Health inspection·February 4, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure fall prevention interventions were in place for four of four residents (R1-R4) reviewed for safety/supervision in the sample of four. The findings include:1. R1's Face Sheet shows he was admitted to the facility on [DATE] with diagnoses including encephalopathy, diabetes, nicotine dependence, cardiomegaly, and history of falling.V1 (Administrator) stated that R1 did not have a Care Plan as he discharged from the facility the same day he was admitted .R1's Fall Scale dated January 24, 2026 shows he was a moderate risk for falling.R1's Nurses Notes dated January 24, 2026 at 4:42 PM shows R1 was admitted to the facility. R1 was transferred to the bed and family was at the bedside. R1 had a scab on his right knee with numerous bruises to both of his lower extremities. R1's Nurses Notes dated January 24, 2026 at 8:16 PM, entered by V3 (Licensed Practical Nurse/LPN) shows R1 was found on the floor face down with his head near the head of the bed and his feet towards his dresser. R1 had a medium sized pool of blood on the floor in front of him. R1 was noted to be incontinent in bed prior to the fall. R1 did not have any clothes on other than socks. R1 initially told staff he fell reaching for food that had fallen on the floor and hit his head first. When the emergency medical personnel arrived, R1 told them he woke up when he hit the floor. Injuries were noted to his right eyebrow, nose, and right knee abrasion re-opened. R1 was transferred to the local emergency room for evaluation.On February 1, 2026 at 5:15 PM, V8 (R1's son) said the day his father fell, V8's sister and brother-in-law were with R1 for about 2.5 hours before they went home. V8 said facility staff left R1 sitting at the side of the bed. V8 said R1 received steri strips to his eyebrow. V8 said R1 went to a different rehab facility after he left the hospital.On February 2, 2026 at 1:20 PM, V6 (CNA) said she saw that R1's call light was on, so she went into his room. V6 said R1 was on the floor next to his bed face down. V6 said R1 did not have any clothes on. V6 said there was blood on R1's knee and his face. On February 2, 2026 at 1:35 PM, V3 (LPN) said R1 was sitting on the side of the bed eating supper. V3 said she did not love the idea of him sitting on the side of the bed since he was a new admission and the staff did not know if R1 would try and transfer himself. V3 said residents use a mechanical lift until therapy can evaluate them. V3 said staff could have used a mechanical lift to put R1 in a chair. V3 said R1 had a history of falling. V3 said when R1 fell, he had a laceration to his eyebrow and reopen the laceration to his knee. V3 said R1 stated his head hurt where he cut it opened. V3 said R1 was naked when he was on the floor. On February 2, 2026 at 2:05 PM, V4 (Certified Nursing Assistant/CNA) said her and V5 (CNA) went into R1's room because his call light was on. V4 said that R1 said he wanted to sit on the side of the bed. V4 said the R1's family was at his bedside. V4 and V5 asked R1's family to let them know when family left. V4 said she let V3 (LPN) know that R1 wanted to sit on the side of the bed. V4 said R1's family did not let staff know when they left. V4 said that R1 was on the floor face down. V4 said R1 told her he was trying to pick food up off of the floor. V4 said she (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: 145200 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 145200 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Grove Living and Rehab 502 North State Street Franklin Grove, IL 61031 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)