Health inspection·October 20, 2025

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to maintain full mechanical lifts in safe/operable condition. This failure has the potential to affect eight of eight residents (R3-R10) reviewed for full mechanical lifts in the sample list of 10. Findings include:On 10/20/25 at 10:10 AM R3 was sitting on a full mechanical lift sling in her wheelchair. R3 stated yesterday the full mechanical lift wasn't working so V7 Certified Nursing Assistant (CNA) used the sit to stand lift to transfer R3 from her wheelchair into bed. R3 stated during the transfer R3 said Dear Jesus please don't let me fall. R3 stated there have been frequent problems with the full mechanical lift not working properly and yesterday the lift would not raise, it would only lower.On 10/20/25 at 1:02 PM R4 was sitting on a full mechanical lift sling in R4's room. R4 stated the staff had trouble getting the full mechanical lift to work this morning and had to go get another lift. At 1:17 PM V15 and V17 CNAs entered R4's room and used a full mechanical lift to transfer R4. V16 CNA went to use another full mechanical lift located in the alcove across the hall from R4's room. This lift contained gray adhesive tape around the housing compartment that covered the gear box and the lift would not raise when the handheld remote was activated. V16 stated the lift is not working properly, it won't raise and only lowers, and the adhesive tape has been there for a long time. V16 demonstrated that the emergency release function was broken, sliding up and down the shaft of the lift. V16 stated it has been like that for a long time and V14 Maintenance was aware of the lift issues. V16 stated the facility needs new lifts, they are always broken. V16 stated the facility has two full mechanical lifts which are used for currently eight residents.On 10/20/25 at 1:27 PM V15 CNA stated the full mechanical lift (referencing the lift in the alcove near R3's room) has been taped like that for at least the three years that V15 has been employed by the facility. V15 stated the emergency release has also been broken for quite a while, and V14 is aware. V15 stated V15 had to take the lift from the South hall since they discovered this morning that this lift was not working.On 10/20/25 at 1:28 PM V15 and V17 used the same full mechanical lift used for R4's transfer to transfer R3 from the wheelchair into bed. At 1:33 PM V15 and V17 stated the emergency release on this lift hasn't worked for quite some time. V15 demonstrated the emergency release did not function.On 10/20/25 at 1:37 PM V14 stated V14 has been the maintenance director since July and has not received any work orders for the full mechanical lifts. V14 stated there are no routine checks performed on the lifts for maintenance and functioning. V14 inspected the two full mechanical lifts that were on R3's/R4's hallway and confirmed the lift with the tape does not raise, and both emergency releases were not functioning. V14 took the remote from the other lift and attached it to the lift with the tape and used it to raise the boom. V14 stated it is a remote/cord issue. V14 stated the tape is used to keep the cover of the gear box in place, which was already there when he started working for the facility. V14 stated staff are to report mechanical lift issues to V14.On 10/20/25 at 2:28 PM V8 Minimum Data Set Coordinator provided a handwritten list of residents, R3-R10, who use the full mechanical lift.The facility's Using a Mechanical Lift policy dated July 2017 documents Test the lift controls. Ensure the emergency release feature works. If the mechanical lift is not deemed in working order, it shall be removed until repaired.The facility's Safe Lifting, Transferring and Movement of Residents policy dated July 2017 documents Maintenance staff shall perform routine checks and maintenance of equipment used for lifting to ensure that it remains in good working order.The User Manual for (full mechanical lift) dated 2023, provided by V1 Administrator, documents to use the hand pendant to raise and lower the boom and activate the emergency lowering device in the event of power failure or emergency. This manual documents to perform routine inspections of the lift and sling for cracks/damage, wear or fraying of straps or fabric, proper function of wheels and Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145416 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 145416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heartland Nursing & Rehab 410 Northwest Third Casey, IL 62420 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 0908 brakes, and condition of electrical cables and connections. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145416 If continuation sheet Page 3 of 3