Health inspection·October 6, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R1 made an allegation of mental abuse and made an initial report to IDPH and initiated the investigation. V9 stated neither V3 or V4 reported R1's allegation to V9 or V1 when R1 had reported it in the morning. On October 2, 2025, at 1:29 PM, V10 (CNA) stated she was the assigned CNA for R1 on September 28, 2025, 2PM-10 PM shift. V10 stated she responded to R1's call light around 8:00 PM , and R1 requested assistance with incontinence care. V10 stated she gave R1 care for incontinence, assisted by V11 (Agency CNA). V10 stated she was standing on the right side of R1's bed and V11 was on the left side. V10 stated while R1 was lying on her left side, after V10 completed cleaning R1, the clean linens were placed under R1. V10 stated she did hold R1's left hand/wrist to try and assist R1 to turn to the right so the linens could be straightened out underneath R1. V10 stated R1 told V10 to let go of her hand, but V10 did not and continued to try and pull R1 to the right, holding on to R1 left hand/wrist. V10 stated she knew R1 well and knew she did not like to feel rushed through care. V10 stated V11 was able to pull the linens from underneath R1 with R1 only being partially on her right side. V10 stated R1 hit her with her right hand while she was holding R1's left hand. V10 stated she did not report that R1 had hit her until she was interviewed on October 1, 2025. V10 stated she did receive a message from V9 on Monday September 29, 2025, in the late afternoon but did not return the call. V10 stated she worked the next day on September 30, 2025, on the 2PM - 10PM shift on R1's unit and stated neither V9 nor any management staff interviewed her or requested to talk to her during that shift.On October 2, 2025, at 2:05 PM, V11 (Agency CNA) stated she assisted V10 to provide incontinence care to R1 on September 28, 2025, 2PM-10PM shift. V11 stated when V10 and V11 were providing care to R1, R1 was complaining of pain. V11 stated she did see V10 hold R1's left hand and wrist and tried to pull R1 to the right side while trying to pull the clean linens underneath R1. V11 stated R1 was complaining while V10 was holding R1's wrist and V10 did not let go. V11 stated R1 hit V10 with her right hand when V10 was holding R1's left arm. V11 stated she did not report R1 hitting V10, did not report R1 was complaining of pain and did not report V10 had been holding R1's left hand/wrist when R1 had told V10 to let go.On October 1, 2025, at 3:56 PM, V8 (Police Officer) stated the department was just notified of an allegation of abuse that occurred on September 28, 2025. V8 stated R1 had told him during the interview that a staff member had held her left wrist and hand and would not let go when asked while R1 was receiving care on September 28, 2025, during the evening.On October 2, 2025, at 3:54 PM, V14 (CNA) stated she had worked full time in the facility for four years and was very familiar with R1's care needs. V14 stated R1 is blind and deaf , however R1 had never been combative with V14 during care. V14 explained R1 needed to be treated with patience and staff need to explain what staff are going to do. V14 stated R1 likes to assist when she can. V14 stated R1's left hand is her stronger hand and prior to her recent abdominal surgery, R1 would hold the upper side rail with her left hand and scoot herself side to side or up in the bed to assist with repositioning during care.On October 1, 2025, at 4:30 PM, V9 stated it is the expectation that staff should immediately report any allegation of abuse, whether it was reported to them or witnessed by them, to the abuse coordinator. V9 stated V1 (Administrator) is the abuse coordinator however V9 is the assistant and also does abuse investigations and reporting.The facility's policy titled Abuse and Neglect dated June 26, 2025, showed If abuse/neglect is suspected the facility will: 1. Take immediate steps to assure the protection of the resident. This may involve separation from the alleged abuser .3. Conduct a careful and deliberate investigation centering on facts, observations, and statements from the alleged victims and witnesses.II. Training.Appropriate interventions to deal with aggressive and/or catastrophic reactions of residents.Abuse identification and recognizing signs of abuse.III. Prevention.The supervision of staff to identify inappropriate behaviors, .such as rough handling. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145511 If continuation sheet Page 2 of 3 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 145511 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bella Terra Lombard 2100 South Finley Road Lombard, IL 60148 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 ignoring residents while giving care. V. Investigation.Interview all involved persons including the victim, perpetrator, witnesses, and others who might have knowledge of the allegation.VII Reporting .All allegations and/or suspicions of abuse must be reported to the Administrator immediately. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145511 If continuation sheet Page 3 of 3