Health inspection·January 8, 2026

F 0689 Level of Harm - Actual harm Residents Affected - Few hospital. V4 LPN's written and signed statement dated 8/12/25 shows, This writer saw the bathroom light went off around 2:55pm on pm shift on 8/10/25, writer ran towards the bathroom, knocked at the door, asking who was inside? V3 CNA replied she was in with R1. Writer then returned to the nurse's station. By 3:10pm, R1 was brought to his room on his wheel-chair by V3 CNA. The CNA never reported to writer that resident had a fall. Around 3:15pm R1 reported to writer that he fell in the shower room, that his back is hurting on his spine, that he wants to go to the hospital. Writer asked resident, when did he fall and how he got up from the floor? R1 replied that V3 CNA got him up. Writer replies that how come he the nurse was not called or informed? By 3:45pm when the CNA who went outside came back into the building, writer asked CNA why she did not report that R1 had a fall in the shower room? CNA replied that she was going to tell writer. Writer replied that, the CNA supposed to call for the nurse first with any fall. CNA replies that she told resident not to take off his rubber shoes, that resident did not listen. She added that she did not witness the fall. Which means she was not with resident prior to the fall. V3 CNA's written and signed statement dated 8/10/25 shows, I told R1 not to take his shoes off in the shower and he didn't listen to me, he stood up in the shower and slipped on the floor. V20 CNA's written and signed statement (no date) shows, On 8/10 (8/10/25) I was in [another resident] room taking care of her. I was taking the trash, clothes and linens to the soiled utility when I was in the soiled utility getting rid of the dirty clothes and trash V3 CNA approached me telling me that she told R1 to go to the shower room to take a shower. I asked her if he was in the shower room. She told me yes. I told her that she should go in there and help him because he can't take a shower by himself. I left the soiled utility and took the linens out to the shed. When I came back V3 CNA approached me to tell me that R1 had fallen in the shower and asked me to help her get him up. She had her gait belt on him and was lifting from the back, I was lifting him on his right side and he was pulling himself from the bar and we got him into his chair. I did not know if she told the nurse or not. I had just walked in from taking linens out. The facility's serious injury and communicable disease report dated 8/21/25 shows, .Final: Interviews conducted w/ (with) staff and residents regarding incident. Upon final investigation, it was determined that resident slipped and had a fall while in the shower room. Resident reported pain in his back, POA (power of attorney)/NP (Nurse Practitioner) notified and orders received for resident to be send to the ED (emergency department) for further evaluation. On 8/11/25 , nurse on duty called hospital to follow up on status of resident and at this tie nurse notified that resident was admitted to hospital w/ dx (diagnosis) closed compression fracture of L1 vertebra per CT scan. Addendum to 8/15/25 final: Interviews conducted w/ staff and residents regarding incident. Upon final investigation, it was determined that resident removed shoes and attempted to self-transfer when he slipped and had a fall while in the shower room. CNA not present in the room at the time of the fall. On 1/7/26 at 10:35 AM, V1 Administrator stated, V3 CNA no longer worked at the facility following the incident with R1. She had a prior incident with V3 CNA and this was the second time something had happened. She had left R1 in the shower room by himself and she is not supposed to leave him alone. He fell and got a fracture. On 1/7/26 at 1:20 PM, V5 NP stated, the fall was the reason for R1's compression fracture. R1 is very impulsive and they should not ever leave him alone. When he is done he will not wait for staff. R1's history and physical by the local hospital dated 8/11/25 shows, Chief complaint: slip and fall in shower. History of Present Illness: Briefly, R1 is a [AGE] year old other male with extensive pas medical history listed below is a skilled nursing resident mostly wheelchair bound for last few years suffered a slip and fall in shower hitting his head and started experiencing neck and back pain afterwards. Brought to the emergency room where CT showed the has L1 compression fracture. Patient (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145609 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 145609 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillside Rehab & Care Center 1308 Game Farm Road Yorkville, IL 60560 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 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete admitted . The same report shows, Imaging: CT lumber spine without IV contrast: Result date: 8/10/25, Impression probable acute low-grade compression fracture involving the inferior endplate of L1 is present, new compared to prior CT. R1's Minimum Data Set, dated [DATE] shows, he is cognitively intact. R1's care plan for ADLs (activities of daily living) functional status with a start date of 8/26/22 shows, he requires 1 assist with bathing.R1's care plan for falls with a start date of 11/11/24 shows, resident has a history of falling and has had multiple falls. 2. R3's face sheet lists his diagnoses to include: pain in right knee, vascular dementia; major depressive disorder and type 2 diabetes mellitus. R3's electronic medical records shows, he had a fall on 10/7/25 resulting in a right leg tibia fracture. He had two falls on 10/19/25 resulting in two separate emergency room visits. The second emergency room visit, he was admitted and the fall resulted in anterior right 5th and 6th rib fractures. The facility's serious injury incident and communicable disease report dated 11/13/25 shows, R3 had another fall on 11/12/25. Detailed incident summary: Initial: R3 is a 79 y/o (year old) Caucasian male w/ BIM score 00 (cognition score- not cognitively intact). Resident noted to be on floor laying on his L (left) side outside room. Resident reported pain to his back, L shoulder, L hip. Resident transported to local ED (emergency department) for further evaluation. Final: Upon final investigation, it was determined that resident's fall resulted in fx (fracture) to L femur, dx given at hospital. R3's hospital communication with the facility from his hospital admission of 10/19/25 shows, V1 Administrator asking if the hospital can discuss memory care with the family, as it might be more appropriate for him. The same documents also show, he had a 1:1 sitter while in the hospital. R3's progress notes for 11/12/25 shows, Resident noted to be on the floor laying on his left side outside RM [ROOM NUMBER].On 1/7/26 at 2:17 PM, V1 Administrator stated, R3 was very impulsive and had dementia. They had discussed with the family that they felt a memory care unit was more appropriate for him. When he was admitted on [DATE] to the local hospital, they asked the hospital to look for other placement however the family insisted they wanted him to come back to the facility. He needed 1:1 support. They were not able to provide 1:1 to care for him all the time but still accepted him back to the facility. On 1/7/26 at 2:34 PM, V6 Registered Nurse (RN) stated, she was his nurse for his first fall on 10/7/25. R3 was very impulsive. When she was working she always had R3 with someone as best as they could otherwise he would get up and fall. He was a 1:1 sometimes. They tried to 1:1 as much as they could. R3's care plan with a start date of 9/17/25 shows, he was at risk for falls due to his vascular dementia. The care plan lists interventions to include: alarms located on chair and bed and keep in visual range of floor staff. The facility's falls management policy dated 4/21/22 shows, Policy: It is the policy of [the facility] to assess and manage resident falls through prevention, investigation, and implementation and evaluation of interventions. Definition: The definition of a fall refers to unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force (e.g., resident pushes another resident). An episode where a resident lost his/her balance and wound have fallen, if not for staff intervention, is considered a fall. Unless there is evidence suggesting otherwise, when a resident is observed on the floor, a fall is considered to have occurred. Procedure: .2. Resident's identified as high risk will have fall prevention addressed on the plan of care. 3. If a resident falls, reports falling or is suspected of falling, the following will be implemented: a. Assess for injury, provide treatment and document in the E.H.R. (electronic health record). Event ID: Facility ID: 145609 If continuation sheet Page 3 of 3