Inspection·July 17, 2025

F 0628 Level of Harm - Actual harm Residents Affected - Few and had to sleep without his CPAP for about 30 days, because he did not have the supplies. He did have trouble sleeping. R2 agreed. V9 said, (R2) was so mad because the facility was not returning our calls. It was very frustrating. He missed the MRI scheduled for [DATE] and the follow-up appointment on [DATE]. They had to be cancelled due to facility's mistake. (R2) just found out yesterday that it has finally been resolved, and (R2's) Medicare was reinstated. [NAME] departments from the hospital kept calling us and asking when the issue was going to be resolved so they could resubmit their claims. (R2) and I were told the date the facility's error went through the system on [DATE]. If we wanted to schedule any appointment, they would tell us we had to pay up front. We can't afford to do that. That is what we are paying the insurance company for. We felt the facility did not care about us. Like we were not important, like trash. No one should have to go through that.On [DATE] at 1:44 PM, V15 (Regional Business Manager for the facility) said, The nurse that discharged (R2) entered him into PCC (the facility's electronic medical record charting system) as discharged expired. We take that information from PCC, and that is how we enter it for billing purposes. V15 said she was notified on [DATE] that R2 went to make an appointment recently, and that is when R2 and V9 found out about the error. V15 said she was informed R2 missed a neuro appointment and some kind of test for his neuro appointment. V15 said she contacted Medicare and informed them that was an error. V15 said she contacted R2 and V9 to inform them it was corrected and would take about 7-10 business days. V15 said yesterday ([DATE]) was business day 4. V15 said she informed R2 if it has not been corrected by Tuesday, to give her a call and she would take care of it. V15 said, Medicare does not require a death certificate to stop Medicare coverage. Social Security needs one wrong key stroke and it could interfere with the resident's benefits. All the more reason to make sure that the information is entered in correctly. The nurse should make sure when they enter discharge information, they enter the correct information. If the nurse puts something in the system, the Business Office Manager (BOM) does not have access to the clinical side. The facility can put something in place where if someone is listed as expired, that we verify before we enter it into the Medicare billing. We can change how we are doing it to make sure that when a resident is entered as expired or deceased that we (the BOM) verify with the facility that the resident has expired before they enter information into the system, regardless of whether or not the resident is Medicare or Medicaid, so there is no disruption in the resident's Medicare coverage.On [DATE] at 3:00 PM, V8 (Registered Nurse-RN) said she was the nurse on duty that discharged R2 home with his wife. V8 said there is a place in PCC to enter whether the resident was discharged home, to a hospital, deceased , etc. V8 said she usually does not enter information to take a resident out of the system in case someone still needs to document on them. V8 said R2 was very much alive. V8 said, It is important to make sure you enter information into the system correctly for the billing, financial aspect, as well as for the resident, so it does not delay their medical care.On [DATE] at 3:12 PM, V1 (Administrator) identified V14 (second shift nurse) entered it incorrectly in the system. V1 said he thinks V14 went to edit R2 in the system and mistakenly checked deceased instead of discharged to home. On [DATE] at 7:41 AM, V14 said she may have been the one that took R2 out of the system, she does not recall. V14 said no one has said anything about there being an error yet to her. She said she would talk to V1 and see what might have happened. She said it is important to make sure you document correctly whether a resident is discharged to home or discharged due to being deceased . V14 said R2 went home with his wife (V9).On [DATE] at 8:56 AM, V16 (Social Services Director) said she was not the one that took R2 out of the system. I do not do that. If I print out a form, my name would be at the top as the user. I did not print out any forms for (R2) or (V9), or for anyone related to this issue. (R2) was at the facility for short-term (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 2 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0628 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete therapy. He discharged to home with his wife. When (R2) and (V9) mentioned that he was ready to go home, we started putting things in place like home health services. We did not try to prolong the discharge. We just had to get everything set up to ensure a safe discharge for (R2).On [DATE] at 10:18 AM, this surveyor called V21's (R2's neurosurgeon's) office and asked V21 to return the call to discuss what the follow up appointments for R2 were for and how the delay could affect R2. At 11:30 AM, V19 (V21's nurse) returned call. V19 said she would let V21 know the reason for the call and ask him to return this surveyor's call. No return call was received prior to exiting the facility on [DATE].On [DATE] at 1:56 PM, V12 (facility's Medical Director) was informed about the discharge to home for R2 being incorrectly documented as deceased . V12 said, Oh no. V12 was informed the error caused R2 to lose his Medicare coverage. V12 said, You mean he had to go for months without insurance? V12 said it is important for the nursing staff to make sure they enter information into the system carefully, so they do not kick a resident off their Medicare, or other insurance. V12 said this is the first time he was hearing of this. The facility's policy and procedure titled Transfer and Discharge (including AMA), with a review date of 11/2024, did not include how to remove a resident from the facility electronic system when a resident is discharged . Event ID: Facility