Inspection·January 20, 2026

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure residents' non-invasive ventilation machine Continuous Positive Airway Pressure (CPAP) masks fit securely on residents faces to provide the prescribed treatment for their obstructive sleep apnea for 2 of 3 residents (R1, R2) reviewed for respiratory care in the sample of 4.The findings include:1.R1's physician order dated 12/12/25 showed an order for R1 to be placed on CPAP at night when sleeping due to his diagnosis of obstructive sleep apnea. On 1/20/26 at 8:54 AM, R1 was awake, lying in bed. A CPAP machine with attached tubing and face mask was noted on a table by the foot of R1's bed. The CPAP machine and equipment appeared clean and unused. R1 stated he had not used his CPAP at night for months because the mask doesn't fit. It leaks air and blows into my eyes. R1 stated he told nursing and a pulmonology nurse practitioner about his ill-fitting mask, but nothing had been done about it. R1's Health Status note dated 12/10/25 showed R1 was seen and examined by V5 Nurse Practitioner (NP). The note showed, Pulmonary NP to follow for refitting of CPAP for sleep apnea as patient complains of ill-fitting mask.R1's Follow Up Pulmonary note dated 12/17/25 showed R1 was seen and examined by V4 Pulmonary Nurse Practitioner. The note showed R1 requested a new mask for his CPAP machine. The note showed V4 notified facility staff R1 needed a new mask.R1's Health Status note dated 1/14/26 showed R1 still had not received a new mask for his CPAP machine. Facility nursing staff notified V4 Pulmonary Nurse Practitioner that R1 had yet to receive a new mask.On 1/20/26 at 10:00 AM, V4 Pulmonary Nurse Practitioner stated R1 requires the use of CPAP at night due to his sleep apnea. V4 stated in December 2025, facility staffed initially notified her that they could not find the mask to R1's CPAP machine but the facility called back shortly after that to tell me they had found the mask. I wasn't notified until January 14th (2026) that (R1's) mask didn't fit. V4 stated she did not recall R1 telling her that his mask didn't fit on 12/17/25. V4 stated if a CPAP or BiPAP does not fit securely on a resident's face, it can cause the resident to not receive enough oxygen while sleeping which could lead to respiratory distress and/or failure.On 1/20/26 at 11:01 AM, V5 NP stated R1 complained of his CPAP mask not fitting to V5 on 12/10/25. V5 stated, I put in a referral then for him to be refitted for a mask by pulmonology. I don't know why he has not received a new one.2. R2's physician order dated 11/4/24 showed an order for R2 to be placed on CPAP at night when sleeping due to her diagnosis of COPD (chronic obstructive pulmonary disease).On 1/20/26 at 8:48 AM, R2 was seated in a wheelchair in her room. A CPAP machine with the attached tubing and mask was wrapped in a plastic bag, sitting on R2's bedside table. R2 stated she had not used her CPAP at night in a long time because the mask doesn't fit. It's too big. R2 stated, I've been waiting on pulmonology to come fit me for a new mask. I keep asking when they are coming but nothing has happened.R2's Follow Up Pulmonary note dated 12/3/25 showed R2 was seen and examined by V4 Pulmonary Nurse Practitioner. The note showed, Patient reports compliance with CPAP device however is asking to replace her medium sized mask with a small, facility staff notified.R2's Health Status note dated 12/17/25 showed R2 was seen and examined by V5 Nurse Practitioner (NP). Residents Affected - Few (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: 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 01/20/2026 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)