Inspection·May 9, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to provide comfortable temperatures in the dining room and visiting room. This failure has the potential to affect all 57 residents residing at the facility. Findings include: 1.R3's medical diagnosis sheet, print date of 5/9/25, documented R3 has diagnoses including type 2 diabetes mellitus, heart failure, fibromyalgia, dementia, and anemia. R3's Minimum Data Set (MDS), dated [DATE], documented R3 is moderately cognitively impaired although resident was alert and oriented at time of interview. On 5/9/25 at 9:24 AM R3 stated the facility was freezing the first day they shut the heat off, my room temperature is okay now, but the dining room is still cold. 2. R4's medical diagnosis sheet, print date of 5/9/25, documented R4 has diagnoses including chronic obstructive pulmonary disease, hypokalemia, atrial fibrillation, osteoarthritis, anxiety, hypertension, and morbid obesity. R4's MDS, dated [DATE], documented R4 is cognitively intact. On 5/9/25 at 9:33 AM R4 stated the dining room and lobby are always cold. Other residents and I have told maintenance about it being so cold. 3. R5's medical diagnosis sheet, print date of 5/9/25, documented R5 has diagnoses including heart failure, muscle weakness, asthma, chronic obstructive pulmonary disease, and myalgia. R5's MDS, dated [DATE], documented R5 is cognitively intact. On 5/9/25 at 9:42 AM R5 stated her room is a comfortable temperature but it is a little cold in the dining room. Resident was observed wearing a scarf over her head and had a hooded jacket on with the hood also covering her head while sitting in her wheelchair in the dining room. 4. R6's medical diagnosis sheet, print date of 5/9/25, documented R6 has diagnoses including morbid obesity, chronic kidney disease, heart failure, anxiety, hypothyroidism, and depression. R6's MDS, dated [DATE], documented R6 is cognitively intact. (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: 145136 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 145136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Auburn 304 Maple Avenue Auburn, IL 62615 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)