ID: 145663 If continuation sheet Page 3 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety Based on interview and record review, the facility failed to ensure dressing changes were done as ordered (R1), and failed to ensure weekly wound assessments and documentation of the assessments were completed, for 2 of 5 residents (R1, R4) reviewed for non-pressure wound care in the sample of 6.This failure resulted in R1's wound getting a maggot infestation, and the wound dehiscing and getting infected. R1 was sent out to a local emergency room, diagnosed with osteomyelitis, requiring two intravenous (IV) antibiotics to prevent sepsis, surgical intervention, and critical care hospital admission. This failure resulted in an Immediate Jeopardy.The Immediate jeopardy began on 7/3/2025 when the facility failed to do the dressing change as ordered and failed to assess R1's surgical site and document an assessment. V1 (Administrator) and V2 (Director of Nursing) were notified of the Immediate Jeopardy on 7/16/2025 at 12:16 PM. The surveyor confirmed by observation, record review, and interview, that the Immediate Jeopardy was removed on 7/17/2025, but noncompliance remains at Level Two, because additional time is needed to evaluate the implementation and effectiveness of the in-service training.The findings include: 1. R1's admission Record, provided by the facility on 7/10/2025, showed she had diagnoses including, but not limited to, transient cerebral ischemic attack (stroke), atherosclerotic heart disease, aneurysm of the ascending aorta without rupture, myocardial infarction (heart attack), cellulitis of unspecified part of limb, and hypertension.R1's Discharge Instructions from a local hospital, dated 6/26/25, showed Wound Care: Dressing to be left in place until seen in the office next week. Do not get wet. R1's 7/1/2025 notes from the follow up appointment showed Wound cleansing and dressings. Dry protective dressing. Do not get wet. The document showed V4 (LPN) clarified the order to be done every other day.R1's Order Summary Report, provided by the facility on 7/10/2025, showed an order, dated 7/1/2025, for Wound #3 right toes area of great toe, 2nd toe, 3rd toe. Wound cleansing and dry protective dressing to be changed every other day. R1's July 2025 Treatment Administration Record (TAR) showed no treatment was documented as being completed from 7/2/2025-7/6/2025.The facility's weekly Skin Condition Report, dated 7/4/2025, showed R1 had arterial ulcers to her right posterior leg, right medial great toe, right second toe and her right third toe. V3 said the measurements on the form were taken from notes from the wound clinic R1 goes to.R1's Progress notes from 7/1/2025-7/5/2025 do not document any dressing change to the surgical site on R1's right foot/toes area. The progress notes only show RLE ((right lower extremity) wound documentation, which was a different wound on R1's right posterior lower leg. There was no documentation of a dressing change or assessment to R1's right foot surgical site until 7/6/2025 at 8:20 PM where it showed, Resident noted with an excessive amount of exudate drainage and possible presence of larvae in wound during wound care. MD (doctor) made aware and gave orders to send resident out for further eval (evaluation).R1's progress note, dated 7/6/2025 at 9:20 PM, showed R1 was noted with an excessive amount of exudate drainage and possible presence of larvae in wound during wound care, Doctor made aware and gave orders to send resident out for further evaluation. when an excessive amount of drainage and larvae were found on R1's right foot surgical wound and she was sent to a local hospital. R1's progress notes from 7/1/2025-7/6/2025 do not show any documentationR1's 7/6/2025 Emergency Department Physician Report from a local hospital showed, Right foot with multiple toe amputations, extensive wound at distal tip with sutures, wound dehiscence, necrotic tissue, copious maggots cleaned from wound, mild surrounding erythema with warmth. the notes showed, admission is required due to the severity of the right foot wound infection with suspected osteomyelitis, need for IV antibiotics, and risk of clinical deterioration. The notes showed Critical Care Statement: Given the patient's presentation with a right foot wound infection and osteomyelitis, which carried a high-risk for rapid clinical Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 4 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few deterioration due to potential progression to severe sepsis or septic shock. The emergency room doctor provided 40 minutes of critical care time exclusive of other billable procedures. this time was spent in direct patient care involving high-complexity medical decision making and required constant attendance to prevent sudden, significant deterioration in the patient's condition. The Podiatry Consultation Physician's Report, dated 7/7/2025, showed R1 had surgery approximately two weeks ago due to amputation of the first, second, and third digits of the right foot. This was due to gangrenous changes due to severe peripheral arterial disease. Patient was seen in the office for follow-up and incision site looked good with the wound edges well coaptated and sutures in place. Patient presented to the emergency room last night with dehiscence of the wound and maggots in the wound. The physician debrided the wound and the maggots out. The notes showed R1 was started on IV antibiotics and admitted for further workup. V6's operative notes on 7/8/2025 showed R1, was placed under general anesthesia, the sutures were still in place, however they were not holding any skin or flaps at this time. The sutures were all removed. the wound base and wound edges were debrided back to healthy tissue .several dead bodies of maggots were noted .bony exposure is noted in the wound site. A wound was also noted on the medial aspect of the first metatarsal phalangeal joint area that was likewise debrided .Surgery site was dressed and covered .The area was anesthetized, and patient was extubated .Patient will