Health inspection·March 14, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to supervise and provide showers as scheduled for 4 of 4 (R1, R2, R3, R5) residents in a sample of 6. Residents Affected - Some Findings include: The facility's Resident Council Minutes, dated 3/5/205, documents, New Business/Department Discussions: Still short staffed, call lights aren't being answered. There is not enough in house staff, too agency workers that aren't doing their jobs correctly. Administration: Too short staffed, today was shower day but (R2) had to have a bed bath because there wasn't enough staff to care for everyone and still get showers done. 1. R1's Care Plan, dated 5/14/2021, documents R1 has an ADL (activity of daily living) Self Care Performance Deficit. It also documents BATHING: R1 requires supervision with bathing. Staff provide supervision as needed. R1's Minimum Data Set (MDS), dated [DATE], documents R1 is cognitively intact. On 3/12/2025 at 1:20 PM, R1 stated he is the president of resident council. R1 stated lack of staff is an ongoing concern. R1 stated this concern is addressed in the resident council meeting. R1 stated they voice these concerns, but feel they are not being heard. R1 stated at times, there is 1 nurse for the entire building. R1 stated the CNAs (Certified Nurse's Assistants) are short as well. R1 stated, Showers are not being completed. It's not enough. You must have staff to do these things and we don't. R1 stated he gets his showers because he does them himself. R1 stated he tells the staff and goes in the shower alone. R1 stated he is not supervised by anyone but himself. R1 stated they tell him if he goes in on his own he can get a shower, because they don't have enough staff to supervise him. R1 stated the staff will tell them that they can't do something because they don't have enough staff. 2. R2's Care Plan, dated 7/7/2021, documents Care/ADL Preferences Staff will honor my preferences while caring for me. I prefer a shower 3 x week in the mornings. It also documents 1/18/2024 R2 has an ADL Self Care Performance Deficit r/t (related to) obesity, respiratory failure, and heart failure. BATHING: the resident requires 1 staff participation with bathing. R2's MDS, dated [DATE], documents R2 is cognitively intact and requires substantial/maximal assistance with bathe/showers. On 3/12/2025 at 11:30 AM, R2 stated she is scheduled to get a shower 3 times a week. R2 stated she (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 8 Event ID: 145500 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 145500 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillsboro Rehab & Hcc 1300 East Tremont Street Hillsboro, IL 62049 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)