Health inspection·January 7, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review the facility failed to ensure enough clean linens, blankets, towels, and wash cloths were available for the residents. Residents Affected - Many This applies to all the 69 residents in the building reviewed for a homelike environment. Findings include: On 01/02/25 at 9:24 AM, V2 DON (Director of Nursing) stated the facility census is 69. Facility's Data Sheet dated 12/31/24 also indicated their total census is 69. On 12/31/24 at 10:56 AM, R1 stated that she has made a list of items that the facility doesn't have. R1 stated that there were no bed pads the previous night and facility staff had given her their last sheet. R1 stated there were no wash rags available and no Kleenex. R1's 12/30/2024 MDS (Minimum Data Set) showed R1 is cognitively intact. On 12/31/24 at 10:22 AM, R3 stated the facility did not have enough bed sheets. R3's 12/8/2024 MDS showed she is cognitively intact. On 1/02/25 at 10:47 AM, R5 stated the facility is short on linen. R5 stated they are supposed to change his linen every Monday and they have not been doing it. R5's 12/2/24 MDS showed he is cognitively intact. On 12/31/24 at 11:05 AM, R2 stated the facility does not have enough towels or linens. R2's 11/26/2024 MDS showed she is cognitively intact. On 12/31/24 at 9:10 AM, a tour was conducted with V2 (DON) on the first floor and the second floor. The facility did not have dedicated linen closets on the floors, instead, staff obtained linens from the linen carts on the floor. On 12/31/24 at 9:40 AM on second floor, one linen cart had six pillowcases, twelve sheets, and nine bath blankets. The cart contained no washcloths or towels. The other cart on second floor had three top sheets, one hospital gown, two blankets, five pillowcases, and five fitted sheets. No towels or washcloths were available. On 12/31/24 at 9:50 AM in the basement laundry area, two laundry aides were working (V3 and V4) and they were folding resident clothing. In the laundry area, there were a total of 5 bedsheets, one reusable bed pad, and 4 blankets. When asked where the facility keeps the surplus linen, V3 and V4 (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: 145611 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 145611 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St James Wellness Rehab Villas 1251 East Richton Road Crete, IL 60417 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)