continue antibiotics.On 7/9/2025 at 3:46 PM, V7 (R1's Power of Attorney/POA) said, (R1) had surgery on 6/25/2025 to amputate her toes. After a brief hospital stay, she returned to the facility. She had a follow up with the surgeon on 7/1/25. The doctor said it was healing nicely on her 7/1/2025 follow up appointment, and everything was okay at that point. V7 said he had not heard any updates from the facility until Sunday night (7/6/2025) after R1 was sent out to the hospital. V7 said the facility staff were supposed to look at her wound every two days. V7 said, Someone from the emergency room (ER) called me on 7/6/2025 and told me (R1) was at the hospital and there were maggots in her surgical wound. (V4, Licensed Practical Nurse-LPN) from the facility called me 10 minutes later. By the time I arrived at the hospital, the emergency room staff had already gotten the maggots out of her wound. There were three maggots in a specimen cup and at least 10 more in a baggie. The reason for (R1's) toes being amputated was due to poor circulation to her feet. Some days (R1) is coherent, but lately she is not as coherent. V7 said he did not think R1 understands why she is in the hospital and did not feel that R1 would be able to say if the facility was doing the dressing changes as ordered. V7 said he spoke with V1 (Administrator) and V2 (Director of Nursing), and they said the facility was doing the dressing changes as ordered. V7 said R1 had to have her surgical site debrided (surgical removal of non-viable tissue). V7 said, It is just too much. This should not have happened. On 7/10/2025 at 10:48 AM, V2 (DON) was shown R1's July 2025 Treatment Administration Record (TAR). V2 said the dressing change for R1's right surgical site/wound in her toes area is not marked off as being completed 7/2/2025-7/6/2025. On 7/11/2025 at 11:50 AM, V3 (Wound Nurse) said the wound clinic provided notes regarding wounds for R1. V3 said the facility got an order to clean the wound and do a dry dressing every other day on 7/1/2025. V7 said he did not do any dressing change or assessment of R1's amputation site. V3 said he did not see any documentation of an assessment being done by any other nurse for R1's surgical site on her right foot in her electronic medical record. V7 said surgical sites should be monitored, assessed, and the assessment should be documented. At 12:51 PM, V3 said, It is important to monitor surgical sites for signs and symptoms of infection, wound dehiscence, a decline, or any changes, and to notify the surgeon of any changes. At 2:11 PM, V3 said the last assessment of R1's right toes, with measurements, was on 6/20/2025. V3 said, When (R1) came back from surgery on 6/26/2025, there was an order to leave covered until her follow up appointment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 5 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (R1's) follow-up was on 7/1/2025. The doctor gave an order to cleanse the site and cover with dressing every other day. There was no dressing change completed, no facility assessment, or measurements that I can tell from 7/1/2025-7/6/2025 for (R1's) right foot. V3 said he will do the assessment and dressing change for the residents that are followed by the wound doctor that comes to the facility. He said he does not do the assessments and dressing changes for the residents that go out to wound clinic. V3 provided R1's Skin Impairment/Wound forms for 6/26/2025 and 7/1/2025. V3 said he got the information for the forms from the wound clinic, and did not do the assessments himself. On 7/10/2025 at 3:20 PM, V4 (Licensed Practical Nurse-LPN) said V5 (Certified Nursing Assistant-CNA) told her it looked like the bandage on R1's right foot had some blood on it. V5 said she went in to check it and thought to herself that is not blood. It had a slight odor, and brown drainage was on the sock. V4 said as she was unwrapping the bandage, she saw maggots on the bandage. She notified R1's doctor and he said to send her out to the emergency room (ER) for evaluation. V4 said she worked on 7/1/2025. She called the doctor to verify the treatment orders. V4 said the order was to do the dressing change every other day. V4 said she had not done any assessment or dressing change for R1, because she did not work again until 7/6/2025. V4 said she started her shift at 2:00 PM on 7/6/2025. V4 said she did not recall seeing a date on the dressing, but she was also concerned with what was going on. The color and smell of the drainage is what was concerning me. (R1) was having pain that day. Normally we don't have to give her anything for pain until about 8:00 PM. That day she was having more pain than normal. V4 said as she was unwrapping the bandage to R1's foot, R1 voiced it hurt and pulled back her foot. I had to stop because it was hurting her too much. She was saying 'Oh, Oh, Oh.' V4 said when she saw the maggots, she stopped, called the doctor, and about 15 minutes later, R1 was going out the door. V4 said based on the odor and drainage, she felt it could have been noticed earlier. There was a strong smell and the bandage was saturated. V4 said, It is important to make sure to assess wounds to make sure the wound does not get infected, to notice right away and catch it before it gets bad, and update the doctor, to see if he wants to give any new orders. The earlier you catch something the better.On 7/11/2025 at 2:53 PM, V5 (Certified Nursing Assistant/CNA) said he worked the shift that R1 was sent out to the hospital. He said, I was assisting an agency CNA with (R1) and noticed something on the dressing at the top of her foot, where she had the surgery. It was dark in color, something unusual that you would not see on a sock. It did not really look like blood. It was discolored. I went to (V4) and asked her to check (R1's) foot and then went to assist other residents. V5 said he saw R1 leaving on a stretcher. He went into her room after hearing what happened and checked the linen on her bed. V5 said he saw 8-10 maggots on R1's linen, so he threw her linen away in the garbage. On 7/11/2025 at 3:05 