Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0585
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must
establish a grievance policy and make prompt efforts to resolve grievances.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to ensure grievances were recorded,
investigated, summarized, confirmed or not confirmed for 2 of 3 residents (R1,R11) reviewed for grievances
in the sample of 15. The findings include:On 01/26/2026 at 10:00AM, R1 was lying in bed on her back. R1's
left, and right arms were contracted close to the body. At 2:33PM, R11 was lying in bed on her back. R1's
MDS-Minimum Data Set, dated [DATE] shows, R1 is cognitively intact, with impairment to left and right
upper and left and right lower extremities. R1 needs extensive assistance from staff to total dependence on
staff for all ADLs-Activities of Daily Living. R11's MDS dated [DATE] shows, R11 is cognitively intact, with
upper extremity impairment on both sides, lower extremity impairment on both sides. R11 needs partial
assist, extensive assist, and is also dependent on staff for ADLs. R1 and R11 need to be supervised when
eating. On 01/26/26 at 10:00AM, R1 said, (V5 CNA-Certified Nursing Assistant) refused to get me up a
week ago from last Friday (01/16/2026). (V5) told me I had to do it her way or not at all. (V5 CNA) left me for
the second shift to get out of bed. I reported the interaction to (V2 DON-Director of Nursing). I also reported
the incident to the Ombudsman. I did not fill out a grievance form. I have Cerebral Palsy; I cannot use my
hand to write.at least not legibly. I would need the staff to fill out the form; I can sign my name. Documents
have a tendency to disappear around here. I prefer to complain to the Ombudsman. On 01/26/2026 at
10:23 AM, V2 DON-Director of Nursing said, I do not have any reports about (V5 CNA). On 01/26/2026 at
10:50AM, V5 CNA said, (R1) likes to get up after lunch. I did not have enough time to get her up and give
(R2) a shower before my shift ended. (R1) was upset. The next time I was assigned to (R1), she told me
she had talked to (V2 DON) and I was not to help her anymore. I stopped and walked out of the room. On
1/26/25 at 2:33PM, R11 said, (V5 CNA) does not follow the rules. One of the nurses reported her for
leaving my roommate hanging alone in the room in a full body mechanical sling lift. (V5 CNA) got written
up. I reported the incident to (V2 DON). Last Thursday (01/22/2026) I stayed in bed. I was not going to let
(V5 CNA) help me. The next day I let (V5 CNA) help me get out of bed and into my wheelchair. I should not
have. I explained how to position the chair and myself, but (V5 CNA) had to do it her way. (V5 CNA) ended
up having to leave me in the sling while she left the room to go get help. (V5 CNA) claimed she did not have
enough training. It is not training, (V5 CNA) needs to follow directions. I do not know anything about a
grievance form. It is easier to tell (V2 DON). On 01/27/26 at 9:14AM, V1 Administrator said, (R1) reported
(V5 CNA) is 'bad'. I did not know about (R11's) grievance with (V5 CNA). On 01/27/2026 at 9:45AM, V13
CNA said, I have had a lot of complaints about (V5 CNA). The residents have complained about the way
(V5 CNA) speaks to them. (V5 CNA) has been using the full body mechanical sling lift without a second
staff member present. (V5 CNA) got into a political argument with one of the residents. I reported my
concerns to (V11 Human Resource Director).: On 01/27/2026 at 10:03AM, V11 Human
(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 3
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
01/27/2026
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)
F 0585
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Resource Director said, I have not had any complaints from the residents about (V5 CNA). I received
feedback from (V13 CNA). (V13) is (V5's CNA) trainer. There was no need to bring the issues to the
Administrator, it was nothing he needed to know about. If the issue is about patient care, it is reported to the
Administrator or DON. A resident can go to any manager, speak to any nurse, and file a grievance. We have
a grievance form. I will listen to the resident's grievance then follow up with social services to do a written
grievance. On 01/27/2026 at 10:22AM, V12 RN-Registered Nurse said, I have no personal knowledge of
any resident complaints. The resident file their grievances with the Social Service Director. On 01/27/2026
at 10:44AM, V9 Social Service Director said, The person the resident reports the grievance to needs to be
the person that fills out a grievance form. Grievance Forms are available in the office and the nurse's
stations. The staff should fill out the form and report to me. If the resident reports a grievance to the CNA or
the nurse, the nurse should fill out the grievance form with the resident there. I will do the investigation. I
may ask another staff to assist me with the investigation. I also bring the grievances to the morning meeting
with administration and the entire management team. The Administrator is required to sign off on every
grievance. I have not had any reported issues about (V5 CNA). On 01/26/26 at 11:07AM, V6 Ombudsman
said, I encourage the resident to first report their grievances to the facility staff prior to contacting The
Ombudsman's Office or The State Agency. However, the residents feel when they report their grievances to
the staff, nothing ever gets resolved. The staff are in a better position to resolve the resident's grievances
than I am. On 01/26/2026 the facility's Grievance Log dated, December 2025 and January 2026 does not
show, R1 and R11's concerns with V5 CNA. The facility's undated Grievance/Concern Report form shows,
this form shall be utilized to provide written documentation of any grievance or concern expressed or filed
by a resident or resident representative and to record the follow-up action taken and results thereof.
