Inspection·February 7, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from verbal abuse for 2 of 2 residents (R2, R3) reviewed for abuse in the sample of 6. Findings include: R2's Face Sheet documents R2 was admitted to the facility on [DATE] with diagnoses including type 2 diabetes, end stage renal disease, dependence on renal dialysis, schizoaffective disorder, and bipolar disorder. R2's Minimum Data Set (MDS) dated [DATE] documents R2 as cognitively intact, had no behaviors, and was able to transfer self with supervision. R2's Undated Care Plan documents R2 has a behavioral problem. The goal is for R2 to have fewer episodes of vulgar language toward others. R3's Face Sheet documents R3 was admitted to the facility on [DATE] with diagnoses including history of mental and behavioral disorders and substance abuse. R3's MDS dated [DATE] documents R3 as moderately cognitively impaired, had behavioral symptoms not directed toward others, ambulated via wheelchair, and was able to transfer with supervision. R3's Undated Care Plan documents R3 has a behavioral problem with goal of having fewer episodes of being verbally abusive. On 2/7/25 at 2:15 PM, R2 stated R3 calls him bad names and has been doing so for the past two or three weeks. He said sometimes R3 curses at him, and staff are aware, but it has continued. On 2/7/25 at 9:02 AM, R3 stated R2 used to be his roommate. R3 stated, (R2) would bend over in the bathroom and let those ladies clean his butt. I would say, (R2) why don't you clean your own self? It's not that hard. On 2/7/25 at 8:58 AM, V6, Licensed Practical Nurse (LPN), stated R3 antagonizes R2 and calls him S***ty (R2). V6 stated he has spoken to R3 about it multiple times, but R3 likes to get in front of people in common areas like the dining room and call him that name. V6 stated it has really bothered R2. (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 02/07/2025 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)