PM, V1 (Administrator) and V2 (Director of Nursing-DON) agreed it is important for the nurses to do an assessment on residents with wounds, at least weekly, even if the resident goes out to the wound clinic. V1 and V2 said unless there is an order not to touch the dressing, it is important the facility nurses assess the resident's wound to monitor and determine if the wound is improving or getting worse, so the doctor can be updated, and new orders can be received if needed.On 7/15/2025 at 10:31 AM, V6 (Wound Clinic Doctor) said R1 had her great toe, second and third digits on her right foot amputated on 6/25/2025. She stayed in the hospital overnight and was sent back to the facility on 6/26/2025. I gave an order to not touch the dressing until her follow-up appointment. When I saw her on 7/1/2025 for the follow-up, the wound was a closed surgical site, no opening, drainage or swelling. It looked very good. V6 said, I gave orders on 7/1/2025 to change the dressing every other day. Keflex was ordered prophylactically to prevent infection. The next time I saw (R1) was the day after she was sent to the hospital (7/7/2025). The stitches were no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 6 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few longer holding the tissue together. It was an open wound. (R1) had the wound cleaned out in the ER due to there being maggots in the wound. On 7/8/2025, I had to take out all the stitches, which were still there, but not holding the tissue in place, debride the wound and flushed it out. Bone was exposed. When bone is exposed to the air, you assume it is infected. Osteomyelitis can occur. V6 said R1 was tested for, and he believes she was diagnosed with, osteomyelitis. The wound was infected and had an infestation of maggots. Two antibiotics were given intravenously (IV) for broad-spectrum antibiotic therapy. It was very serious. Infestation and infection. Infection could get in the blood and the patient could become septic. It is important for the facility nurses to do the dressing changes as ordered. If not done as ordered, it will slow the wound healing and increase the risk of infection. I would expect the nurses to assess the wound during the wound changes, so if there is a problem, they could contact me for guidance on how to proceed. V6 said he has a 24-hour answering service. V6 said, If the facility would have done the dressing changes and monitored the surgical site, it may have prevented the wound from getting infected and infested with maggots, and I would not have had to perform the surgical debridement procedure.On 7/16/2025 at 8:24 AM, V1 (Administrator) said, When (R1) came back from her follow up appointment on 7/1/25, there was some ambiguity about the orders. (V4, LPN) called the doctor and clarified the order. (V4) entered the order into the system wrong. She entered it into other orders (no documentation required), not into the Treatment Administration Record (TAR). When an order is entered into the system like this, the nurses cannot see the order. V1 said he investigated what happened, however, he did not document his investigation. V1 said the order was discontinued on 7/6/2025 and entered in the system correctly. V1 said V3 (Wound Nurse) could have followed up to see what the new orders were after her follow up visit and made sure the treatment was being done as ordered, just like any management team member is expected to do with their department. V1 said he let V2 (DON) know the nurses need training on entering medication orders because that is not acceptable. V1 was asked if the nurses that worked on all three shifts from 7/2/2025-7/6/2025 should have verified the orders for R1 after her follow-up appointment to make sure there was no treatment ordered. V1 nodded yes. On 7/16/2025 at 1:56 PM, V12 (facility's Medical Director) said, Some residents go out for wound care, then come back to the facility. They are here for us to provide medical care. It is important to follow the doctor's orders for wound care. If a resident goes out for wound care and comes back with an order to do dressing changes, the facility nurses should be doing their own wound assessment with every dressing change, document their findings, and notify the physician if there are any changes. The facility's 10/2023 policy and procedure, titled Wound Treatment Management, showed to promote wound healing of various types of wounds, it is the policy of this facility to provide evidence-based treatments in accordance with current standards of practice and physician's orders.1. Wound treatments will be provided in accordance with physician's orders, including the cleansing method, type of dressing, and frequency of dressing change.8. The effectiveness of treatments will be monitored through ongoing assessment of the wound. The facility presented an abatement plan to remove the immediacy on 7/16/2025 at 3:34 PM. The survey team reviewed the abatement plan and was unable to accept the plan to remove the immediacy. The abatement plan was returned to the facility for revisions. The facility presented a revised abatement plan on 7/17/2025 at 11:29 AM. The survey team reviewed the abatement plan and was unable to accept the plan to remove the immediacy. The abatement plan was returned to the facility for revisions. The facility presented a second revised abatement plan on 7/17/2025 at 2:37 PM, and the survey team accepted the abatement plan on 7/17/2025.The Immediate Jeopardy that began on 7/3/2025 was removed on 7/17/2025, when the facility took the following actions to remove the immediacy:1. Corrective Actions which will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 7 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few accomplished for those residents found to be affected by the deficient practice. i. Facility Medical Director was notified of the incident on 7/16/2025 at 2:50 PM. ii. The DON completed a chart audit on every resident with wounds and skin conditions and compared the wound physician's orders and evaluations for accuracy. iii. The DON completed a