Inspection·June 3, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify a resident's representative of a hospital admission for 1 (R1) of 3 residents reviewed for notification of changes in the sample of 8. Findings include: R1's admission Record documents an admission date of 03/06/25 and includes diagnoses of encounter for orthopedic aftercare following surgical amputation, type 2 diabetes mellitus with diabetic neuropathy, unspecified; unspecified severe protein-calorie malnutrition; osteomyelitis, unspecified; local infection of the skin and subcutaneous tissue. R1's Minimum Data Set (MDS) assessment dated [DATE], documented a Brief Interview for Mental Status (BIMS) score of 6, indicating that R1 has severe cognitive impairment. On 06/03/25 at 10:24am, V2 (Director of Nursing/DON) stated R1 had an appointment with Podiatry on 05/29/25 and they scheduled him for a debridement the next morning. V2 stated they were waiting on the preauthorization for R1's procedure. V2 stated on 05/30/25 when they took R1 to the hospital for the procedure they did not have the authorization for the procedure and they sent him to the ER (Emergency Room). V2 stated R1 was a direct admit from the ER and he had the procedure inpatient. V2 stated she was not sure what R1's BIMS score was, but confirmed he was listed as financial responsible party and his wife was listed as his first emergency contact, not POA (Power of Attorney). V2 stated if someone was cognitively intact and did not have a POA or responsible party it would be up to the resident if they contacted family or not, if they were not cognitively intact, family should be contacted. On 06/03/25 at 12:08pm, V3 (Family Member) stated she was not aware that R1 was hospitalized until a Social Worker from the hospital called and left a message about where to send her husband to. V3 stated she called them back and was all but arguing with the hospital because she had no knowledge of R1 being hospitalized . V3 stated she had received a picture of R1's foot the night before and it looked good, she stated she could hardly believe that he needed surgery on it. V3 stated she was not even informed R1 was scheduled for the outpatient debridement on 05/30/25. V3 stated that R1 on his best days has a BIMS of maybe a 4. V3 stated that she is R1's POA and designated R1's son as his emergency contact #1. V3 stated she filled out the POA paperwork at the facility. V3 stated she has yet to hear anything from the facility about R1. On 06/03/25 at 12:39pm, V2 (DON) stated that residents who have a BIMS score of 6 or 7 should have a Power of Attorney (POA) in place. V2 stated in a perfect world R1's family should have been (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: 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 06/03/2025 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)