Inspection·May 1, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few incident: resident states employee was being rough during shower. He states he asked several times for her to be easier with his genitals. Resident no longer wishes to have employee in his room or to provide care or to give shower. Employee educated on proper peri care/shower technique. This form documented signatures (all dated 4/18/25) by V1, V2 (former Director of Nursing), and V11. On 4/28/25 at 2:36 PM V9, Social Service Director, stated R2's mom (V12) called her and mentioned R2 was upset about the care he received during a shower, that the shower transfer sling had pinched his private area, and V12 requested that the CNA (V11) not shower R2 anymore. V9 said she did not document this in the facility grievance book, nor did she discuss this issue with R2 because she gave the information to the Administrator (V1). On 4/28/25 at 2:45 PM V1, Administrator, stated she did not interview R2 nor the other CNA working with V11. V1 then stated she did not investigate R2's allegation against V11. On 4/28/25 at 2:50 PM R2 stated the day V11 gave him a shower he informed V11 the transfer sling was hurting his privates, she did not reposition him or do anything to ease his discomfort, and that it felt like all his body weight was putting pressure on his testicles during the shower. R2 stated he was on the shower chair, it felt like the sling was not applied properly, he repeatedly told V11 that he was hurting, and V11 ignored his statements. R2 stated after the shower V11 did not dry him off and he was put to bed soaking wet. R2 stated no facility employees including management came and spoke to him about the incident, no nurses looked him over after the incident, so he told his mom (V12) and she called and reported it to someone at the facility. R2 stated he feels it was abuse and he will not allow V11 to care for him again. On 4/28/25 at 2:58 PM V10 CNA stated about 2 weeks ago R2 told him V11 had him sitting on his scrotum and she didn't reposition him when he told her it was hurting. On 4/28/25 at 3:37 PM V12, R2's mother, stated she called the facility's Social Service Director (V9) two weeks ago on 4/14/25 and informed her (V9) of her son's (R2) concerns with how he was treated by the CNA (V11) during his shower on 4/11/25. V12 stated R2 told her V11 was rough and rude, his private area was pinched, he was hurting during his shower, and the CNA (V11) would not reposition him. V12 stated R2 also told her V11 did not dry him off after his shower and she put him to bed soaking wet. V12 stated R2 informed her of the incident during her visit with him on 4/13/25. On 4/30/25 at 9:35 AM V9, Social Service Director, stated R2's mom, V12, did say V11 was rough with R2 during his shower. V9 stated she did not speak to R2 about his concerns because she took it to V1, Administrator, to follow up on. On 4/30/25 at 9:42 AM V11, CNA, stated the last time she gave R2 a shower was a couple of weeks ago on a Friday. V11 stated R2 normally speaks to her during care but he did not on this day, and she tried to speak with him throughout the shower, but he just cursed in response. V11 stated R2 never complained of pain during the shower. V11 stated she informed R2's nurse of his behavior during the shower. V11 stated she was never suspended pending an investigation of R2's allegation. On 4/30/25 at 11:15 AM V1, Administrator, stated she does not have any statements from R2, any other residents, nor staff other than the one on the write up that was given to V11. V1 then confirmed the facility did not complete an investigation of R2's allegations of V11 being rude and rough with him during a shower. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 2 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. R1's, face sheet, print date of 4/30/25, documented R1 has diagnoses including congestive heart failure, atrial fibrillation, hypertension, atherosclerotic heart disease, and type 2 diabetes mellitus. R1's MDS, dated [DATE], documented R1 is moderately cognitively impaired although during interview with surveyor R1 was alert and oriented. This MDS also documented R1 requires partial to moderate assistance with showering indicating R1's helper/CNA does less than half the effort as R1 is able to complete most of his own shower. R1's care plan, undated, documented R1 is needs limited assistance for activities of daily living and is receiving restorative programs in order to maintain his present level of function. On 4/28/25 at 1:05 PM R1 stated he has had issues with the way (V11) CNA gives him showers. R1 stated we don't like the way she does things; she shows no respect to us, she has not abused me in anyway, she just doesn't show any respect. 3. On 4/28/25 at 1:08 PM R4 stated (V11) is not abusive, she just doesn't let us do as much as we can for ourselves when she showers us. She just does it. R4's MDS, dated [DATE], documented R4 is cognitively intact and independent with ADLS including showers. R4 ' s face sheet, print date of 4/30/25, documented R4 has diagnoses including congestive heart failure, depression, hypertension, and atherosclerotic heart disease. R4 ' s care plan, undated, documented R4 requires supervision for activities of daily living prn (as needed) and is independent with transfers, FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 3 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review the facility failed to report an allegation of verbal and physical abuse to the State Agency for 1 (R2) of 3 residents reviewed for abuse in the sample of 10. Residents Affected - Few Findings Include: R2's face sheet, print date of 