chart audit on every resident with wounds and skin conditions to ensure all have a completed weekly skin evaluation assessment. iv. The wound nurse assessed all residents with wound and skin conditions to ensure wound treatments were rendered as ordered per MD/NP.2. How the facility will identify other residents having the potential to be affected by the same deficient practice by: The DON and/or designee completed a chart audit on every resident with wounds and skin conditions and compared the wound physician's orders and evaluations for accuracy.The DON and/or designee completed a chart audit on every resident with wounds and skin conditions to ensure all have a completed weekly skin evaluation assessment.The MDS(Minimum Data Set) coordinator and/or designee conducted an audit on every resident with wounds and skin conditions to ensure the care plan reflects their current plan of care. All residents were screened for pressure risk on 7/16/2025, and will be assessed upon admission/re-admission initially, then x 4 weeks, then quarterly. Assessments will be conducted after a change of condition or after any newly identified pressure injury. All residents with wounds and skin conditions treatment orders clarified with medical practitioner and have been changed to AM shift for wound nurse to provide treatments as ordered per MD starting on 7/17/2025. Floor nurses to render wound treatment on weekends and in the absence of wound nurse. Nurse on the floor will render treatment, conduct assessments, and document.A full body, or head-to-toe assessment will be conducted by a licensed or registered nurse and by the wound nurse upon admission/re-admission, quarterly and annually. The assessment will be performed after a change of skin condition, or after any newly identified skin condition a/or pressure injury initially and weekly until resolved. The QAPI (Quality Assurance Performance Improvement) committee reviewed the Skin Assessment and Wound Treatment Management, Quality of Care policies to determine if any revisions needed to be made and determined the policies did not need changes.3. The measures the facility will take or systems the facility will alter to ensure that the problem will be corrected and will not recur:The facility initiated in-service training for staff on 7/15/2025 on Skin Assessment and Wound Treatment Management policy. This training will be conducted by the DON and/or designee, is ongoing and will continue with all the new staff upon hiring, and orientation and agency nurses prior to the start of their next shift. The training includes, but is not limited to: A full body, or head-to-toe assessment will be conducted by a licensed or registered nurse and by the wound nurse upon admission/re-admission, quarterly and annually. The assessment will be performed after a change of skin condition, or after any newly identified skin condition a/or pressure injury initially and weekly until resolved.Wound treatments will be provided in accordance with physician orders, including the cleaning method, type of dressing, and the frequency of dressing change.In the absence of treatment orders, the licensed nurse will notify physician to obtain treatment orders. This may be the treatment nurse, or the assigned licensed nurse in the absence of the treatment nurse. Treatments will be documented on the Treatment Administration record or in the electronic health record. The effectiveness of treatments will be monitored through ongoing assessment of the wound until healed. Considerations for needed modifications include:a. Lack of progression towards healing. b. Changes in the characteristics of the wound.c. Changes in the resident's goals and preferences, such as at end-of-life or in accordance with his/her rights.d. Documentation and Completion of Skin Assessment:Include date and time of the assessment, your name, and position title.Document observations (e.g. skin conditions, how the resident tolerated the procedure, etc.)Document type of wound.Describe wound (measurements, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 8 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few color, type of tissue in wound bed, drainage, odor, pain). Document if resident refused assessment and why.Document other information as indicated or appropriate. 2. The facility initiated in-service training for staff on 7/16/2025 on Provision of Quality of Care. The training is ongoing and the DON and/or designee will continue with all the new staff upon hiring and orientation and agency nurses prior to the start of next shift.The training includes but is not limited to each resident will be provided care and services to attain or maintain his/her highest practicable physical, mental, and psychosocial well-being. 3. The facility initiated in-service training for nursing assistants on 7/17/2025 on Skin Audits by Nursing Assistants policy. The training is ongoing, and the DON and/or designee will continue with all the new nursing assistant staff upon hiring and orientation and agency nursing assistants prior to the start of next shift. The training includes, but is not limited to: Nursing assistants shall inspect all skin surfaces during bath/shower and report any concerns to the resident's nurse immediately after the task. Nursing assistants shall also report changes in skin condition that are noted during any care procedure. Skin Conditions that shall be reported include, but are not limited to:Redness, bruising, swelling rashes, hives, blisters (clear or blood filled), skin tears, open areas, ulcers, lesions. Notification shall be made to the nurse verbally or in writing.Notification shall be made to nurse verbally or in writing on any noted soiled or non-intact dressings. The Director of Clinical Excellence scheduled Mandatory All Nursing Staff, DON and Wound Nurse wound care training with (the contracted wound care company that comes to the facility and oversees residents' wounds). DON and/or designee conducted a wound care competency with wound nurse on 7/14/2025 and will conduct one weekly with the wound nurse and nursing staff on all shifts until every staff has participated at least once. This will be ongoing and will continue to be held weekly for two months. Findings will be reviewed at the monthly QAPI committee meeting. 