Inspection·May 22, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect a resident right to be free from verbal abuse (R3) by another resident (R2) and failed to protect a resident right to be from physical abuse (R3) by another resident (R2). R2's Facility Census documents R2 was admitted to the facility on [DATE] and has the following medical diagnosis; Spastic Quadriplegic Cerebral Palsy, Seizures, Quadriplegia, Obstructive Sleep Apnea, Anxiety Disorder, Hyperlipidemia, Deficiency of Specified B Group Vitamins, Schizophrenia, Esophagitis without Bleeding, GERD, Insomnia, Functional Quadriplegia, HTN, Depression, Retention of Urine and Personal History of Malignant Neoplasm of Testis. R2's Minimum Data Set (MDS) dated [DATE] documents R2's Brief Interview for Mental Status (BIMS) score 6, severe cognitive impairment and is dependent on staff's assistance with Activities of Daily Living. R2's Care Plan dated 6/21/23 documents R2 potential for abuse and neglect due to current cognition, medical condition and physical function. Interventions/ monitor R2 whereabouts, monitor for changes in behavior, notify Medical Doctor and family for any changes in condition, encourage R2 to verbalize any incidents of abuse and neglect and staff to monitor and intervene with any potential or actual acts of abuse and neglect. R2's Incident Note dated 4/23/25 at 4:12 pm documents assessment completed due to R2 to R3 altercation, no redness/bruising noted to right side of face/head. R2 denies any pain/discomfort at this time. 15-minute checks continue at this time. R3's Facility Census documents R3 was admitted to the facility on [DATE] and has the following medical diagnosis; Parkinson's Disease with Dyskinesia, Hemiplegia and Hemiparesis following Cerebral Infraction Affecting Right Dominant Side, Symptoms and Signs Involving Cognitive Functions Following Cerebral Infarction, COPD, Atrial Fibrillation, Shortness of Breath, Long Term Use of Anticoagulants, Chronic Kidney Disease Stage 2, Adult Failure to Thrive, Insomnia, Benign Prostatic Hyperplasia, Anemia, HTN, Paroxysmal Atrial Fibrillation, Rheumatoid Arthritis, Hyperlipidemia, and Chronic Diastolic Heart Failure. R3's Minimum Data Set (MDS) dated [DATE] documents R3's Brief Interview for Mental Status (BIMS) score 14, cognitively intact and is dependent on staff's assistance with Activities of Daily Living. R3's Incident Note dated 4/23/25 at 4:15 pm assessment completed, and no redness/bruising/injuries (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 4 Event ID: 145439 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 145439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Accolade Healthcare of Savoy 302 West Burwash Savoy, IL 61874 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)