Health inspection·March 6, 2024

F 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure therapy services were provided for two (R1 and R3) of three residents reviewed for therapy services in the sample of three. Residents Affected - Few Findings include: The facility's admission Packet (current) documents the following information: Dear Residents and Family Members: Our facility offers services that may be covered by the Medicare Program. These services include skilled nursing care, therapy services, pharmacy, and medical supplies. If you have Medicare benefits and you or a family member consents, we will bill the Medicare program for services that are rendered at this facility. 1. R1's Face Sheet (current) documents R1 being admitted to the facility on [DATE]. R1's Therapy Evaluation and Treatment order dated 1/22/24 per Physician Order Sheet (POS) documents R1 is to receive Therapeutic Treatment for Neurological Re-Education, Gait Training, Group Therapy and Therapeutic Activities 2 times a week for 4 weeks (ending on 2/23/24). R1 is also documented to receive Occupational Therapy for Therapeutic activities, Activities of Daily Living and Activity Group 2 times a week for 4 weeks (ending on 2/23/24). A NOMNIC (Notice of Medicare Non-Coverage) letter dated 2/20/24 documents R1's Medicare A benefits for Rehabilitative Therapy ends on 2/23/34. R1's Therapy Notes document that R1 last received Rehabilitative Therapy on 2/18/24, 5 days short of R1's approved/benefited time. There are no further evaluations in R1's chart for continuing Medicare A or Medicare B benefits. A Social Service Note dated 2/16/24 documents R1's Health Care Power of Attorney (V6) was notified concerning R1's NOMNIC letter and Therapy would not be available to R1 after 2/18/24. This same Note documents family would like to pay privately for room and board, are aware and will address part B service for Therapies when Therapy resumes. On 3/6/24 at 9:00 am R1 was lying supine in bed and confirmed that R1 had not received any therapy services since 2/18/24. R1 stated I really need to get some therapy. I want to be able to go home. (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 2 Event ID: 145631 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 145631 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Newman Rehab & Health Care Ctr 418 South Memorial Park Drive Newman, IL 61942 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)