Hope Creek Nursing & Rehab

F 0563

Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and observation, the facility failed to ensure 1 of 4 residents (Resident R1) in the sample of 7 reviewed for visitation rights were allowed to receive their chosen visitors.The findings include:On 8/22/25 at 11:37 AM, V4, Social Services Director, said V13 is Resident R1's significant other/girlfriend. V4 said V13 is not allowed to visit Resident R1 any longer. V4 said V13 calls the facility almost every day trying to come to the facility. V4 said Resident R1's guardians, V9, would go back and forth about allowing V13 to visit Resident R1. V4 said currently the decision to not allow V13 to visit has been made by the facility and the police.On 8/22/25 at 10:32 AM, V3, Receptionist, said V13 is not allowed to visit Resident R1 at all. V3 said V4 came and told all the receptionists not to allow V13 to visit. V3 said she is supposed to ask V13 to leave and if she won't leave, they are supposed to get the police involved. V3 said V13 calls frequently and asks when she can visit again. V3 said she tells V13 to call V9. V3 said the electronic kiosk at the front desk even says, Access denied when V13 tries to check in to visit.On 8/22/25 at 12:35 PM, V1, Administrator, said V13 has not been in the facility since he has been the administrator (eight weeks). V1 said he just got caught up to speed on everything regarding V13 in relation to visiting Resident R1 today since you (IDPH) came in and asked questions. V1 said he would never stop V13 from coming to visit Resident R1. V1 said unless there is an order of protection, they cannot restrict a visitor. V1 said it's the resident's right to have visitors.Resident R1's admission Record dated 8/22/25 shows V13 is his significant other.The facility was unable to provide any legal documents which prohibit V13 from visiting Resident R1.The facility's Visitation Guidelines Policy (reviewed May 2025) shows the facility supports and encourages visitation for all residents in accordance with CMS federal regulations. Residents have the right to receive visitors. Any concerns, incidents, or restriction of visitation must be documented and reported to

the Administrator.Resident R1's current care plan provided by the facility does not address any restricted/limited visitation needs.

Residents Affected - Few

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

Facility ID:

If continuation sheet

Event ID:

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hope Creek Nursing & Rehab

4343 Kennedy Drive East Moline, IL 61244

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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

Based on observation, interview and record review the facility to ensure a resident's therapeutic diet was provided. This applies to 1 of 3 residents (Resident R3) reviewed for diets in the sample of 7.The findings include:On 8/22/25 at 12:40 PM, Resident R3 was in the dining room eating his noon meal. Resident R3 was served one corndog, pasta salad, watermelon and cottage cheese. Resident R3's neon colored diet card shows he is on regular diet, low concentrated sweets, no pork and double protein. Resident R3 said he was served one corndog and should receive double protein.On 8/22/25 at 12:54 PM, V6 (Dietary Manager) said Resident R3 is on regular diet, low concentrated sweets and no pork. V6 said the corn dogs are made with turkey and chicken. Resident R3 should receive double protein with each meal and should have received two corn dogs. The cooks in the kitchen are new and she will in-service the staff to ensure residents receive their correct diet.Resident R3's Physician Order Sheets dated through August 2025 shows his diet order is cardiac low concentrated sweets, provide 1/2 portion carbs and double proteins with meals and no pork.The facility's Therapeutic Diets undated Policy states, therapeutic diets are prepared and served as ordered by the attending physician.residents' trays will be clearly identified by a color-coded tray card, The tray card information is to include residents name, diet order and room number.

Event ID:

Facility ID:

If continuation sheet