Inspection·October 4, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to answer resident call lights timely for five (R1, R2, R3, R4 and R5) of seven Residents reviewed for call lights in a sample of seven. Residents Affected - Some Findings include: Facility Resident Call Bells Policy, revised 11/5/2020, documents: it is the Policy of the Facility to ensure Residents have a functioning call bell to alert staff to their needs and that calls are responded to timely; and any staff member that hears or sees a call bell on is responsible to answer within a reasonable time frame. Facility Certified Nursing Assistant Job Description, undated, documents to answer call lights promptly. Facility Resident/Family Concern/Grievance Log, 5/16/23, documents Resident concerns (three of thirteen Residents) that call lights are taking fifteen to twenty minutes to be answered on Second and Third Shift. Facility Resident/Family Concern/Grievance Log, 6/15/23, documents Resident concerns (six of thirteen Residents) that Certified Nursing Assistants (CNA's) are taking twenty to thirty minutes to answer call lights on Second Shift. Facility Resident/Family Concern/Grievance Log, 8/3/23, documents Resident concerns (five of ten Residents) that call lights are taking forty minutes to be answered. Facility Resident/Family Concern/Grievance Log, 9/18/23, documents Resident concerns (nine of eleven Residents) that call lights are taking forty minutes to an hour to be answered on Third Shift, because CNA's are either smoking or playing on their phones at the nurses' station. The Facility Resident Council Minutes, dated 5/10/23, document that three of fourteen Residents in attendance are complaining that call lights on Second Shift are taking fifteen to twenty minutes to be answered. The Facility Resident Council Minutes, dated 6/14/23, document that six of thirteen Residents in attendance are concerned that CNA's are taking twenty to thirty minutes to be answered on Second Shift. The Facility Resident Council Minutes, 7/5/23, document that seven of ten Residents in attendance are concerned that call lights are taking forty minutes to an hour to be answered on Third Shift. (continued on next page) 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 Page 1 of 2 Event ID: 145021 Printed: 05/15/2026 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 145021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Macomb Post Acute Care Center 8 Doctors Lane Macomb, IL 61455 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)