4/30/25, documented R2 has diagnoses including flaccid hemiplegia affecting left dominant side and dysphasia following cerebral infarction, hypertension, hyperlipidemia, epilepsy, and arthritis. R2's MDS (Minimum Data Set), dated 3/22/25, documented R2 is cognitively intact, is dependent on a wheelchair and assistance for mobility, and is dependent on facility staff for hygiene needs including showers. R2's care plan, undated, documented category: psychosocial well-being, I am considered at risk for abuse/neglect per assessment with approaches including address all complaints/concerns promptly with grievance policy and procedure. Category ADLS (activities of daily living), resident needs limited to extensive assistance for activities of daily living related to CVA (cerebral vascular accident), flaccid on left side with approaches including transfer with assistance of 2 and a full body mechanical lift. On 4/28/25 at 12:52 PM R2 stated he had an issue with a CNA (Certified Nurse Assistant) when she gave him a shower a few weeks ago. R2 stated the CNA used a hoist to transfer him onto the shower chair, the hoist hurt his private parts, she was rough, she acted like he had no rights, and she said stated he does not have any rights. R2 stated his mom reported this to management but no one from management has talked to him about the incident. R2 then stated the CNA is (V11). On 4/28/25 at 2:17 PM V1, Administrator, stated the facility does have a CNA named (V11). V1 then stated we did a write up on her about (R2) on C hall because his mom called and stated he had a bad experience with her during his shower. I didn't report it because there was no allegation of abuse when his mom called our Social Service Director. V1 stated V9, Social Service Director, spoke to R2's mom (V12) and V12 told her R2's privates were pinched from the sling. V1 then provided surveyor with a facility employee disciplinary form, dated 4/18/25, that documented employee (V11), summary of incident: resident states employee was being rough during shower. He states he asked several times for her to be easier with his genitals. Resident no longer wishes to have employee in his room or to provide care or to give shower. Employee educated on proper peri care/shower technique. This form documented signatures (all dated 4/18/25) by V1, V2 (former Director of Nursing), and V11. On 4/28/25 at 2:36 PM V9, Social Service Director, stated R2's mom (V12) called her and mentioned R2 was upset about the care he received during a shower, that the shower transfer sling had pinched his private area, and V12 requested that the CNA (V11) not shower R2 anymore. V9 said she did not document this in the facility grievance book, nor did she discuss this issue with R2 because she gave the information to the Administrator (V1). On 4/28/25 at 2:45 PM V1, Administrator, stated she did not interview R2 nor the other CNA working with V11. V1 then stated she did not investigate R2's allegation against V11. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 4 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 4/28/25 at 2:50 PM R2 stated the day V11 gave him a shower he informed V11 the transfer sling was hurting his privates, she did not reposition him or do anything to ease his discomfort, and that it felt like all his body weight was putting pressure on his testicles during the shower. R2 stated he was on the shower chair, it felt like the sling was not applied properly, he repeatedly told V11 that he was hurting, and V11 ignored his statements. R2 stated after the shower V11 did not dry him off and he was put to bed soaking wet. R2 stated no facility employees including management came and spoke to him about the incident, no nurses looked him over after the incident, so he told his mom (V12) and she called and reported it to someone at the facility. R2 stated he feels it was abuse and he will not allow V11 to care for him again. On 4/28/25 at 3:37 PM V12, R2's mother, stated she called the facility's Social Service Director (V9) two weeks ago on 4/14/25 and informed her (V9) of her son's (R2) concerns with how he was treated by the CNA (V11) during his shower on 4/11/25. V12 stated R2 told her V11 was rough and rude, his private area was pinched, he was hurting during his shower, and the CNA (V11) would not reposition him. V12 stated R2 also told her V11 did not dry him off after his shower and she put him to bed soaking wet. V12 stated R2 informed her of the incident during her visit with him on 4/13/25. On 4/30/25 at 9:35 AM V9, Social Service Director, stated R2's mom, V12, did say V11 was rough with R2 during his shower. V9 stated she did not speak to R2 about his concerns because she took it to V1, Administrator, to follow up on. On 4/30/25 at 9:42 AM V11, CNA, stated the last time she gave R2 a shower was a couple of weeks ago on a Friday. V11 stated R2 normally speaks to her during care but he did not on this day, and she tried to speak with him throughout the shower, but he just cursed in response. V11 stated R2 never complained of pain during the shower. V11 stated she informed R2's nurse of his behavior during the shower. V11 stated she was never suspended pending an investigation of R2's allegation. On 4/30/25 at 11:15 AM V1, Administrator, stated she does not have any statements from R2, any other residents, nor staff other than the one on the write up that was given to V11. V1 then confirmed the facility did not complete an investigation of R2's allegations of V11 being rude and rough with him during a shower. On 4/30/25 at 12:53 PM V1, Administrator, stated she did not report R2's allegation about V11 being rough with him during a shower. On 4/30/25 at 12:56 