Inspection·September 22, 2023

F 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide physical therapy (PT) services to a resident with ordered rehab services. Residents Affected - Few This applies to 1 of 3 residents (R1) reviewed for physical therapy. The findings include: On 9/22/23 at 9:46 AM, R1 said he started getting physical therapy a few days ago. R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility with diagnoses including fracture of vertebrae, psychosis, dementia, difficulty in walking, age-related physical debility, lack of coordination, fall, and dysphagia. R1's MDS (Minimum Data Set) dated 8/2/23 shows R1 was cognitively intact and required supervision for eating, and extensive assistance for bed mobility, transferring, dressing, toileting, and personal hygiene. On 9/22/23 at 7:45 AM, V4 (Family Member) said R1 went to the neurologist's office on 9/13/23 and got an order for physical therapy. V4 said she gave the nurse the paperwork with the orders and the nurse forgot about it and did not tell anybody about it. V4 said R1 should have started physical therapy on 9/13/23. V4 said R1 only began getting therapy on 9/21/23 after R1's family member notified the facility. On 9/22/23 at 11:57 AM, V7 (LPN/Licensed Practical Nurse) said R1's family member gave her the order on 9/13/23 and she put the order into the EMR. V7 said she put the paper order into the scan box to be scanned into the computer on 9/13/23. V7 said she did not call therapy to let them know R1 had a new order for therapy. On 9/22/23 at 11:41 AM, V6 (Program Manager of Rehab) said R1's family member came and spoke to her on 9/19/23. V6 said R1's family member told her R1 had a neurology appointment on 9/13/23 and the doctor had ordered physical therapy. V6 said she did not know R1 needed rehab services until she spoke to the family member on 9/19/23. V6 said if she had known R1 had an order for PT (Physical Therapy) on 9/13/23, she would have evaluated him by 9/14/23. V6 said the physical therapists evaluate the residents within 24 hours of receiving the order. V6 said after she spoke to R1's family member, she saw there was an order put in on 9/13/23 to evaluate and treat by the primary care doctor for the facility. V6 said usually when a resident gets an order from a specialist for therapy, the nurse puts the order into the computer and then notifies the therapy department via call or placing the order in her mailbox. V6 said without the nurse notifying them, there was no way the therapy department would be aware of new orders for therapy. (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: 145711 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 145711 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bella Terra Elmhurst 420 West Butterfield Road Elmhurst, IL 60126 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)