Inspection·July 1, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on observation, interview, and record review, the facility failed to report a resident fall to the licensed nurse, directly resulting in a lack notification of the residents physician and family member. This failure affects one resident (R1) out of one reviewed for notifications on the sample list of six. This past compliance occurred from 6/20/25 and 7/1/25. Findings include: On 7/1/25 at 10:39 AM, V3, Family Member and legal Power of Attorney for R1, stated that the facility had not notified her of R1's most recent fall. V3 stated she had found out about R1's fall during a conversation with a friend (unidentified) who worked at the facility. R1's comprehensive Electronic Medical Record did not document any actual recent fall event experienced by R1. R1's Nurses Notes dated 6/20/25 documented facility staff held a care plan conference for R1 attended by V3. R1's Nurses Notes dated 6/21/25 document one post fall neurological check conducted by V15, Licensed Practical Nurse. R1's Assessment record documented further neurological checks beginning with the documented one on 6/21/25 and continuing through 6/25/25, with one additional check on 6/27/25 (date of survey entrance). On 7/1/25 at 2:40 PM, V10, Registered Nurse Manager, stated that V3 had attended the care plan conference on 6/20/25 and questioned why she (V3) had not been notified about R1's fall the day prior to the care plan conference. V10 stated she had questioned the nurse who was on duty (unidentified) at the time of the alleged fall who told V10 that there had been no reported falls from the day referenced (6/19/25). V10 further stated she had checked with the Certified Nursing Assistants (CNA) and did find that V16 CNA had found R1 on the floor and, with assistance form V17 CNA, did pick R1 up from the floor without reporting the fall to the nurse on duty. V10 confirmed there was no documentation in R1's medical record about the actual fall event, only a note in the risk management portion of R1's record (inaccessible to state survey staff). V10 stated she had then reported the incident to the Administrator (V1), and Director of Nursing (V2), who had given a written disciplinary notice to V16, and conducted an investigation into the fall experienced by R1. On 7/1/25 at 2:50 PM, V16, Certified Nursing Assistant, stated she was delivering meal trays to resident rooms and had gone into R1's room to find R1 on the floor by the bed. V16 stated she could not locate the nurse on duty, assumed the nurse was on lunch break, and did seek assistance to pick R1 up from the floor and back into bed. V16 further stated she was busy during the resident supper time into the evening shift and by the time she saw the nurse, had forgotten about R1's fall. (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 07/01/2025 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)