F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
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
interview and record review, the Facility failed to respond to call lights in a timely manner for 3 (R1, R3, and
R7) of 7 residents reviewed for adequate and timely care in the sample of 8.
Findings include:
1-R1's Face Sheet documents R1 was admitted to the facility on [DATE] with diagnoses including type 2
diabetes mellitus, congestive heart failure, and aphasia, hemiplegia, and hemiparesis following cerebral
infarction.
R1's Minimum Data Set (MDS) dated [DATE] documented R1 was moderately cognitively impaired,
required partial/moderate assistance with toileting and transfer, required substantial/maximal assistance
with rolling from side to side, had colostomy, and was occasionally incontinent of urine.
R1's Care Plan initiated 1/26/23 documents R1 has a self-performance deficit with activities of daily living
and is frequently incontinent of urine.
On 10/3/24 at 8:50 AM, R1 was lying in bed in her room. She was unable to articulately express responses,
but was able to nod her head yes and no with continued attempts at verbalization. R1 nodded yes and no
when asked about specific time frames for call lights and indicated staff usually take around 20 minutes to
answer the call light which she feels is too long. She pointed at her incontinent brief which was saturated
and indicated she needed to be changed.
2-R3's Face Sheet documents R3 was admitted to the facility on [DATE] with diagnoses including acute
respiratory failure, severe protein calorie malnutrition, and need for assistance with personal care.
R3's MDS dated [DATE] documented R3 was cognitively intact and always incontinent of bowel and
bladder. R3's mobility was not assessed.
R3's Care Plan initiated 4/28/23 documents R3 has a self-performance deficit with activities of daily living
and requires extensive assistance with activities of daily living and transfer.
On 10/3/24 at 8:52 AM, R3 was lying in bed in her room. She stated call lights take a long time to get
answered, especially on the midnight shift.
On 10/3/24 at 1:25 PM, R3 stated, It makes me feel like I want to get out of here. It is hard, and
(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:
145651
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
145651
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/04/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
LA Bella of Alton
3490 Humbert Road
Alton, IL 62002
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 0550
Level of Harm - Minimal harm
or potential for actual harm
I have a muscle disease where I'm supposed to be turned every 2 hours and I always have to push my call
light and remind them.
3-R7's Face Sheet documents R7 was admitted to the facility on [DATE] with diagnoses including type 2
diabetes mellitus, right above the knee amputation, and left below the knee amputation.
Residents Affected - Few
R7's MDS dated [DATE] documented R7 was moderately cognitively impaired.
The Facility's Grievance/Complaint Report dated 8/2/24 by R7 documents, Call light responses take too
long.
On 10/3/24 at 2:40 PM, R7 was sitting in his wheelchair in his room. He stated, They (call lights) have
gotten worse than before. They take so long I just go ahead and clean myself up.
The Facility's Grievance/Complaint Report dated 7/19/24 by Resident Council Group documents, CNA's
(Certified Nursing Assistants) are doing the best they can however it is still taking them a bit longer to
answer call lights in a timely manner.
The Facility's Anonymous Grievance/Complaint Report dated 9/23/24 documents, Res (Resident) reports
waiting 4 hrs (hours) for help getting out of bed over the weekend. 9/22 waited 40-50 minutes for call light
responses.
The Facility's Grievance/Complaint Report dated 9/30/24 by V7, R2's Family, documents, Concerned about
call light times.
On 10/3/24 at 8:40 AM, V4, CNA, stated she usually has no trouble answering call lights timely unless they
are really short staffed, but today someone called off and another person went home sick.
On 10/4/24 at 12:06 PM, V2, Director of Nursing (DON), stated she expects call lights to be answered
timely, and if staff are busy at that time, she would expect them to pop their head in the door and tell them
they will assist them as soon as possible.
On 10/4/24 at 12:08 AM, V1, Administrator stated he does not have policies on call lights or resident rights.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145651
If continuation sheet
Page 2 of 2
