Inspection·June 23, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm 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 protect a resident's right to be free from mental abuse. Residents Affected - Few This applies to 1 of 3 residents (R1) reviewed for abuse in the sample of 3. The findings include: R1's face-sheet showed R1 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, hypertension, benign prostatic hypertrophy, and depression. R1's 5/21/25 MDS (Minimum Data Set) showed he has moderate cognitive impairment. R8's 6/12/25 MDS showed he has severe cognitive impairment. R1's 6/8/25 progress note from 4:14 AM showed R1 had a verbal altercation with his roommate (R8). The note showed they were separated and R8 was moved to another room for the night. On 6/18/25 at 1:10 PM, V6 (Nursing Supervisor) stated she was informed by V5 LPN (Licensed Practical Nurse) that R8 alleged R1 pulled out a knife at R8. V6 stated she sent a message to V2 (DON-Director of Nursing). On 6/17/25 at 3:20 PM, V2 (DON) stated that on the early morning of 6/8/25 around 4:15 AM, he was notified that R8 had alleged R1 (his roommate) threatened him with a small pocketknife. V2 stated V5 had moved R8 to another room where R8 was more comfortable and felt safe. V2 stated nursing staff did a room check and did not find any knife in the room, and that R1 did not allow the staff to do a body check on him. R1 remained supervised in the single room. V2 stated R1's family was called and R1's two sisters arrived at the facility at about 10:00 AM. R1, and the DON had a meeting together. V2 stated when family spoke with R1, he took out a small knife from his sock, which was confiscated, and R1 was sent out to the hospital as ordered by his Physician. R1's 6/8/25 Late Entry progress note from 2:00 PM showed R1 was found in a state of agitation, holding a knife and making alarming remarks, stating that he has killed before and would do so again. Recognizing the immediate risk to safety, the knife was promptly removed. R1's 6/9/25 progress note from 9:37 AM showed R1 had been admitted to the hospital with altered mental status. The facility's undated Abuse Prevention Policy defined abuse as .the willful infliction of intimidation . with resulting mental anguish . The policy further showed threats of harm is defined under verbal abuse, and mental abuse includes, but is not limited to humiliation, harassment, threats of punishment . 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: 145694 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 145694 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renwick Nursing and Rehab 3401 Hennepin Drive Joliet, IL 60435 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)