4. Quality Assurance plans to monitor facility performance to make sure that corrective actions are achieved and are permanent. 1. Facility created quality assurance tool Wound Treatment Orders and Assessments will be implemented on 7/16/2025 used by the DON and/or designee to assess all residents and new admissions/re-admissions with wounds and/or skin conditions daily for month and then weekly for 3 months, then quarterly for a year to monitor that the facility is following the policy, and treatments are being completed as ordered, and assessments are being done and completed. Findings will be reported at the monthly QAPI Committee meeting.2. Facility-created quality assurance tool Quality of Care will be implemented on 7/16/2025 and used by the DON and/or designee daily to randomly assess 2 residents daily for a month, then monthly for 3 months, then quarterly for one year to monitor that the facility is following the policy and residents are provided with Quality of Care and Services. The results will be reviewed during the facility's QAPI meetings. Any issues identified will be immediately addressed. On 7/17/2025, a review of the facility's in-service documentation showed all the facility's nurses received the in-service training from the contracted wound care company on 7/17/2025. The Agency nurses, and any new staff will be educated prior to the start of their next shift. The Certified Nursing Assistants working received in-service training on reporting any changes to nurses. The remainder of staff, and any new staff will receive education prior to the start of their next shift. Interviews with staff working on 7/17/2025 showed staff have received the education and were able to verbalize the education they had received that aligned with the facility's abatement plan. 2. R4's admission Record, provided by the facility on 7/16/2025, showed diagnoses including, but not limited to type II diabetes mellitus with diabetic neuropathy (a type of nerve damage that can occur with diabetes. Symptoms include pain, numbness, and slow healing of leg or foot sores), hypertension, congestive heart failure, acquired absence of left leg below the knee, iron deficiency anemia, ischemic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 9 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few cardiomyopathy, acute hematogenous osteomyelitis, chronic obstructive pulmonary disease, and acquired absence of right foot. R4's Order Summary Report, printed by the facility on 7/11/2025, showed an order, dated 7/11/2025, to clean wound on right foot with normal saline. Apply xeroform to wound. Cover with abdominal pad and (rolled gauze) once daily and as needed. The report showed an order, dated 7/11/2025, for a nuclear stress test on 7/21/2025 (a cardiac imaging procedure that assesses blood flow to the heart muscle at rest and during stress. It helps doctors diagnose coronary artery disease and determine the extent of any blockages or damage).R4's care plan, dated 5/20/2025, showed, Weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate, and any other notable changes or observations.R4's July 2025 TAR showed the dressing changes were being done as ordered. On 7/10/2025 at 9:59 AM, R4 was sitting in his wheelchair in his room. R4's left leg was amputated below the knee. R4's right foot and lower leg was wrapped with rolled gauze. No drainage or odor was observed on R4's dressing. R4 said when he was first admitted to the facility, they missed a couple dressing changes. R4 said the nurses change his dressing every morning now. R4 said the dressing had already been changed at 6:30 AM. R4 said he goes to (a local wound clinic) once a week on Mondays. The doctor said I am making steady progress in healing, especially with my circulatory issues. R4 said since he was admitted to the facility, he has not had any infection or decline in his wound. R4 said he is not sure if the nurses do an assessment of the wound or not. No nurse at the facility has measured it that he is aware of. Sometimes his wound does have drainage, that is why it is wrapped, and he has a boot on his foot. R4 said his wound doctor at the wound clinic said he is pleased with the progress so far considering all R4's circulation issues. R4 said the wound doctor thinks something else may be going on and has ordered a nuclear test be done. R4 said he also has anemia, diabetes, and other issues. R4 said he had the amputations prior to admission. I came to the facility because I could not take care of the wounds. They were very bad.On 7/11/2025, R4's wound assessments from 6/1/2025 through the present were requested from V3. V3 (Wound Nurse) said he did not do weekly assessments on R4 due to R4 going out to the wound clinic for wound care. V3 said the facility nurses change R4's dressing daily as ordered; however, weekly wound assessments are done at the wound clinic. V3 said he gets the information from the wound clinic notes, and uses the information from the wound clinic to fill out the Skin Impairment/Wound Forms on R4. On 7/11/2025 at 1:54 PM, V3 said, I will do measurements and wound assessments for the residents that use (contracted wound company that comes to the facility) when I do rounds with the wound doctor. If a resident is not seen by (the contracted wound company), and goes out for wound care, then we go by the measurements and assessments done by the outside wound clinics. There are 3 residents in the facility with wounds that go out for wound care. (R1), (R4) and (R5) are the residents that go out to wound clinics. At 2:48 PM, V3 said there was not a wound nurse when he first took the job, so he did not really receive any training on how to do the job. V3 said he is still learning things.On 7/15/2025 at 10:00 AM, V3 said, Initially, (R1) was being seen by (contracted wound company) that comes to the facility. (R1) was referred to (a local