PM V15, Director of Operations, stated R2's allegations against the CNA (V11) should have been reported and investigated. The facility's Abuse Prevention Program policy, dated 9/29/22, documented abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. It continues, 8. External Reporting of Potential Abuse: Initial reporting of allegations. In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: a. Must ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the event that caused the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 5 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. It continues, d. Five-day final abuse investigation report. Within 5 working days after the report of the occurrence, a complete written report of the conclusion of the investigation, including steps the facility has taken in response to the allegation, will be sent to the Department of Public Health. Event ID: Facility ID: 145502 If continuation sheet Page 6 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0610 Respond appropriately to all alleged violations. 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 operationalize their policy to conduct an investigation of allegations of physical and verbal abuse for 1 (R2) of 3 residents reviewed for abuse in the sample of 10. Residents Affected - Few Findings Include: R2's face sheet, print date of 4/30/25, documented R2 has diagnoses including flaccid hemiplegia affecting left dominant side and dysphasia following cerebral infarction, hypertension, hyperlipidemia, epilepsy, and arthritis. R2's MDS (Minimum Data Set), dated 3/22/25, documented R2 is cognitively intact, is dependent on a wheelchair and assistance for mobility, and is dependent on facility staff for hygiene needs including showers. R2's care plan, undated, documented category: psychosocial well-being, I am considered at risk for abuse/neglect per assessment with approaches including address all complaints/concerns promptly with grievance policy and procedure. Category ADLS (activities of daily living), resident needs limited to extensive assistance for activities of daily living related to CVA (cerebral vascular accident), flaccid on left side with approaches including transfer with assistance of 2 and a full body mechanical lift. On 4/28/25 at 12:52 PM R2 stated he had an issue with a CNA (Certified Nurse Assistant) when she gave him a shower a few weeks ago. R2 stated the CNA used a hoist to transfer him onto the shower chair, the hoist hurt his private parts, she was rough, she acted like he had no rights, and she said stated he does not have any rights. R2 stated his mom reported this to management but no one from management has talked to him about the incident. R2 then stated the CNA is (V11). On 4/28/25 at 1:05 PM R1 stated he has had issues with the way (V11) CNA gives him showers. R1 stated we don't like the way she does things; she shows no respect to us, she has not abused me in anyway, she just doesn't show any respect. R1's MDS, dated [DATE], documented R1 is moderately cognitively impaired although during interview with surveyor R1 was alert and oriented. On 4/28/25 at 1:08 PM R4 (R1's roommate) stated (V11) is not abusive, she just doesn't let us do as much as we can for ourselves when she showers us. She just does it. R4's MDS, dated [DATE], documented R4 is cognitively intact. On 4/28/25 at 1:15 PM V6 CNA stated she recently heard R2 say he doesn't like V11 to give him showers because she hurt him the last time, she gave him one. On 4/28/25 at 2:17 PM V1, Administrator, stated the facility does have a CNA named (V11). V1 then stated we did a write up on her about (R2) on C hall because his mom called and stated he had a bad experience with her during his shower. I didn't report it because there was no allegation of abuse when his mom called our Social Service Director. V1 stated V9, Social Service Director, spoke to R2's mom (V12) and V12 told her R2's privates were pinched from the sling. V1 then provided surveyor with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 7 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0610 Level of Harm - Minimal harm or potential for actual harm a facility employee disciplinary form, dated 4/18/25, that documented employee (V11), summary of incident: resident states employee was being rough during shower. He states he asked several times for her to be easier with his genitals. Resident no longer wishes to have employee in his room or to provide care or to give shower. Employee educated on proper peri care/shower technique. This form documented signatures (all dated 4/18/25) by V1, V2 (former Director of Nursing), and V11. Residents Affected - Few On 4/28/25 at 2:36 PM V9, Social Service Director, stated R2's mom (V12) called her and mentioned R2 was upset about the care he received during a shower, that the shower transfer sling had pinched his private area, and V12 requested that the CNA (V11) not shower R2 anymore. V9 said she did not document this in the facility grievance book, nor did she discuss this issue with R2 because she gave the information to the Administrator (V1). On 4/28/25 at 2:45 PM V1, Administrator, stated she did not interview R2 nor the other CNA working with V11. V1 then stated she did not investigate R2's allegation against V11. On 4/28/25 at 2:50 PM R2 stated the day V11 gave him a shower he informed V11 the transfer sling was hurting his privates, she did not reposition him or do anything to ease his discomfort, and that it felt like all his body weight was putting pressure on his testicles during the shower. R2 stated he was on the shower chair, it felt like the sling was not applied properly, he repeatedly told V11 