Health inspection·February 14, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few On 2/11/25 at 9:40 AM, V10 stated that V10 works with R1 almost every day, but I wasn't working on 1/28/25 when R2 bit R1. R1 is nonverbal and cannot understand a lot. He has early-onset frontal lobe dementia and wanders to other residents' rooms. Both R1 and R2 reside in a locked dementia unit. According to V10, on 1/28/24, when R1 entered R2's room for the first time, R2 bit R1 on his left wrist. R1 was not bleeding from the injury. V10 than added that R1 returned to R2's room again about 10 minutes later and tried to move R2's wheelchair. R2 got upset, and a bit on both R1's forearms caused bleeding from the left forearm. R1 was sent out to the hospital, and he returned with oral antibiotics. V10 added that R1 must be monitored as, he wanders around to keep him safe. On 2/11/25 at 10:00 AM, V5 (Certified Nursing Assistant/CNA) stated, I was in the nurse's station when the incident happened when R1 entered R2's room. We heard shouting from R2 to R1. There was no staff in the resident's room, and nobody witnessed the incident. R2 bit R1 two times 5 minutes apart. For the first time, R2 bit on R1's lateral side of his left hand. When R1 came out of R2's room, we noticed no bite on his left wrist. Then, R1 was bleeding a decent amount the second time and turned into purple discoloration with the bite site. R1 was assigned to V6 (CNA) as V7 (CNA) called off. I believe V6 is suspended, and I don't know why. On 2/11/25 at 11:20 AM, V13 (Restorative Aide/CNA) stated, I heard commotions between R1 and R2, and R1 had a bit mark on his left wrist from the first bit and was bleeding, but not that much. When R2 bit on R1 a second time after 30 minutes, I went into the hallway and saw R1 was bleeding from the left arm. R1 always wanders around and is hard to redirect. Somebody must monitor the hallway to see the dementia resident's activities and prevent them from going to other resident rooms/isolation rooms. On 2/11/25 at 11:35 AM, V6 (CNA) stated, I was assigned to another group of residents. R1 was assigned to V12 (CNA), and R1 is a resident who wanders around and triggers other residents to get upset. On 2/11/25 at 10:15 AM, V4 (CNA) stated, I heard about the issue between R1 and R2 on 1/28/25. R1 wanders to R2's room, and R2 gets irritated by R1, and R2 gets on R1's arm and bites him. I was in the hallway just outside of the dementia unit. R2's room was very close to the nurse's station, and we could hear when R2 was shouting and screaming at R1. I went to the dementia hall and checked on R1, and he was bleeding. On 2/11/25 at 11:20 AM, V2 (Director of Nursing/DON) stated, We were short by one CNA on the dementia unit on 1/28/25 due to call off (V7). V7's residents were not assigned to any specific CNA. The other four CNAs were supposed to chip in to cover for V7's residents, including R1. R1 was bit two times by R2. The first bit wasn't as bad as the second bite. The second bite was bleeding. Somebody must have followed him to redirect him to prevent injury from other residents entering their room. He has the right to be free from abuse/harm. On 2/11/25 at 11:35 AM, V6 (CNA) added, Almost a month ago, when R1 entered R3's room and lay on R3's bed, R3 got upset, put his hands on R1's neck, and threw him to the door. They are not doing anything to prevent R1's trigger to other residents. On 2/11/25 at 12:40 PM, V3 (Agency Licensed Practical Nurse/LPN) stated, I didn't witness the incident. V12 said that R1 went to R2's room, and R2 bit on R1's forearms. R1 always goes to other resident's room. R1 needs to be closely monitored to make him safe. There were a lot of conversations regarding who should take care of the resident group, including R1, as the originally assigned CNA (V7) called off. Overall, all the CNAs are responsible for monitoring the residents in the dementia unit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145316 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 145316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481 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 0600 Level of Harm - Actual harm On 2/11/25 at 3:21 PM, V16 (Nurse Practitioner) stated, It was reported to me that R1 was bit by another resident (R2). The injury was assessed, and we sent him to the hospital for further evaluation, and he returned with an oral antibiotic. There was blood on his left forearm. To keep him safe in the unit, they should closely monitor and redirect him when he attempts to enter another resident's room. Residents Affected - Few On 2/11/25 at 3:35 PM, V1 (Administrator) stated, I know residents have the right to be free from harm. We had a call-off on 1/28/25 and were short by one CNA. R1 is a resident who wanders to other residents' rooms and needs to be monitored. On 2/14/25 at 10:00 AM, V17 (Staffing Scheduler/CNA Supervisor) stated, Since V7 called off on 1/28/25, we split her residents among the other four CNAs in the dementia unit. V6 was assigned to care for R1. She (V6) refused to care for R1, so we suspended her for not caring for R1. Behavior Management Team Review Meeting Note dated 11/4/24 document: R3 became agitated when R1 entered his room and lay on his bed. R3 attempted to maneuver R1 to the bedroom door, and R1 tripped and fell over. R3 is a [AGE] year-old male admitted with moderate cognitive impairment as per the MDS dated [DATE]. R3 was admitted with an admitting diagnosis, including anxiety, hallucination, dementia, depression, and schizophrenia. Behavior Management Team Review Meeting Note dated 12/22/24 documented that R1 had entered R4's bedroom, and residents were observed pushing each other. Behavior Management Team Review Meeting Note dated 12/29/24 documented that R4 struck R1 on his chest and arms. The facility presented the Abuse Prevention and Reporting Guidelines document: The facility affirms the right of the resident to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff, or mistreatment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145316 If continuation sheet Page 3 of 3