Abbington Vlge Nrsg & Rhb Ctr

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

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

shift. V4 stated she never asked Resident R1 if he needed incontinence care because Resident R1 usually asks himself for his incontinence brief to be changed. On 9/25/25 at 10:33 AM, V11 (Restorative) stated between 10:00 AM and 11:00 AM, she asked Resident R1 if he wanted a shower and Resident R1 told V1 that he was scheduled for a shower during

the PM shift that day. V11 stated Resident R1 never stated he did not want his incontinence brief to be changed until

the PM shift. V11 stated the CNAs should offer residents to have their incontinence briefs changed every two to three hours even if a resident can verbalize that they need changed. On 9/25/25 at 11:28 AM, V1 (Administrator) stated the facility nursing staff should check incontinent residents' incontinence briefs every two to three hours regardless if a resident can verbalize their briefs are soiled. Facility Incontinence Care Policy, undated, shows, Incontinence care is provided to keep residents as dry, comfortable and odor free as possible. Incontinent residents are changed every two hours and more frequently if needed. Facility Activities of Daily Living Policy, undated, shows, 4. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. 2. Face sheet, dated 9/25/25, showed Resident R7's diagnoses included hemiplegia and hemiparesis and dementia. MDS, dated [DATE REDACTED], shows Resident R7 was cognitively intact, and Resident R7 was dependent on staff for toileting transfers and toileting hygiene. Review of Resident R7's care plan showed Resident R7 was dependent on two staff for transfers with a mechanical lift and was incontinent of bowel/bladder. Resident R7 was care planned for being upset

after five minutes if a CNA did not arrive to assist him and care planned to allege that he was waiting for hours. On 9/24/25 at 3:250 PM, Resident R7 stated it took over an hour for staff to arrive to change his soiled incontinence brief. Resident R7 stated he had the same incontinence brief on since 8:30 AM that morning. 3. Face Sheet, dated 9/25/25, shows Resident R9 had a diagnosis of hemiplegia and hemiparesis following a cerebral infarction affecting her left non-dominant side. MDS, dated [DATE REDACTED], shows Resident R9 was cognitively intact, was completely dependent on staff for toileting hygiene, and was always incontinent of bowel and bladder.

Review of Resident R9's care plan showed Resident R9 was incontinent of bowel/bladder, was dependent on staff assistance for toileting, and required the assistance of two staff utilizing a mechanical lift for transfers. The care plan showed Resident R9 was to be provided incontinence care after each incontinence episode. On 9/25/25 at 11:35 AM, Resident R9 stated she usually waits an hour for CNAs on the first and second shifts to arrive to change her soiled incontinence briefs.

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbington Vlge Nrsg & Rhb Ctr

31 West Central Roselle, IL 60172

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 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

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 provide palatable food at warm temperatures. This applies to 4 of 5 residents (Resident R1, Resident R5, Resident R7, and Resident R9) reviewed for food palatability in a sample of 5. The findings include:

1. 1. MDS (Minimum Data Set), dated 9/3/25, shows Resident R1 was cognitively intact. On 9/24/25 at 1:10 AM, Resident R1

stated his food was often served late and the hot food was cold. 2. MDS, dated [DATE REDACTED], shows Resident R7 was cognitively intact. On 9/24/25 at 3:50 PM, Resident R7 stated his food is served cold and usually an hour late. 3.

MDS, dated [DATE REDACTED], shows Resident R9 was cognitively intact. On 9/25/25 at 11:35 AM, Resident R9 stated the food was often served late and cold. 4. MDS, dated [DATE REDACTED], shows Resident R5's cognition was severely impaired. On 9/24/25 at 11:55 AM, Resident R5 stated her food is often served late and the hot food is cold. 5. Resident Council Meeting Minutes, dated 6/27/25, show the residents in the meeting complained that the breakfast meals were always cold when they received them. Resident Council Meeting Minutes, dated 7/25/25, show the residents stated the kitchen food continued to arrive cold, and the CNAs (Certified Nursing Assistants) were taking too long to pass meal trays to residents. Emergency Food Committee Meeting Minutes, dated 9/12/25, shows Residents will have lunch in the dining room to improve food temps. On 9/27/25 at 8:26 AM, V1 (Administrator) stated the facility did not have a policy on food palatability or food temperature expectations at the point of service to residents.

Residents Affected - Some

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

09/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Abbington Vlge Nrsg & Rhb Ctr

31 West Central Roselle, IL 60172

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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.

Based on observation, interview and record review, the facility failed to serve resident meals at regular times per the facility meal schedule. This applies to all 60 residents residing in the facility receiving oral diets. The findings include: On 9/24/25 in the main dining room, meal times were posted stating that Breakfast would be served at 8:30 AM, Lunch would be served at 12:30 PM and Dinner would be served at 5:30 PM. On 9/24/25 in the main dining room lunch trays began to be delivered at 12:50 PM and were finished being served by 1:00 PM. On 9/24/25 during facility tour, Resident R1, Resident R2, Resident R4, Resident R5 and Resident R7 all stated the meals at the facility were served late. Resident R2 and Resident R4 stated the meal trays arrived 30-45 minutes late, Resident R6 stated sometimes the food came 20 minutes late, and Resident R7 stated the food was usually served an hour late and sometimes received lunch at 1:15 PM. On 9/25/25 at 11:35 AM, Resident R9 stated the food was usually served more than 30 minutes late. On 9/24/25 at 12:23 PM, V4 (Certified Nursing Assistant) stated the meal trays were usually served approximately 25 minutes late. On 9/24/25 at 11:03 AM, V5 (Cook) stated the food service was staffed with two aides in the morning but they were reduced to one aide which slowed down meal service. V5 stated the meal service may be later depending on how many items must be placed on

the tray. V12 (Food Service Worker) stated the latest the staff have finished lunch was 1:15 PM. V12 stated

in the past they were able to finish plating meals at 12:30 PM. On 9/25/25 at 8:40 AM, V8 (Food Service Manager) stated he was back from vacation and would serve as a second aide to ensure that meals were served on time. On 9/25/25 at 8:45 PM, V1 (Administrator) stated V8 returned from vacation and would serve as the second aide to make sure the meals were served on time. Facility Bed Roster, dated 9/23/25, shows the facility census was 61 residents. On 9/28/25, V1 (Administrator) stated there was one resident in

the facility who did not receive oral diets. Resident Council Meeting Minutes, dated 7/25/25, shows the residents expressed concerns that the staff were taking too long to pass trays to residents. Resident Council Meeting Minutes, dated 8/29/25, show, Lunch keeps coming later and later. Facility Meal Schedule Policy, undated, shows, Three meals will be served daily at similar times as served in the community. The policy states mealtimes will be posted throughout the facility where they are accessible to residents and visitors.

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Facility ID:

If continuation sheet