Eastview Healthcare & Senior Living

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review the facility failed to ensure timely call light response for one of four residents (Resident R6) reviewed for staffing in the sample list of eight residents. Findings include: On 12/29/25 at 11:17 AM Resident R6 stated there aren't enough Certified Nursing Assistants (CNAs) on second and third shifts, Resident R6 waits an hour for Resident R6's call light on these shifts while needing incontinence cares, causing Resident R6 to be left in urine/feces. Resident R6 stated call lights are frequently brought up in resident council. The Grievance/Complaint Report dated 11/10/25 documents unidentified residents complain that third shift isn't answering call lights fast enough so residents can be changed. Resident R6's Minimum Data Set, dated [DATE REDACTED] documents Resident R6 as cognitively intact, is dependent on staff for toileting and Resident R6 is frequently incontinent or urine and always incontinent of bowel.

On 12/29/25 at 1:06 PM, V9 Activity Director stated call lights were brought up in November's resident council meeting, but V9 could not recall which residents voiced the concerns. On 12/29/25 at 1:45 PM, V11 Certified Nursing Assistant (CNA) stated four CNAs is not enough for days/evenings, there are a lot of residents that require toileting assistance which affects call light response times. The facility's Residents Call System policy dated September 2022 documents calls for assistance should be answered as soon as possible, but no later than five minutes, with urgent requests for assistance immediately addressed.

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

12/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Eastview Healthcare & Senior Living

100 Eastview Place Sullivan, IL 61951

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 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

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 showers as scheduled for one of four residents (Resident R6) reviewed for staffing in the sample list of eight residents. Findings include: The facility's Shower/Tub Bath policy dated February 2018 documents the purpose of this procedure is to promote cleanliness, provide comfort and monitor skin condition. This policy documents to record if the resident refused showers/baths and notify the supervisor. On 12/29/25 at 11:17 AM, Resident R6 stated Resident R6 is supposed to get showers twice per week and Resident R6 prefers to have them in the evenings after 7:00 PM. Resident R6 stated her shower days used to be Mondays/Thursdays and then changed to Tuesdays/Fridays, and Resident R6 goes two weeks without getting showers. Resident R6's Grievance/Complaint Report dated 11/10/25 documents Resident R6 stated Resident R6 had not received a shower in two weeks. Resident R6's Minimum Data Set, dated [DATE REDACTED] documents Resident R6 as cognitively intact and is dependent on staff for bathing. Resident R6's active Care Plan documents Resident R6 has activities of daily living self-care deficit related to above knee amputations and requires supervision/assistance to complete. This care plan includes an intervention that Resident R6 will receive showers twice weekly.The facility's undated shower schedule documents Resident R6's showers are scheduled on Tuesdays and Fridays on second shift. Resident R6's November and December 2025 shower documentation, provided by V2 Director of Nursing, documents showers given on 11/10/25, 11/20/25, 11/25/25, 12/17/25, 12/29/25 and 12/26/25. Resident R6's Shower/Abnormal Skin Report dated 12/2/25 documents Resident R6 did not know that Resident R6's shower day was changed and Resident R6 would wait until Friday. Resident R6's Response History for showers documents not applicable on 12/5/25. On 12/29/25 at 1:30 PM, V2 provided Resident R6's shower documentation for November/December 2025. V2 stated that is all the documentation V2 was able to locate. V2 confirmed showers are scheduled twice per week and gaps in Resident R6's shower documentation. V2 stated refusals would also be documented on the paper shower forms.

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

12/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Eastview Healthcare & Senior Living

100 Eastview Place Sullivan, IL 61951

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

prior to the seizure. V20 verified the refusal of the seizure medication caused the seizure which caused the fall which caused the subdural hematoma and the laceration.

Level of Harm - Actual harm 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

12/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Eastview Healthcare & Senior Living

100 Eastview Place Sullivan, IL 61951

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review the facility failed to prevent cross contamination during incontinence care for one of four residents (Resident R2) reviewed for incontinence in the sample list of eight residents. Findings include: The facility's Perineal Care policy dated February 2018 documents for female perineal care wash/dry from front to back, washing the labia and perineum followed by the rectal area/buttocks. On 12/29/25 at 1:34 PM, Resident R2 was lying in bed. V11 and V12 Certified Nursing Assistants applied gloves and gowns and entered Resident R2's room. V11 pulled down Resident R2's brief which was wet with urine and had a small amount of soft bowel movement. V11 used wash cloths to clean Resident R2's vaginal area in a front to back motion and then turned Resident R2 on her side to cleanse buttocks. V11 did not change gloves and applied a clean brief. V11 then turned Resident R2 onto Resident R2's back and cleaned Resident R2's vaginal area again while wearing the same gloves used to wash Resident R2's buttocks. At 1:45 PM, V11 confirmed V11 used the same contaminated gloves to wash Resident R2's vaginal area after washing Resident R2's buttocks. V11 confirmed V11 should have changed her gloves. Resident R2's Minimum Data Set, dated [DATE REDACTED] documents Resident R2 has moderate cognitive impairment, Resident R2 is always incontinent of bowel and bladder, and is dependent on staff for toileting hygiene. Resident R2's urine culture dated 12/3/25 documents greater than 100,000 colony forming units per milliliter (CFU/ml) of Klebsiella Oxytoca ESBL (Extended Spectrum Beta Lactamase) and Escherichia Coli, (E. Coli) indicating infection. Resident R2's Provider Note dated 12/8/2025 at 12:49 PM documents persistent UTI / ESBL to start Tobramycin 80 milligram injection three times daily for 10 days. Resident R2's Nursing Note dated 12/27/2025 at 2:35 PM documents Resident R2's urine culture returned with E. Coli ESBL greater than 100,000 CFU/ml. Orders were received for Meropenem intravenous three times daily for seven days and contact isolation were implemented. On 12/29/25 at 3:00 PM, V13 Resident Care Coordinator stated during female incontinence care staff should change gloves when moving from soiled to clean areas and should cleanse from front to back.

Event ID:

Facility ID:

If continuation sheet