 4/16/25 until 4/23/25 when Resident R1 was transported to the local hospital emergency department and Resident R1 has not returned to the facility since that time.On 10/8/25 at 3:00PM V5, Resident R1's family member stated (Resident R1) is at (a different facility) now. I have asked and signed for (Resident R1's) medical record from the facility, but I haven't gotten anything but the runaround.On 10/9/25 at 10:00AM V8, Medical Records stated (V5) did request (Resident R1's) medical record in May. Since the request came from a lawyer I had to send it to corporate and I can verify that the record has not been sent to (V5's) lawyer.On 10/9/25 at 2:00PM V1, Administrator stated (Resident R1's) medical record has now been sent out. It would be my expectation that it should have been sent some time ago.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

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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

10/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Loft Rehab of Decatur

500 West McKinley Avenue Decatur, IL 62526

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 0689 Level of Harm - Actual harm Residents Affected - Few

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

facility) to inspect and repair a wheelchair securement system. What I found in the front row of seating was that both shoulder belts were malfunctioning. One would not pull out and the other would not retract. One of

the two seat belts was completely missing. Employees securing residents should have known it wasn't in safe working order. The occupant securement system was not fully functioning and that van should not have been in service. We recommend the securement system be inspected every six months. The last inspection we did was dated May of 2024.Resident R5's Minimum Data Set MDS dated [DATE REDACTED] documents Resident R5 is cognitively in tact. On 10/9/25 at 2:00PM Resident R5 was seated in her room in a wheelchair. Resident R5 was agreeable to be interviewed. Resident R5 stated Boy do I ever remember that wreck. The first I knew (V9) screamed out and I went flying forward. I didn't get tossed out of my chair because I got trapped between my wheelchair and

the back of (Resident R2's) wheelchair. (Resident R2) went flying right out of her wheelchair and she hollered 'OUCH Help me Help me.' Then the cops (police) and ambulance guys came. I wasn't hurt, but I was lucky and I was sure shook up. (Resident R2) was hurt and I haven't seen her back. That kind of worries me. (Resident R2's) seat belts were real loose and I didn't have the lap belt or the shoulder belt on. I guess it could have been worse, but I was scared. On 10/9/25 at 2:30 V14, Nurse Practitioner verified the 9/16/25 accident caused the fractures of (Resident R2's) humerus, fibula, and tibia.

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