Helia Healthcare Of Energy

Nurse/RN) stated she did assess R1 after her fall event in the dining room on 10/18/2025. V9 stated R1 had been sitting in a high back wheelchair when she had fallen face forward on the dining room floor. V9 stated R1 had been sitting in a high back wheelchair and is not appropriate for her, because the high back wheelchair sits to high up for her and R1 had no core muscle control and is unable to reposition or balance herself.R1's Occupational Therapy Evaluation dated 10/12/2025 documented under Reason for Therapy: Clinical Impressions/Reasons for skilled services, R1 presents with impairment in balance, fine motor coordination, gross motor coordination, mobility and strength.

Under Initial Assessment/Current Level of Function, Other System/Condition Assessment, Balance: Patient sits unsupported x 30 seconds with feet flat on floor and no back support? No; Amount of assist needed to sit at edge of bed is Moderate Assistance; Time patient can sit unsupported is 5 seconds.R1's local emergency room notes by V19 (Emergency Physician) documented under ED (Emergency Department) Course on 10/18/2025 that R1 had imaging of facial bones showing evidence of left nasal bone deformity and both ulnar and olecranon fracture of the left upper extremity.R1's Serious Injury Incident Report final report received on 10/24/25 documents under Detailed Incident Summary see attached.

The attached document titled Final Reportable to IDPH - Fall with Fracture documents under Conclusion based on the investigation, the facility concludes the fall was accidental and related to forward momentum during wheelchair movement.The facility policy titled Falls Management (revision date July 2017) documents It is the policy of (name of facility) to assess and manage resident falls through prevention, investigation, and implementation and evaluation of interventions.

Facility ID: