Inspection·August 27, 2025

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Note: The nursing home is disputing this citation. (the facility) telling us they were having problems with their AC unit. I am replacing the thermal expansion valve today. The North Hall unit was out. I needed the parts, which I had to order and am replacing everything today. Hopefully, this will take care of everything for that hall.1-R2's Physicians Order Sheet (POS) for August 2025 documents diagnoses of Morbid Severe Obesity, Heart Failure, diabetes mellitus 2, kidney Failure, hypertension; chronic pain syndrome; unspecified protein calorie malnutrition; acute kidney failure; shortness of breath; hypertension; and generalized anxiety.R2's Minimum Data Set/MDS dated [DATE] document R2 was cognitively intact for decision making of activities of daily living, uses a wheelchair, and is dependent on staff for most activities of daily living.R2's Care Plan with a start date of 7/29/2024 documents, the resident has an ADL (Activities of daily living) self-care performance deficit r/t (related to) respiratory failure, obesity, chronic pain, depression. The resident has diabetes mellitus start date 8/28/2024; Intervention: Avoid exposure to extreme heat or cold.On 8/13/2025 at 10:03 AM, R2's room was measured with a Humidity Meter Hygrometer and Indoor Digital Thermometer with Temperature Gauge and Humidity Gauge which was calibrated and documented R2's room was 86 degrees with 61 percent humidity = for 91-degree Fahrenheit (F) room (extreme caution). On 8/12/2025 at 12:08 PM, V5, Family of R2 stated, The nursing home has failed to repair the broken air conditioner. It broke on Thursday August 7th, the system stopped functioning in my mom's room. There is no Air conditioning on their wing at all. Nurses have opened the windows and are using what fans they can find. The temperature outside has been in the high 80's and 90's all 5 days the air conditioner has been down. There was a thermometer in her room and her room was 87 degrees inside. My mom was sweating and complaining of headaches and how she was having issues sleeping because the room was so hot. The temperature inside the building exceeds outside temperatures at times. We are worried for my mom's and others' safety. It is too hot, for too long. She is bedridden and cannot escape the heat. They don't have the staff to get her up and move her throughout the day. She has asked for ice water, but (Facility) is experiencing problems with their ice.On 8/12/2025 at 12:08 PM, V5, Family of R2 stated, The nursing home has failed to repair the broken air conditioner. On Thursday August 7th the system stopped functioning in my mom's room. There is no Air conditioning on this wing at all. Nurses have opened the windows and using what fans they can find. The temperature outside has been in the high 80's and 90's all 5 days the air conditioner has been down. The temperature inside the building exceeds outside temperatures at times. We are worried for her and others' safety. It is too hot, for too long. She is bedridden and cannot escape the heat. They don't have the staff to get her up and move her throughout the day. She has asked for ice water, but Arcadia is experiencing problems with their ice machine as well, so it is in short supply. I came to visit my mother and noticed there wasn't air in the room, and it was very hot. I asked staff why it was so hot, and they stated the air doesn't work. There had been a storm, and it knocked out the air conditioning unit (A/C). When I asked how long it had not been working, they said for over a week now. I sat up a fan for my mom. The facility had put a box fan at the bottom of her bed, and I was dripping in sweat. Her room was so hot. They were not passing out any liquids. I was there for about two hours and a half, and no liquids or ice water were being passed out. I moved the fan up off the floor so it would circulate better. I am not sure if it really does anything because the fans are blowing around hot air. I was not sure what else to do to cool her down. I gave her a washcloth, but it got hot fast. It was hot outside too, but it was even hotter in my mom's room.On 8/13/2025 at 12:08 PM, R2 stated, the a/c had been broken for over a week. It is finally better today. Last week was miserable, the whole week we were without air conditioning. I was having issues sleeping and I was having problems breathing and suffering from headaches and I was sick to my stomach. Sleeping was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145136 If continuation sheet Page 2 of 4 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 08/27/2025 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)

