Inspection·April 18, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility to ensure a resident's right to be free from neglect for 1 of 3 residents (R1) reviewed for neglect in the sample of 5. This failure resulted in R1 lying in urine for hours causing embarrassment and emotional distress. The findings include: R1's face sheet showed an [AGE] year-old female admitted to the facility on [DATE] with diagnosis of acute cystitis with hematuria, syncope and collapse, acute kidney failure, obstructive sleep apnea, hypertension, history of falling, adult failure to thrive, and urinary tract infection. On 4/18/24 at 10:41 AM, R1 was in her room. R1 became tearful and her crying increased as she spoke about the incident night of 4/9/24. R1 said I done forgot about that girl. She didn't want to help me go to the bathroom. I put the call light on waited hours and started calling out nurse, nurse. She had a nasty remark. She didn't want to be bothered with me. I wet myself. I feel like she was abusive to me. You got to have a decent attitude. I don't think she is qualified to take care of people. Some people got jobs they ain't cut out for, but they think they are. I prayed and hoped I made it through the night. I felt afraid to ask for help. She was the one waiting on me. You don't want to call that person to come back in. I hate to say it but that's the way I feel. I was embarrassed that I had to wet myself. On 4/18/24 at 9:41 AM, V7 (Registered Nurse/RN) said R1 alert and oriented x 3. If I was told a resident had not been changed all night and was upset, I would report it to management. If it's true, then someone did not perform their duties. I would call it neglectful if it's true. On 4/18/24 at 9:48 AM, V8 (Certified Nursing Assistant/CNA) said the morning of 4/10/24, R1 told her nobody changed her all night. I got her up and cleaned up, washed her good. R1's bed was wet all the way to the mattress. I reported it to V1 (Administrator) as soon as I cleaned her up. It felt like that was neglect on the patient. We give report that she gets up to the bathroom. Normally she gets up to the bathroom and doesn't wet herself. She is very aware of her surroundings. She was very upset and embarrassed. Honestly, as wet as she was, I don't think she was changed or toileted at all. I know she is continent, and she lets you know when she needs to use the bathroom. She'll put her call light on. If you leave them in their urine too long their skin can start breaking down and leave bedsores. On 4/18/24 at 2:24 PM, V11 (R1's daughter) said she arrived at the facility around 10:00 AM on 4/10/24. R1 told her that during the night she put her call light on to tell staff she needed to go to (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: 145142 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 145142 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Debes Rehab & Hcc 550 South Mulford Avenue Rockford, IL 61108 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)