wound clinic) around the end of April/beginning of May. She had a doppler scan and other tests and was referred to the wound clinic. V3 said, The only trainingI received for the wound nurse position was about 4 hours of training when I took the job. Mostly on paper and laptop. A regional consultant provided some guidance. V3 was asked if he had any specific wound training or certification prior to taking the Wound Nurse position. V3 said he had been a nurse for 20 yrs. Other than that, he said he has not had any specific wound training or certification.V3 provided Skin Impairment/Wound Forms for R4, dated 6/23/2025, 7/1/2025, and 7/8/2025. V3 said he filled out the forms with the information provided by the local wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 10 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete clinic. V3 also provided wound clinic notes for R4, dated 6/30/2025, 7/7/2025, and 7/14/2025, as well as R4's initial admission assessment form for the local wound clinic. The only other assessment V3 provided was dated 6/12/2025; V3 did assess R4's wound and documented a partial assessment (No measurements. Just the wound bed characteristics). The facility's September 2024 policy and procedure titled Skin Assessment showed. 1. A full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission and weekly thereafter. The assessment may also be performed after a change of condition or after any newly identified pressure injury. The policy showed documentation and Completion of Skin Assessment: A. Include date and time of the assessment, your name and position title. B. Document observations (e.g. skin conditions, how the resident tolerated the procedure, etc.). C. Document type of wound. D. Describe wound (measurements, color, type of tissue in wound bed, drainage, odor, pain). E. Document if resident refused assessment and why. F. Document other information as indicated or appropriate. Event ID: Facility ID: 145663 If continuation sheet Page 11 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to perform a pressure risk screen for a resident (R6) at risk for developing pressure ulcers, failed to ensure pressure-reducing interventions were implemented correctly for one resident (R6), and failed to perform weekly facility wound assessments for one resident (R5). These failures affected two of three residents (R5, R6) reviewed for pressure ulcers in the sample size of 6.Findings include:1. R6's face sheet documented an admission date of 11/07/2024, with a past medical history not limited to: hemiplegia and hemiparesis, aphasia, hypertension, type 2 diabetes mellitus and chronic kidney disease. Brief Interview for Mental Status (BIMS), dated 05/23/2025, indicated R6 has moderate cognitive impairment, with a score of 11/15.R6's care plan, with review start date of 05/27/2025, documented R6 is an extensive assist too dependent with activities of daily living (ADL's); has had pressure ulcer development related to disease process and impaired mobility; and has a wound to sacrum, and right/left buttock. Care plan interventions for R6 included but not limited to the following: transfer/positioning requirements, importance of taking care during ambulating/mobility, good nutrition and frequent repositioning and follow facility policies/protocols for the prevention/treatment of skin breakdown.Weekly pressure ulcer and unstageable pressure ulcer report, dated 07/07/2025, documented R6 acquired at facility on 05/29/2025, an unstageable pressure ulcer to the left buttock, with current measurement of 6.8x4.8x2.8 (length x width x depth) in centimeters, and an unstageable pressure ulcer to the right buttock with current measurement of 3.8x1.8x0.6 in centimeters; and acquired at facility on 07/07/2025, a stage two pressure ulcer to sacral region, with no measurements documented.R6's last documented weight on 07/14/2025 at 11:42 AM indicated weight of 148.6 Lbs.Review of R6's clinical assessment log on 07/16/2025 at 11:30 AM showed no pressure ulcer risk assessment (Braden) on file. On 07/15/2025 at 10:24 AM, 07/16/2025 at 10:57 PM, and 07/17/2025 at 10:35 AM and 12:15 PM, R6 was observed lying in bed on his back and wearing an incontinent brief. Low air loss mattress was in place and set to 350 pounds. R6 was also observed to be lying on top of two incontinent pads and the air mattress was covered with a cotton bottom sheet. R6 was alert to self and not interviewable.R6's active physician orders as of 07/16/2025 included to cleanse left and right buttock wounds with a topical antiseptic (dakins), apply calcium alginate and medical honey then cover with borderer gauze and to cleanse sacral wound with a topical antiseptic (dakins), apply medical honey then cover with borderer gauze daily and as needed. admitted to hospice on 07/12/2025.On 07/17/2025, facility presented a pressure ulcer risk assessment for R6, dated 07/16/2025 at 12:08 PM.2. R5's face sheet documented admission date of 07/15/2024, with a past medical history not limited to: paraplegia, traumatic brain injury, and neuromuscular dysfunction of the bladder. Brief Interview for Mental Status (BIMS), dated 05/01/2025, indicated R5 had no cognitive impairment.R5's pressure ulcer risk assessment (Braden), dated 04/10/2025, indicated resident is at moderate risk for developing a pressure ulcer. Weekly pressure ulcer and unstageable pressure ulcer report, dated 07/07/2025, documented R5 acquired at facility on 12/21/2025, and a pressure ulcer to the sacral region with current measurement of 3.5x3.0x0.1 in centimeters and an unstageable pressure ulcer to the right buttock with current measurement of 3.8x1.8x0.6; and acquired at facility on 07/07/2025, a stage two pressure ulcer to sacral region, with no measurements documented.On 07/15/2025 at 10:12 AM, R5 was observed in room seated in a wheelchair watching television. R5 said he goes out on Mondays to a wound clinic every two weeks and receives daily wound care at the facility between visits to wound clinic. R5 then added the wound nurse has never measured or assessed his wounds until last week. R5 