Health inspection·February 6, 2025

F 0755 depends when they get to you. Level of Harm - Minimal harm or potential for actual harm Review of R3's (MAR) dated 2/1/25 documents: Residents Affected - Some - Fluticasone and salmeterol inhaler for chronic obstructive pulmonary disease to be given BID at 8AM, 4PM. On 2/1/25, R3's inhaler 8AM dose was given at 11:35 AM. (3.5 hours late) 4. R4's facility assessment dated 12/27 shows R4 is alert and able to verbalize her needs. On 2/6/25 at 9:40 AM, R4 was sitting in her wheelchair. R4 said there has been times her medication was given to her late, R4 said she was not in pain but would like her meds timely to anticipate the pain. Review of R4's MAR dated 2/1/25 documents: -R4's Hydrocodone 5/325 mg (pain medication) 1 tab BID to be given 8AM, 8PM. On 2/1/25 R4's Hydrocodone that was due at 8AM was given at 11:55 AM. (almost four hours late) 5. On 2/6/25 at 10 AM, R5 was sitting in her wheelchair in her room. R5 said she was fine; she was waiting for her meds. Review of R5's (MAR) dated 2/1/25 documents: -R5's Alprazolam 0.5 mg BID to be given at 8AM, 4PM for anxiety. On 2/1/25, R5's Alprazolam that was due at 8AM was given at 11:02 AM. (three hours late) -R5's Hydralazine 25 mg 1 tablet TID for hypertension. (8AM, 12 PM and 4PM.) The 8AM dose was given at 10:55 AM. (almost three hours late) -R5's Buspirone 15 mg 1 tablet TID for anxiety. (8AM, 12 PM and 4PM.) R5's 8AM dose was given at 10:55 AM. (almost three hours late) On 2/6/25 at 10:30 AM, V3 (License Practical Nurse- LPN) said she worked last 2/1/25 which was a Saturday. She was one of the morning Nurses in the Skilled Unit. That day there was scheduled two Nurses with 24 residents in the skilled unit. V3 said she called V2 (Director of Nursing DON) around 10AM, when the Agency Nurse that was one of the Nurses in the Long Term Care did not show up. V3 said her and the other Short Term/Skilled Unit Nurse (V4) went to the Long Term and administered morning meds. V3 confirmed the morning meds in the long term unit (where R1-R5 were) were administered late. On 2/6/25 at 12:44 PM. V2 (DON) said on 2/1/25 she gave direction that the Skilled Unit only needs 1 nurse (with only 24 residents) and 2 Nurses in the Long Term Unit. It was almost 11AM when the other Nurse moved to the Long Term. V2 said R1-R5 were all residents in the Long Term Unit and their meds were late. V2 said medications should be given an hour before or an hour after it was due. Medications are important to treat residents' sickness and symptoms. The facility policy entitled Medication Administration (undated) states, All medications are administered safely and appropriately to aid residents to overcome illness, relieve and prevent symptoms and help in diagnosis. 19. If the medication is given at a different time from the scheduled time, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145703 If continuation sheet Page 2 of 3 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 145703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silvis Center for Nursing Rehab & Care 1455 Hospital Road Silvis, IL 61282 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 0755 update the MAR to reflect administration time. Scheduled medications will be given within an hour window before and after its scheduled and as preferred by resident. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145703 If continuation sheet Page 3 of 3