Inspection·December 24, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to provide ordered medications and failed to administer the correct medication. This applies to 2 of 5 (R5 & R1) reviewed for medications in the sample of 13.The findings include: 1. R5's admission Record showed diagnoses to include but not limited to stroke, heart failure, atrial fibrillation (rapid and irregular heartbeat). R5's December 2025 Medication Administration Record (MAR) showed her 12/18/25 diltiazem for her congestive heart failure 240 milligrams (mg) extended release medication was documented as not given. R5's MAR also showed her 12/18/25 duloxetine 30 mg for her depression was documented as not given. On 12/18/25 at 9:20 AM, V4 stated R5 was out of her duloxetine and diltiazem. V4 stated the medication refills were rejected by the pharmacy for an unknown reason. V4 said the diltiazem was rejected on 12/15/25 and the duloxetine was rejected on 12/17/25. V4 stated it is the policy that the nurses notify the Director of Nursing if medications are rejected. On 12/19/25 at 9:30 AM, R5's December 2025 MAR showed her 12/19/25 duloxetine and diltiazem had been documented as given. On 12/19/25 at 10:35 AM, V12 RN stated she had given R5 her last available dose of diltiazem and duloxetine from R5's medication cards. (The residents' prescription medications come in a foil-backed punch cards.) V12 was asked to provide R5's completed duloxetine and diltiazem cards. V12 was then made aware that V4 was not able to pass these medications the day prior due to the medications being unavailable. V12 then stated she borrowed these medications from other residents. V12 showed R11's medication card for duloxetine 30 mg stating she used this card. V12 then showed R12's diltiazem 60 mg tablets (not extended release) and stated she gave R5 this medication. On 12/19/25 at 10:45 AM, V12 stated she gave R5 three tablets of R12's 60 mg diltiazem. V12 then changed and said two tablets were given, then four tablets, then stated no, I gave two tablets. On 12/19/25 at 10:50 AM, V12 then approached this surveyor in the conference room and stated, At first I gave her two (tablets of Cardizem) then saw she was on 240 (mg dose) and then I gave her two more. On 12/19/25 at 10:55 AM, V12 approached this surveyor in the conference room and stated she only gave one tablet of R12's diltiazem to R5. R12's December 2025 MAR showed an order for diltiazem 60 mg (not extended release) to be given three times a day. On 12/19/25 at 11:10 AM, V2 Director of Nursing stated, They cannot take the meds from the other residents, it violates the 5 right of medications. They could give the wrong dose and then the other resident, depending on their insurance, they may not be able to get their medication filled when they need it. On 12/19/25 at 12:23 PM V2 stated, [Diltiazem] is a cardiac medication, and it is used to treat high blood pressure. It comes with parameters of when it can be given and if it needs to be held. Extended release and the regular diltiazem treat the same issues, but they cannot be interchanged. The nurses should not be making judgement calls when it comes to medications dosages. The facility's policy Medication Administration General Guidelines showed, Five Rights- Right resident, right drug, right dose, right route, and right time, are applied for each medication being administered. A triple check of these 5 rights is recommended. The policy showed, If a medication with a current active order cannot be located in the medication cart/drawer, other areas of the medication cart.the pharmacy is contacted or the medication is removed from the emergency kit. The policy continued, Medications supplied for one resident are never administered to another resident. 2. R1's Face Sheet showed diagnoses to include but not limited to dysuria (difficult and/or painful urination), urinary tract infections, and kidney cancer. R1's Order Summary Report (Physician Order Sheet/POS; provided 12/19/25 at 12:55 PM) showed an active order for Mirabegron 50 milligrams daily for incontinence. R1's December 2025 Medication Administration Record (MAR, printed 12/19/25 at 1:00 PM) showed R1's mirabegron was documented as 9 Other/See Progress Notes on 12/3/25, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145261 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 145261 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Dekalb 1212 South Second Street Dekalb, IL 60115 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 12/6/25, 12/7/25, 12/8/25, 12/9/25, 12/11/25, 12/14/25, 12/15/25, and 12/17/25. On 12/19/25 the medication was documented as Hold/See Progress Notes. On 12/18/25 at 8:51 AM, V3 Registered Nurse stated R1's mirabegron was not available, and she was not able to administer it. (At this time R1's MAR showed the Mirabegron was documented as given.) On 12/18/25 at 2:07 PM, V3 stated she has not looked to see if R1's mirabegron was available in the facilities emergency supply. On 12/18/25 at 2:20 PM, R1 was alert and oriented to person, place, time, and condition. R1 stated she was uncertain if she was on a medication for her bladder; however, R1 stated she has an overactive bladder and needed to use the bathroom frequently. R1 stated she would expect the staff to notify her if she is out of a medication. R1 stated she had not been notified of missing medications. On 12/23/25 at 1:10 PM, V2 Director of Nursing stated she expects staff to notify her if the pharmacy rejects filling a medication, so she can correct the reason for the rejection. V2 stated, lately, if a resident's medication is rejected, it is often related to insurance issues. V2 said, if she is notified, she can contact the provider for an alternative medication. V2 said R1's missing medication is for her overactive bladder. V2 said R1's medication was rejected by the pharmacy, and she was not notified of the rejection by nursing staff. V2 stated she was unable to determine the last day R1 received her mirabegron; however, if she had been notified some of the missed doses could have been prevented. Event ID: Facility ID: 145261 If continuation sheet Page 3 of 3