Health inspection·August 20, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain a safe home like comfortable environment for three residents (R1, R2, R3) reviewed for safe homelike environment in a sample list of three residents.Findings Include:R1's current diagnosis list includes the following diagnoses: Chronic Neuropathy, Anxiety, and Major Depression.MDS (Minimum Data Set) dated 6/30/25 documents R1 is cognitively intact.On 8/19/25 at 11:15 AM, R1 was in her bed watching TV. The windowsill was covered in dust, dead spiders, and ants. The edge of the baseboard in R1's bathroom was crusted with brown debris and there was an odor of urine present. R1 stated there had been no toilet paper for several days last week. R1 stated I had to get family to bring me toilet paper, or I would have been without toilet paper. R1 stated there are ants in here all the time they crawl on the walls and the window.R2's current diagnosis list includes the following diagnosis: Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Diabetes, Anxiety, and Depression.R2's MDS (Minimum Data Set) dated 7/19/25 documents R2 is cognitively intact.On 8/19/25 at 11:28 AM, R2 was sitting up in his room in a wheelchair. The windowsills in R2's room were covered with dust and dead insects. The baseboards in R2's bathroom was crusted with yellow brown matter and there was a distinct odor of urine. Paint was peeling and several places from the wall of R2's room. R2 stated there are ants in here all the time. They just crawl all over the wall by the window. I take my meals in here and I've had ants get in my food. Regarding the toilet paper supply in the facility R3 stated They have been out of toilet paper more than once I keep some extra. R2 had two rolls of toilet paper in his drawer. When showing the toilet paper R2 keeps in the drawer, R2 pulled a sandwich out of the drawer in a plastic bag. The bread looked hard, and the meat was dry. R2 stated I've had this for a couple of days. I hate the food, so I keep stuff in here if I get hungry.R3's current diagnosis list includes the following diagnosis: Multiple Myeloma, Chronic Obstructive Pulmonary Disease, Depression, and Anxiety.R 3's Minimum Data Set (MDS) dated [DATE] documents R3 is cognitively intact.On 8/19/25 at 11:35 AM, numerous chipped areas in the paint in R3's room were observed. There was an empty bed on the opposite side of R3's room with no mattress or linens with springs exposed.On 8/19/25 at 11:35 AM, R3 stated we ran out of toilet paper last week. We had to use whatever we had like napkins and tissues. We went days like that. It just made me feel disrespected and ignored. Regarding the insects, R3 stated I have seen ants and spiders in here but not for a while.On 8/20/25 at 11:30 AM, V6 and V5 certified nursing assistants (CNAs) stated there are ants in the rooms and V5 stated I have even seen them on residents which is bad for residents who can't brush them off. V5 and V6 verified there was a shortage of toilet paper a couple of days last week the facility sent someone out and bought some.On 8/20/25 at 11:45 AM, V1 Administrator stated, I became aware we were out of toilet paper on the floor last week and I went to (a local big box store) and purchased some toilet paper. A receipt was provided supporting this by the facility from a local Page 1 of 4 145371 145371 08/20/2025 Arcadia Care Bloomington 1509 North Calhoun Street Bloomington, IL 61701

F 0584 big box store. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 145371 Page 2 of 4 145371 08/20/2025 Arcadia Care Bloomington 1509 North Calhoun Street Bloomington, IL 61701

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, Interview, and record review the facility failed to maintain a safe, sanitary, comfortable environment by providing inadequate supplies of toilet paper for residents and failing to maintain communal shower floors in a safe sanitary manner. This failure has the potential to affect all 92 residents who reside in the facility.Findings Include:The facility's daily census dated 8/19/25 documents 92 residents reside at the facility.On 8/19/25 at 11:28AM, R2 stated They have been out of toilet paper more than once. I keep some extra, so I have some. R2 had two rolls of toilet paper in his drawer. On 8/19/25 at 11:15AM, R1 stated for several days last week I had to have family members bring me some (toilet paper) or I would have been without toilet paper. On 8/19/25 at 11:35AM, R3 stated we ran out of toilet paper last week. We had to use whatever we could like napkins and tissues. We went days like that. It just made me feel disrespected and ignored. On 8/20/25 at 12:30PM, V5 (CNA) Certified Nurse's Aide and V6 CNA verified there was a shortage of toilet paper a couple of days last week. The facility sent someone out and bought some. On 8/20/25 at 11:45 AM, V1 Administrator stated, I became aware we were out of toilet paper on the floor last week and I went to (a local big box store) and purchased some toilet paper. The facility provided a receipt dated 8/8/25 from a local big box store to support the facility purchased a supply of toilet paper to rectify the shortage.On 8/19/25 at 11:40AM, The main shower room on 100 hall was observed to have several missing ceramic tiles in the shower. Several other tiles were cracked and loose creating an uneven, unstable surface where the shower chair is placed when giving a dependent resident a shower. On 8/19/25 at 2:58PM, V1 Administrator stated, I am aware of the broken tiles in the big shower, and I have a contractor coming to fix that. 145371 Page 3 of 4 145371 08/20/2025 Arcadia Care Bloomington 1509 North Calhoun Street Bloomington, IL 61701

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, Interview, and record review the facility failed to provide adequate pest control when ants were observed for one (R1) of three reviewed for pest control on the total sample of five. Findings include:The facility census report dated 8/19/25 documents 92 residents reside at the facility.R1's current diagnosis list includes the following diagnoses: Chronic Neuropathy, Anxiety, and Major Depression.MDS (Minimum Data Set) dated 6/30/25 documents R1 is cognitively intact.On 8/19/25 at 11:15 AM, R1 was in her bed watching TV. The windowsill was covered in dust, dead spiders, and ants. R1 stated there are ants in here all the time they crawl on the walls and the window.R2's current diagnosis list includes the following diagnosis: Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Diabetes, Anxiety, and Depression.R2's MDS (Minimum Data Set) dated 7/19/25 documents R2 is cognitively intact.On 8/19/25 at 11:28 AM, R2 was sitting up in his room in a wheelchair. The windowsills in R2's room were covered with dust and dead insects. R2 stated there are ants in here all the time. They just crawl all over the wall by the window. I take my meals in here and I've had ants get in my food. On 8/20/25 at 11:30 AM, V6 and V5 Certified Nursing Assistants (CNAs) stated there are ants in the rooms and V5 stated I have even seen them on residents which is bad for residents who can't brush them off.On 8/20/25, V1 Administrator verified she was aware there had been a problem with ants and she was planning to call the exterminator (the facility) has a contract with. Residents Affected - Few 145371 Page 4 of 4