Inspection·September 23, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Note: The nursing home is disputing this citation. Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility repeatedly failed to notify the Physician of one (R1) resident's elevated glucose levels out of three residents reviewed for Quality of Care in a sample list of eight residents.Findings include:R1's Minimum Data Set (MDS) dated [DATE] documents R1 as severely cognitively impaired. R1's Physician Order Sheet dated August documents a physician order to obtain R1's blood glucose levels twice daily. R1's Electronic Medical Record (EMR) does not show that V17 (R1's) Physician was notified of R1's blood glucose levels above 200 mg/dl.R1's Medication Administration Record (MAR) dated August 2025 document R1's blood glucose level were:8/12/25 at 5:00 PM was 2138/18/25 at 9:00 AM was 2208/19/25 at 9:00 AM was 2728/20/25 at 9:00 AM was 2488/23/25 at 9:00 AM was 2858/24/25 at 9:00 AM was 3008/24/25 at 5:00 PM was 2068/25/25 at 9:00 AM was 2988/25/25 at 5:00 PM was 2218/26/25 at 9:00 AM was 3068/27/25 at 5:00 PM was 2218/28/25 at 5:00 PM was 2358/29/25 at 9:00 AM was 3508/29/25 at 5:00 PM was 229.On 9/23/25 at 1:00 PM V2 Director of Nurses (DON) stated staff should notify the physician for any resident that has their blood glucose checked who is not on Insulin whose blood glucose level is less than 50 milligrams (mg)/deciliter (dl) and greater than 200 mg/dl. On 9/18/25 at 3:00 PM V5 Nurse Practitioner stated R1's elevated blood glucose levels should have been reported per the facility policy. V5 NP stated R1's elevated glucose levels were ‘predominantly' due to his diet that was supported by R1's spouse. V5 NP stated V5 would not have made any changes to R1's medicines or treatment plan due to R1's elevated blood glucose levels.The facility policy titled Blood Glucose Monitoring revised June 2023 documents staff are to report any reading below 50 or above 200, or per physician ordered parameters. 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 09/23/2025 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)