that he was hurting, and V11 ignored his statements. R2 stated after the shower V11 did not dry him off and he was put to bed soaking wet. R2 stated no facility employees including management came and spoke to him about the incident, no nurses looked him over after the incident, so he told his mom (V12) and she called and reported it to someone at the facility. R2 stated he feels it was abuse and he will not allow V11 to care for him again. On 4/28/25 at 2:58 PM V10 CNA stated about 2 weeks ago R2 told him V11 had him sitting on his scrotum and she didn't reposition him when he told her it was hurting. On 4/28/25 at 3:37 PM V12, R2's mother, stated she called the facility's Social Service Director (V9) two weeks ago on 4/14/25 and informed her (V9) of her son's (R2) concerns with how he was treated by the CNA (V11) during his shower on 4/11/25. V12 stated R2 told her V11 was rough and rude, his private area was pinched, he was hurting during his shower, and the CNA (V11) would not reposition him. V12 stated R2 also told her V11 did not dry him off after his shower and she put him to bed soaking wet. V12 stated R2 informed her of the incident during her visit with him on 4/13/25. R2's shower sheet, dated 4/11/25, documented V11 CNA did give R2 a shower on 4/11/25. On 4/30/25 at 9:35 AM V9, Social Service Director, stated R2's mom, V12, did say V11 was rough with R2 during his shower. V9 stated she did not speak to R2 about his concerns because she took it to V1, Administrator, to follow up on. On 4/30/25 at 9:42 AM V11, CNA, stated the last time she gave R2 a shower was a couple of weeks ago on a Friday. V11 stated R2 normally speaks to her during care but he did not on this day, and she tried to speak with him throughout the shower, but he just cursed in response. V11 stated R2 never complained of pain during the shower. V11 stated she informed R2's nurse of his behavior during the shower. V11 stated she was never suspended pending an investigation of R2's allegation. On 4/30/25 at 11:15 AM V1, Administrator, stated she does not have any statements from R2, any other residents, nor staff other than the one on the write up that was given to V11. V1 then confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 8 of 9 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 145502 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Taylorville Care Center 600 South Houston Taylorville, IL 62568 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)

F 0610 Level of Harm - Minimal harm or potential for actual harm the facility did not complete an investigation of R2's allegations of V11 being rude and rough with him during a shower. On 4/30/25 at 12:56 PM V15, Director of Operations, stated R2's allegations against the CNA (V11) should have been reported and investigated. Residents Affected - Few The facility's Abuse Prevention Program policy, dated 9/29/22, documented abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. It continues, 4. Establishing a resident sensitive environment; the facility desires to prevent abuse, neglect, or misappropriation of property by establishing a resident sensitive and resident secure environment. This will be accomplished by a comprehensive quality management approach involving the following: Grievance/Concern Identification and Follow-up: Resident and family concerns will be recorded, reviewed, addressed, and responded to using the facility's concern identification procedures. Residents and families will be informed of the facility's grievance policy and procedures process. An essential element of customer satisfaction is a timely response back to the family or resident to concerns expressed. The reported concerns from residents and families, and the facility response, will be reviewed on a regular basis by the facility Quality Improvement committee to assure that individual concerns are being addressed and to assess any patterns that might indicated needed changes in the facility practices. It continues, 5. Internal Reporting Requirements and Identification of Allegations: Employees are required to report any incident, allegation, or suspicion of potential abuse, neglect, or misappropriation of property they observe, hear about, or suspect immediately to the administrator. Supervisors shall immediately inform the administrator of all reports of incidents, allegations, or suspicion of potential abuse, neglect, or misappropriation of property. Upon learning of the report, the administrator shall initiate an incident investigation. 6. Protection of Residents: The facility will take steps to prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress and will immediately take appropriate steps to remediate the non-compliance and protect residents from additional abuse. It continues, c. Employees of the facility who have been accused of abuse, neglect, or mistreatment will be removed from resident contact immediately until the results of the investigation have been reviewed by the administrator or designee. Employees accused of possible abuse, neglect, or misappropriation of property shall not complete the shift as a direct care provider to the residents. 7. Internal investigation of abuse, neglect or misappropriation allegations and response: a. All incidents will be documented, whether or not abuse occurred, was alleged or suspected. b. Any incident or allegation involving abuse, neglect, or misappropriation will result in an abuse investigation. c. Any other incident or pattern involving reasonable cause to suspect abuse, neglect, or misappropriation will result in an abuse investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145502 If continuation sheet Page 9 of 9