Flanagan Rehabilitation & Hcc

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Based on interview and record review the facility failed to ensure care plans included problems, goals, and interventions to address diagnoses and medication use for two of three residents (Resident R2, Resident R3) reviewed for medications in the sample list of three. Findings include:1.) Resident R2's active diagnoses list includes epileptic seizures related to external causes, not intractable, without status epilepticus. Resident R2's September 2025 Medication Administration Record (MAR) documents Resident R2 receives Lamotrigine 200 milligrams (mg) by mouth twice daily for seizures since 2/3/24 and Phenytoin Sodium100 mg give two capsules by mouth twice daily for seizures since 5/24/25.Resident R2's active care plan does not include a problem, goal, and interventions for Resident R2's seizure disorder and seizure medications. On 9/18/25 at 12:55 PM V2 Director of Nursing confirmed Resident R2's seizure disorder and seizure medications were not on Resident R2's care plan. V2 stated V2 is responsible for updating the care plans and V2 will update Resident R2's care plan. 2.) Resident R3's September 2025 MAR documents Resident R3 receives Tramadol (opioid) 50 mg one tablet by mouth daily since 4/18/23. Resident R3's active care plan does not have a problem, goal, and interventions for opioid use and monitoring, including risk for constipation. On 9/18/25 at 12:55 PM V2 confirmed Resident R3's care plan does not address Tramadol use, interventions, and risk for constipation. V2 stated V2 will need to update Resident R3's care plan.

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

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Flanagan Rehabilitation & Hcc

201 East Falcon Highway Flanagan, IL 61740

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 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review the facility failed to implement a bowel program for one of three residents (Resident R3) reviewed for medications in the sample list of three. Findings include:Resident R3's August and September 2025 Medication Administration Records document Resident R3 receives Tramadol (opioid) 50 milligrams by mouth daily since 4/18/23 and Milk of Magnesia 30 milliliters daily as needed for constipation. These records document Resident R3 does not receive any scheduled bowel medications and did not receive any doses of Milk of Magnesia. Resident R3's Minimum Data Set, dated [DATE REDACTED] documents Resident R3 has severe cognitive impairment and requires dependence on staff for toileting hygiene. Resident R3's active care plan does not address Resident R3's Tramadol use and monitoring, including risk for constipation. Resident R3's Bowel Tracking Report with date range 8/20/25-9/18/25 documents the following: Large on 8/20/25. None 8/21/25-8/23/25. Large on 8/24/25. None 8/25/25-8/27/25.

Large on 8/28/25. None 8/29/25-9/1/25. Large on 9/2/25. None on 9/3/25 and 9/4/25. Large on 9/5/25. Two to three daily 9/6/25-9/8/25. Once on 9/9/25 and 9/10/25. None 9/11/25-9/13/25. Large on 9/16/25. None 9/17/25 and 9/18/25. Resident R3's Nursing Notes with range 8/15/25-9/18/25 do not document Resident R3 was assessed for constipation, offered Milk of Magnesia, or offered any other bowel interventions. On 9/18/25 at 11:29 AM V4 Registered Nurse stated the (electronic medical software) triggers an alert if a resident doesn't have a bowel movement (BM) for three or more days. V4 stated the Certified Nursing Assistants (CNAs) document

the residents' BMs. V4 stated Resident R3 has Milk of Magnesia to administer daily as needed. V4 stated Resident R3 has occasional constipation, but nothing frequent. V4 confirmed Resident R3 does not have orders for any other bowel medications. On 9/18/25 at 11:55 AM V3 CNA stated V3 is assigned to Resident R3's care today and Resident R3 has not had

a BM today. V3 stated BMs are documented by the CNAs in (electronic medical software) and complaints of constipation are reported to the nurses. V3 stated Resident R3's BMs are generally soft, but Resident R3 has constipation about once per week. On 9/18/25 at 12:55 PM V2 Director of Nursing confirmed Resident R3's care plan does not address opioid use and monitoring, including risk for constipation. V2 stated the facility has a bowel protocol to follow, which V2 will provide. V2 stated the (electronic medical software) sends an alert after three full days have passed with no BM, and continues to alert until addressed/resolved with BM documented. V2 reviewed Resident R3's bowel tracking 30 day report, and confirmed duration of days with no BMs recorded. V2 stated Resident R3 had BMs on day four, so the system would not have prompted an alert. V2 stated V2 will have to see if the system can be changed to alert on day two. V2 stated V2 would expect Milk of Magnesia to be given on day four of no BM. V2 stated V2 might look into getting Resident R3 something scheduled routinely for Resident R3's bowels. V2 confirmed risk of constipation with opioid use. At 2:45 PM V2 stated V2 followed up with corporate staff, and the facility does not have a bowel protocol; it is individually based on each resident's needs and bowel patterns. V2 stated it would also be based on if the resident was experiencing any symptoms such as nausea, vomiting, decreased appetite; which Resident R3 has not had.

Residents Affected - Few

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

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

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Flanagan Rehabilitation & Hcc

201 East Falcon Highway Flanagan, IL 61740

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 0760 Level of Harm - Actual harm Residents Affected - Few

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

which caused her to have withdrawal symptoms. V7 states that any decrease of a controlled substance could cause harm if stopped abruptly without tapering and could lead to seizures, altered mental status, dizziness, syncope, and unresponsiveness. V7 stated from his clinical standpoint that stopping Resident R1's Ativan abruptly caused Resident R1 to become unresponsive and fall, resulting in admission into the hospital. The Facilities Medication Administration Policy Documents that Any changes in medication orders must be documented

in the resident's medical record and Medication administration records should be maintained for each resident and must be up to date and easily accessible.

Event ID:

Facility ID:

If continuation sheet