Inspection·January 28, 2026

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 follow their policy to obtain measurements of a pressure injury during a wound evaluation. This applies to 1 of 3 residents (R1) reviewed for pressure injuries in the sample of 6. The findings include:R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], with multiple diagnoses including rheumatoid arthritis, chronic kidney disease, congestive heart failure, pressure-induced deep tissue damage of right buttock, unstageable pressure ulcer of sacral region, and unstageable pressure ulcer of left buttock. R1's skin integrity care plan dated January 13, 2026, [R1] has an actual impairment to skin integrity related to sacral and bilateral buttock wound unstageable pressure ulcer. The care plan continued to show multiple interventions dated January 13, 2026, including Monitor/document location, size and treatment of skin injury. Report abnormalities, failure to heal, signs and symptoms of infection, maceration, etc. to physician. On January 27, 2026, at 10:43 AM, V3 (Wound Nurse) said she assesses newly admitted residents for skin impairments with 24 hours of admission. V3 said if she is unsure how to measure the wound then she will wait for the next time the wound nurse practitioner comes to that facility. V3 said she did not measure R1's buttock pressure injuries and she is unsure why she did not measure R1's pressure injuries on her buttocks. V3 said sometimes she does not measure pressure injuries because she does not want to measure incorrectly and measure the pressure injury as larger than it is. A Skin/Wound Evaluation dated January 14, 2026, at 5:01 PM, by V3 showed R1 had a suspected deep tissue injury to the bilateral buttocks. The documentation does not show measurements of R1's bilateral buttock pressure injury. A Nursing-Admission/readmission assessment dated [DATE], at 3:57 PM, did not show measurements of R1's bilateral buttocks pressure injuries. A wound assessment report dated January 19, 2026, by V16 (Wound Nurse Practitioner) showed Date of Service: January 16, 2026. Wound 2, Location: Left glute, Primary Etiology: Pressure Ulcer/Injury, Stage/Severity: DTI (Deep Tissue Injury), Wound Status: Present on admission, Size: 6.7 cm (centimeters) by 3.9 cm by 0 cm. Calculated area is 26.13 square cm. Wound Base: 100% (percent) epithelial, Periwond: Intact, Fragile. Wound 3, Location: Right glute, Primary Etiology: Pressure Ulcer/Injury, Stage/Severity: DTI, Wound Status: Present on Admission, Size: 9.3 cm by 5.3 cm by 0 cm. Calculated area is 49.29 square cm, Wound Base: 100% epithelial, Wound Edges: Attached, Periwound: Intact, fragile. On January 27, 2026, at 3:12 PM, V2 (Director of Nursing) said when a resident is admitted to the facility, the admitting nurse will assess the resident for wounds and document what they see. V2 said V3 then comes within 24 hours to assess the resident's skin. V2 said she would think as a nurse, the pressure injuries should be measured when being assessed. V2 said without admission wound measurements, V2 cannot say if a wound had gotten larger between the time the resident was admitted to the facility and when the wound nurse practitioner comes in to assess the resident. V2 said staff should follow the policy for wound care guidelines. The facility's policy titled Wound Care Guidelines dated January 24, 2025, showed Overview of the Program: This Residents Affected - Few (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 3 Event ID: 145511 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 01/28/2026 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)