Inspection·June 11, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the Facility failed to maintain residents' well-being and dignity by accommodating preference for 4 of 5 residents (R1, R2, R4, and R5) reviewed for accommodation of needs in the sample of 6. Residents Affected - Some Findings include: On 6/6/2025 at 9:14 AM, R4 stated, the facility runs out of towels, pads and sheets all the time. I think they need to order more. They are always running out. It happens a lot, too much. I have my own briefs that I keep at my bedside, but staff had come in here and taken mine. I get cold sometimes and they do not have enough blankets and when I ask, they say they do not have any more. On 6/6/2025 at 9:18 AM, R2 stated the Facility at night runs out of adult briefs and pull ups at least two or three times a month. On 6/6/2025 at 9:28 AM, R5 stated the Facility has run out of (adult diapers) and staff made her stay in her room when she did not want to because they did not have anything to put on her. On 6/6/2025 at 10:29 AM, V8, Certified Nursing Assistant (CNA) stated, I started working in the Facility as a housekeeper and then I became a CNA. She stated the facility was always running out of supplies. We are always running out of gloves, adult briefs, adult diapers, linens, pads, sheets. We run out of linen and blankets especially at night. I have residents that get cold, and I have no blankets to give them. (V11, CNA) had to purchase snacks out of her own money and was working the night shift and she had to buy the bigger depends on the other night because we ran out. I heard them tell everyone at a morning meeting they if they bought anything they could give them a receipt and they would be reimbursed. But really one should not have to purchase any supplies to begin with. The supplies should be restocked and supplied so staff don't have to buy anything out of their own pocket. I don't think it is right, and it's not a one-time thing, it is constantly happening. There are times that we run out and when that happens, we have to keep residents in their rooms, in their beds, and it's not right. On 6/6/2026 at 1:24 PM, V11, CNA, stated she had been working in the Facility for six years. She usually works 6 AM to 6 PM. V11 stated It is not uncommon for us to run out of stuff especially on nights. We run out of linens, adult briefs, and this is not a one-time thing, this has been happening for months now. Management is aware, but nothing really changes. Last week we ran out of stuff and the agency staff walked out. When we run out, we try and look in other places to find something, and then we have to leave residents in their bed, in their room. There are times when residents just had to lay in bed because there were not enough incontinent supplies. (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 2 Event ID: 145456 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 145456 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeside Health & Rehab Center 1200 University Avenue Carlinville, IL 62626 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)