Health inspection·January 31, 2025

F 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Potential for minimal harm Based on observation, interview and record review, the facility failed to ensure the facility's annual State Survey Results were readily and easily accessible to residents for review. This failure has the potential to affect all 90 residents residing at the facility. Residents Affected - Many Findings include: The facility's Resident Rights Policy, dated 1/30/24 documents: Policy Statement: Staff shall treat all residents with kindness, respect, and dignity. 1. Federal and state laws guarantee certain basic rights to all residents of the (facility) community. These rights include the resident's right to: H. Be supported by the (facility) community in exercising their rights; M. Exercise rights not delegated to a legal representative; and W. Examine survey results. The facility's State Survey Results Binder was located in a cabinet drawer in the front foyer. The access to the front foyer was through double glass doors that were not wheelchair accessible; an electronic code was used by staff to open the glass doors to enter into the front foyer, which led to another set of glass doors to exit. Staff stated that residents did not have access to the electronic code. On 1/29/2025 at 1:00pm, Residents R8 and R21 attended the Resident Council Meeting. Both R8 and R21 indicated that V9 Activities Director informed them that the State Survey Results Binder was located at the East Wing Nursing Station. On 1/29/25 at 1:30pm, R8 asked V9 Activities Director to show (R8) the Binder at the East Wing Nursing Station. The Binder was not at that location. On 1/29/25 at 1:40pm, V9 Activities Director confirmed that she had informed the residents that the Binder was at the East Wing Nursing Station; stated that the Binder used to be at the East Wing Nursing Station prior to facility remodel in 2017 and that it (the Binder) probably was moved to the front foyer with the remodel. At this same time, V9 stated, None of the residents had asked to see the Survey Binder; they (residents) would have to ask to see it. On 1/29/25 at 1:30pm, V15 Licensed Practical Nurse/LPN stated: The Binder is in the front foyer; it has never been at the East Wing Nursing Station since the time I have worked here, five years. Residents cannot get out there (into foyer) unless someone gets them there. (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 4 Event ID: 145058 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 145058 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arc at Chillicothe 1028 Hillcrest Drive Chillicothe, IL 61523 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)