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Note: The nursing home is disputing this citation. so difficult, because the room was so hot. The maintenance man brought in a thermometer, and I know it read it was 87 degrees inside this room at that time. I can't get up on my own. I was trapped in the heat, and it was horrible, it was just horrible. I was just laying here suffering. Thank goodness it is better today as I am not sure how much more I could have taken. I can now breathe better, and my headaches are gone, and my stomach feels better. It is amazing how that heat can wipe you out.R2's August 2025 vitals document here weight was documented on 8/3/2025, blood sugar 8/22/2025, oxygen and pain on 8/22/2025. No other documentation was present addressing vitals and or any resident assessment related to heat.2- R1's POS for August 2025 documents diagnoses of chronic kidney disease stage 4, severe sepsis with septic shock; acute respiratory failure with hypoxia, major depression, sleep apnea; chronic pain, major depressive disorder, heart failure, and type 2 diabetes mellitus with diabetic neuropathy.R1's MDS dated [DATE] document R1 was cognitively intact for decision making of activities of daily living. R1 has impairment on one side on her upper extremity, she uses a wheelchair, and needs some assistance with her ADL's, (Activities of Daily Living). R1's Care Plan with a revision date of 4/19/23 document she (R1) resident has an ADL self-care performance deficit r/t obesity, pain, difficulty walking.On 8/12/2025 at 9:58 AM, R1 is a large woman in a bariatric wheelchair. R1's forehead is covered with droplets of sweat. R1 is in the main room when entering the facility near a fish tank. R1 does not have any water and/or cup near her.On 8/12/2025 a 9:59 AM, R1 stated my room is a furnace. I had to go and order myself another fan because it is just too hot for me to stay in there, and I am a large woman and can't take the heat. The A/C has been broken since Thursday. It has been over a week. I just can't take it. I guess they had to order a part to get it fixed. They tinkered with it, but it is still broken and not working. It has been miserable trying to sleep in this heat. We have ice water passed out to us, but no popsicles or anything like that. I have had a headache since the heat started, which I think is due to the extreme heat.On 8/13/2025 at 10:02 AM, R1's room registered 86 degrees Fahrenheit with 62% humidity = 102 degrees F (extreme caution). R1's August 2025, Medical records were reviewed and does not document any vitals were taken except for pain on 8/9/2025 and 8/21/2025. No other vitals were documented for any other days. No other documentation was present addressing vitals and or any resident assessment related to heat.3- R3s POS August 2025 documents diagnoses of acute osteomyelitis, left ankle and foot, morbid (severe) obesity with alveolar hypoventilation, type 2 diabetes mellites without complications, acute respiratory failure, chronic systolic heart disease, and major depression. R3's MDS dated [DATE] document R3 was cognitively intact for decision making of activities of daily living.R3's Care Plan: The resident has an ADL self-care performance deficit r/t respiratory failure, obesity, weakness, lack of coordination, reduced mobility. The resident has Diabetes Mellitus; Avoid exposure to extreme heat or cold. (2/14/2025)On 8/12/2025 at 10:24 AM, R3 stated it was so hot, it was like living in a furnace. He was very uncomfortable, and the heat was out of control and the AC had been out for 8 days now. He had just gotten out of the hospital and was not sure that the room being so hot was good for him. He stated he has asked for multiple bed baths, and they give them to him, but he is still sweating really bad because of the heat.On 8/12/2025 at 10:22 AM, R3's room temperature was 86 degrees Fahrenheit with 60 degrees humidity = 91 degrees (extreme caution for heat index). R3's August Medical Records/Vital Signs only document the weight on 8/3/2025, blood sugar, 8/22/2025, oxygen 8/22/2025, and pain 8/22/2025. No other documentation was present addressing vitals and or any resident assessment related to heat.4- R11's POS for August 2025 documents, diagnoses of chronic obstructive pulmonary disease, acute kidney failure, type 2 diabetes without complications, shortness of breath and specified abnormal findings of blood chemistry. R11's MDS dated [DATE] document R2 was cognitively intact for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145136 If continuation sheet Page 3 of 4 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 08/27/2025 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)

