Inspection·July 28, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to have evidence that R4's alleged allegations were thoroughly investigated for 1 of 6 residents (R4) reviewed for abuse in the sample of 6. The findings include:On 07/23/2025 at 12:22PM, R4 was lying in bed on his left side with eyes closed. On 07/23/2025 at 12:22PM, R4 said, the staff have been giving me a hard time when I call for help. I went to the bathroom; the staff gave me a hard time due to them getting off work soon. I told the administrator. V5 CNA's-Certified Nursing Assistant told me she did not want to come in my room to provide care. I told her to shut her mouth. She started walking down the hallway cussing. I watch the security video with the administrator yesterday. It showed V5 CNA walking down the hallway. The video did not have sound at the time, V1 may not have turned the volume on.On 07/23/2025 at 12:30PM, V1 Administrator was not in the facility.On 07/28/2025 at 8:37AM, V1 Administrator said, I will call you back. On 07/28/2025 at 11:19AM, V4 Nurse Consultant said, V1 Administrator has been removed from his position; I attempted to obtain information about R4 and V5 CNA from V1 last Wednesday (07/23/25) after I was told about the incident. On 07/23/25 and on 07/28/25 The facility was not able to provide documentation or verbal confirmation to show R4's allegation of verbal abuse was investigated.V5 CNA was not available at the time of the survey. The facility's Abuse Policy dated 11/2024 shows, Verbal Abuse means the use of oral, written or gestured communication or sounds that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance regardless of their age, ability to comprehend, or disability. Alleged Violation is a situation or occurrence that is observed or reported by . resident .but has not yet been investigated and, if verified, could be indication of noncompliance with the Federal requirements .Written procedures for investigations include . Providing complete and thorough documentation of the investigation. Residents Affected - Few 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: 145222 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 145222 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Woodstock 309 McHenry Avenue Woodstock, IL 60098 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)