Event ID:
Facility ID:
145222
If continuation sheet
Page 2 of 3
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
01/27/2026
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)
F 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Actual harm
Based on observation, interview, and record review the facility failed to provide R3, a resident assessed to
have a high level of pain, with pain medication for 1 of 5 residents reviewed for pain in the sample of 15.
This failure allowed R3's pain from a traumatic rib fracture go untreated in the facility from 1:00PM to
6:49PM. The findings include: On 01/26/2026 at 11:30AM, On 01/26/2026 R3 was not in the facility. On
01/26/2026 at 9:23AM, R3 said, I fell at home. I was discharged from the hospital with multiple rib fractures.
I was using intravenous hydromorphone in the hospital to control the pain. I was admitted to the facility for
rehabilitation and pain control. I had pain 20 out of 10. I waited 7.5 hours to get a pain pill. The facility had
pain medication available but something about the rules would not allow them to treat me. I was in a lot of
pain. I could not even open the door to the room I hurt so bad. I called my friend to pick me up and left. The
nurse said I was leaving against their will. What WILL? I had no idea what their will was, no one saw me. V3
RN-Registered Nurse said, (R3) arrived at the facility during medication pass. I needed to finish the
medication pass before putting in (R3's) orders. (R3's) admission gave me resident number 30. This hall is
a challenge, admitting a new resident makes it more difficult. I did not put (R3's) orders in fast enough. We
did not have (R3's) pain medication on hand. It took quite a few hours for (R3) to get treatment for the pain.
The medication was provided on the second shift around 7:30PM. The physician was called at 7:00PM,
shift change. (R3) left the facility against medical advice. On 01/27/2026 at 11:11AM, V4 NP-Nurse
Practitioner said, I assessed (R3) on 01/19/2026 at 4:21PM, (R3) rated the pain 9/10. (R3) had multiple left
rib fractures. The fractures extended from rib number 6 to rib number 9. (R3's) number one diagnosis was
Rib Fracture; R3's second diagnosis was, Pain. I was notified around 6:00PM, the facility did not have (R3's)
pain medications available. If I would have been notified sooner, I would have provided an alternative pain
medication immediately. On 01/27/2026 at 3:48PM, V12 RN said, Zero is no pain, 10 is the worst pain ever.
R3's Vital Sign Record shows, Pain: on 01/19/2026 at 1:00PM, 8/10, at 5:44PM, 8/10. R3's Medication
Administration Record dated January 19, 2026 shows, R3 was provided with her first dose of pain
medication at 6:49PM. The facility's Pain Management policy dated 10/01/2025 shows, Acute Pain refers to
pain that is usually sudden in onset.caused by injury, trauma, or medical treatments.Policy Explanation: to
help a resident attain or maintain his/her highest practicable level of physical, mental, and psychosocial
well-being and to prevent or manage Pain.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145222
If continuation sheet
Page 3 of 3
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F585 - Grievances
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
FAQ · About this visit
Common questions about this visit
What happened during the January 27, 2026 survey of La Bella of Woodstock?
This was a inspection survey of La Bella of Woodstock on January 27, 2026. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at La Bella of Woodstock on January 27, 2026?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grie..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.