F 0584 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete decision making of activities of daily living.R11's Care Plan with a revision date of 1/13/2025, documents, Resident has an actual skin impairment of (specify type: pressure/skin tear/bruise/surgical incision/rash/venous/stasis ulcer/arterial/ischemic ulcer/cellulitis/diabetic ulcer/) to (location). *Do not list stage* diabetes, diuretics, edema, fragile skin, impaired mobility, incontinence. Avoid exposure to temperature extreme.On 8/13/2025 at 10:02 AM, R11's room registered 86 degrees Fahrenheit with 62% humidity = 102 degrees F (extreme caution). On 8/15/2025 at 1:11 PM, R11 stated, The AC did break, and it was so hot in here and I am so thankful it is fixed now. They brought in some fans for my room, but it was just blowing around hot air, and it was not pleasant. It was so uncomfortable, and I felt so tired.R11's August 2025 Vital Documents for breathing 8/12/2025, and 8/19/2025. No other documentation was present for the month of August. No other documentation was present addressing vitals and or any resident assessment related to heat.On 8/13/2025 at 2:32 PM, V16, Medical Director stated, I would expect the residents' room temperatures to follow the policy and standards for the temperature guidelines. I know the AC is up and working now. For this population extreme heat is not always good thing but sometimes there can be other things going on as well with the patient. I would expect fans to be placed in residents' rooms and attempts to lower the room temperatures made by the facility. The Heat Emergency Policy with a revision date of 11/1/2024 documents, The purpose of this guideline is to provide precautionary and preventative measures for our residents during the hot and humid summer months. Older adults are extremely vulnerable to heat related disorders. Heat Exhaustion: A disorder resulting from overexposure to heat or to the sun. Early symptoms are headache and a feeling of weakness and dizziness, usually accompanied by nausea and vomiting. There may also be cramps in the muscles of the arms, legs, or abdomen. The person turns pale and perspires profusely, skin is cool and moist, and pulse and breathing are rapid. Body temperature remains at a normal level or slightly below or above. The person may seem confused and may find it difficult to coordinate body movements. Heat Stroke: A profound disturbance of the body's heat-regulating mechanism, caused by prolonged exposure to excessive heat, particularly when there is little or no circulation of air. The first symptoms may be headache, dizziness and weakness. Later symptoms are an extremely high fever and absence of perspiration. Heat stroke may cause convulsions and sudden loss of consciousness. In extreme cases it may be fatal. If the heat in the building increases above state mandated guidelines evacuate if necessary and follow evacuation policy.The Facility Vital Signs Monitoring Policy with an effective date of 4/2025 documents, Definition includes temperatures, pulse, respirations, and blood pressure, May also include pain level and oxygen saturations. Blood pressure 90/60 mm Hg to 120/80 mm Hg. Breathing 12-18 breaths per minutes; Pulse 60-100 beats per minute. Temperature 98.8 F to 99.1 F (36.5 C to 37.3 C/ average 98.6 F (37.0). Vital signs may be obtained more frequently with change of condition. Abnormal vital signs will be reported to the physician.The Immediate Jeopardy and deficiency practice that began on 8/7/2025 when the air conditioning was no longer working and the IJ was corrected/removed on 8/27/2025 after the facility took the following actions to correct the noncompliance prior to the start of current survey: AC unit was immediately repaired. Facility purchased extra fans and portable AC unit. Facility initiated Heat Emergency Policy making hourly rounds, offering water, wet rags, offering to relocate residents. R1, R2, R3 and R11 have been accessed and documented for risk of heat induced illness. All staff was in-serviced on Heat Emergency Policy. All nursing staff were in-serviced on documenting and monitoring resident's vitals and identify signs and symptoms of head induced illness. Also offering to relocate residents while under a Heat Emergency. All residents were assessed, and a QA (Quality Assurance) meeting was held to ensure compliance with facility Heat Emergency Policy. Event ID: Facility ID: 145136 If continuation sheet Page 4 of 4