said he was shocked because his wounds have never been assessed at the facility, only done at the wound clinic. Review of R5's care plan on 07/15/2025 showed no Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 12 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few documentation related to wounds or wound care. Facility presented undated care plan on 07/16/2025 for R5 that documented resident has actual impairment to skin integrity with current wounds to sacral, lateral right and left ankles. Interventions included but not limited to weekly treatment documentation to include measurement of each skin breakdown's width, length, depth, type of tissue and exudate and any other notable changes or observations. R5's active physician orders as of 07/16/2025 included to cleanse sacrum with normal saline/wound cleanser then apply (aquacel silver) dressing and cover with bordered gauze nightly and cleanse left lateral ankle with normal saline/wound cleanser then apply (aquacel silver) dressing and cover with absorbent bordered gauze dressing nightly every Monday, Thursday, and Saturday.On 07/11/2025 at 1:54 PM, V3 (Wound Nurse) said if a resident goes out for wound care, he does not perform a wound assessment and goes by the measurements and assessments done by the wound clinic. V3 added R5 goes to an offsite clinic for wound care. At 2:48 PM, V3 said there was not a wound nurse when he first took the position as wound nurse, and did not really receive any training on how to do the job; V3 is still learning things.On 07/15/2025 at 09:50 AM, V3 (Wound Nurse) said he has not received any extensive training in wound care and is not wound care certified. V3 added he received about four hours of training when he took the job that was mostly on paper and on a laptop. V3 also said the regional consultant provided some guidance. V3 stated V3 was nurse for 20 yrs, other than that, he said he has not had any specific wound training or certification.On 07/16/2025 at 2:02 PM, V12 (Medical Director) said, Staff nurses should assess a resident's wound weekly, do dressing changes and follow physician's orders and monitor wounds for improvement. If a resident goes out to the wound care clinic, facility nurses should do their own wound assessment with every dressing change, document their findings and inform the physician of any significant changes. On 07/16/2025 at 3:02 PM, V3 (Wound Nurse) said wound care/dressing changes were all changed on day shift so that he can supervise the wounds and wound care.On 07/17/2025 at 09:38 AM, V2 (Director of Nursing) said pressure ulcer risk assessments should be done upon admission, readmission, quarterly, annually, and with a significant change in condition.On 07/17/2025, facility presented pressure ulcer risk assessment log, dated 07/16/2025, that documented both R5 and R6 were at high risk for developing a pressure injury.On 07/17/2025 at 11:20 AM, V3 (Wound Nurse) said the protocol for a low air loss mattress is that nothing should be between the mattress and the resident, such as layers of pads and/lines because that defeats the purpose of the mattress. V3 added only a turning sheet should be placed. V3 then said the mattress is set to the resident's weight and to their preference level. V3 then said R5 is able to reposition himself in bed, and R6 is on a turning schedule and should be turned every two hours.On 07/17/2025 at 1:02 PM, V1 (Administrator) indicated he was informed by supplier that the low air loss mattress setting is auto adjusted based on the resident's weight.On 07/17/2025 at 2:55 PM, V2 (Director of Nursing) indicated R6 cannot communicate his preference for his low air loss mattress settings.Skin Assessment policy, last revised 03/2025, reads: It is our policy to perform a full body skin assessment as part of our systematic approach to pressure injury prevention and management. This policy includes the following procedural guidelines in performing the full body skin assessment.a full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission and weekly thereafter. The assessment may also be performed after a change of condition or after any newly identified pressure injury.Pressure Injury Prevention Guidelines, last revised 03/2025, reads: To prevent the formation of avoidable pressure injuries and to promote healing of existing pressure injuries, it is the policy of this facility to implement evidence-based interventions for all residents who are assessed at risk or who have a pressure injury present. Policy Explanation and Compliance Guidelines: individualized interventions will (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145663 If continuation sheet Page 13 of 14 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 145663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Aurora 1017 West Galena Boulevard Aurora, IL 60506 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete address specific factors identified in the resident's risk assessment, skin assessment, and any pressure injury assessment.prevention devices will be utilized in accordance with manufacturer recommendations (e.g., heel flotation devices, cushions, mattresses).interventions will be documented in the care plan and communicated to all relevant staff.the effectiveness of interventions will be monitored through ongoing assessment of the resident and/or wound.Repositioning: reposition all residents at risk of, or with existing pressure injuries, unless contraindicated due to medical condition.routine positioning schedule: every two hours, using both side-lying and back positions.avoid positioning resident on bony prominences/turning surfaces with existing pressure injurie.Wound Treatment Management policy, last revised 03/2025, reads: To promote wound healing of various types of wounds, it is the policy of this facility to provide evidence-based treatments in accordance with current standards of practice and physician orders.the effectiveness of treatment will be monitored through ongoing assessment of the wound. Event ID: Facility ID: 145663 If continuation sheet Page 14 of 14