Inspection·August 21, 2024

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 answer resident call lights in a timely manner for 5 of 8 residents (R1, R2, R3, R4, R5) reviewed for call light response times in a sample of 8. Findings included: 1. R1's EHR (electronic health records) documented R1 was admitted to this facility on 6/26/2024 on Hospice with diagnoses of Breast Cancer, Anemia and Right Renal Cell Carcinoma among others. R1's MDS (minimum data set) dated 7/2/2024 documented R1 has a BIMS (Brief Interview for Mental Status) score of 15 out of 15 which indicated R1 is cognitively intact. This same MDS documented R1 needs partial moderate assistance to transfer, for toileting and showering. On 8/20/2024 at 10:00am, R1 said she has waited up to two hours for staff to answer her call light. R1 said she couldn't remember what the date was but she spoke with V4 (Family) and a grievance form was completed concerning the event. The facility's grievance log for 6/1/2024-8/20/2024 documented R1 filed a grievance for excessive call bell response times on 6/30/2024, 7/13/2024 and 8/8/2024. The facility's written response to R1's call bell response time grievance for 6/30/2024 was documented as, Call lights are answered in an appropriate manner just being timely is a must and staff were verbally educated. The facility's written response to R1's call bell response time grievance for 7/13/2024 was documented as, Call light response time not appropriate according to family and discussions were had with staff. The facility's written response to R1's call bell response time grievance for 8/8/2024 was documented as, Call light was not answered and or care not provided in a timely manner and staff are to answer call bell in a timely manner. 2. On 8/21/2024 at 9:35am, R5 said he filed a grievance due to waiting 45 minutes for staff to come help him with pulling up his pants and underwear after toileting. R5 said he can do everything else but can't get his pants over his feet and pulled up. R5 said he sees call lights activated all the time while staff stand around the desk socializing and on their cell phones. R5's MDS dated [DATE] documented R5 has a BIMS of 15 out of 15, which indicates R5 is cognitively intact. The facility's grievance log for 6/1/2024-8/20/2024 documents R5 filed a grievance for excessive call bell response time on 6/27/2024. The facility's written response to R5's call bell grievance was documented as, Call bell had not been answered timely and spoke with staff about answering call lights in timely manner. (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: 145649 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 145649 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Odin Health and Rehab Center 300 Green Street Odin, IL 62870 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)