Inspection·September 5, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure dignity was provided during incontinence care and mealtime for five of five residents (R3, R4, R5, R6, R7) reviewed for dignity in a sample list of seven residents.Findings include:1.R3's Electronic Medical Record (EMR) documents medical diagnoses as Dementia, Psychotic Disturbance, Mood Disturbance, Anxiety, Osteoarthritis, Hypertension, Disorders of Bone Density and Structure, Cardiomyopathy, Dysphagia and Mild Protein-Calorie Malnutrition.R3's Brief Interview for Mental Status (BIMS) dated 8/22/25 documents R3 as severely cognitively impaired. R3's Minimum Data Set (MDS) dated [DATE] documents R3 is fully dependent on staff for eating, oral hygiene, toileting, bathing, dressing, personal hygiene, bed mobility and transfers. On 9/4/25 at 1:05 PM V9 and V12 (Certified Nursing Assistants/CNAs) provided incontinence care for R3. V9 and V12 pulled R3's sweatshirt up to R3's chest. V9 and V12 pulled down R3's pants to her knees. V9 removed R3's incontinence brief and provided incontinence care for R3. R3's privacy curtain was pushed back to the wall leaving R3's front and back perineal area entirely exposed during cares provided. R4 (R3's roommate) was sitting in her wheelchair in R3's room during the entire time V9 and V12 were providing incontinence care for R3. On 9/4/25 at 1:20 PM V9 (CNA) stated R3's privacy curtain should have been pulled while providing incontinence care for R3. V9 stated R3 requires total care and is unable to provide privacy for herself. 2. R4's Brief Interview for Mental Status (BIMS) dated 6/19/25 documents R4 as severely cognitively impaired. R4's Functional Abilities and Goals Review dated 6/17/25 documents R4 requires maximum assistance from staff when eating. R5's Brief Interview for Mental Status (BIMS) dated 3/10/25 documents R5 as severely cognitively impaired. R5's Functional Abilities and Goals Review dated 6/10/25 documents R5 is totally dependent on staff for eating.R6's Brief Interview for Mental Status (BIMS) dated 6/27/25 documents R6 as cognitively intact. R6's Functional Abilities and Goals Review dated 6/30/25 documents R6 requires supervision when eating. R7's Brief Interview for Mental Status (BIMS) dated 3/27/25 documents R7 as severely cognitively impaired. R7's Functional Abilities and Goals Review dated 6/24/25 documents R7 is totally dependent on staff for assistance with eating. On 9/5/25 from 7:30 AM-7:50 AM R3, R4, R5, R6 and R7 were sitting at the same dining room table. R6 was feeding herself oatmeal. R6 had oatmeal on her Left cheek and chin. R3, R4, R5 and R7's plates of food were uncovered. The main resident dining room was full of residents eating their breakfast. No staff were present in the dining room.On 9/5/25 at 7:51 AM V10 (CNA) stated two other CNAs did not show up to work today which leaves two CNAs for the front two halls. V10 stated the residents need help eating. V10 walked back and forth from R3, R4, R5 and R7 offering each resident a bite and then moving to the next resident. V10 assisted each resident from a standing position. V10 did not sit with each resident individually. On 9/5/25 at 2:05 PM V2 (Director of Nurses) stated residents should be provided dignity while providing cares for all residents regardless of their cognitive capacity. V2 stated the staff should have pulled R3's (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: 145584 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 145584 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Garden of Mattoon 1000 Palm Mattoon, IL 61938 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)