Health inspection·April 24, 2025

F 0550 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the Facility failed to ensure residents wear treated in a dignified manner by providing timely toileting assistance and respecting the resident's right to a home-like environment for 2 of 6 residents (R1 and R4) reviewed for resident's rights in the sample of 6. This failure caused R1 to feel like V4 was mean to R1, resulting in R1 crying, and R4 feeling a little depressed. Findings include: 1. R1's Face Sheet, dated 4/23/2025, documents R1 has diagnoses including, but not limited to, Morbid Obesity, Need for Assistance with Personal Care, Weakness, Reduce Mobility, Depressive Disorder, and Anxiety Disorder. R1's Minimum Data Set (MDS), dated [DATE], documents R1 is cognitively intact and is dependent of toileting hygiene. The Facility's CNA (Certified Nursing Assistant) Staffing Assignment, dated 4/20/2025, documents V4 and V11 were assigned to R1's hall. It further documents V9 and V10 were assigned to 200 hall. On 4/22/2025 at 7:30 PM, V16, R1's sister, stated, My sister (R1) is heavy set and in a wheelchair. She is unable to stand without the help of the CNAs (Certified Nursing Assistants) to use the bathroom. She has been in and out of the hospital and is very weak. Now they have to use the (mechanical lift) to use the bathroom. I think they think using the lift is too much work. (R1) is terrified to stand up because she's weak. They tell her, 'you're going to have to stand up and not use the hoyer lift'. (V4, CNA) told (R1) you're gonna have to wait (to use the bathroom) because I have to serve lunch soon. For the past 6 months, I've heard (V4) talk harshly to (R1), telling her she has to wait to use the bathroom. She gets frequent UTIs (Urinary Tract Infections). If she has to wait 15-20 minutes to use the bathroom, she's about ready to pee her pants. (V4) said to her (R1), 'How old are you?' and (R1) replies, 'I'm 58' and (V4) tells her, '[AGE] year olds don't cry'. There's a resident two doors down, whose family is there everyday. The family member was waiting for her mom to lay down. (V4) points to her watch and said, I have only have 20 minutes left of my shift, I'll take you, but I have to lay (another resident) down, then I'll do you (take her to the bathroom). Another CNA told (V4), 'You can do (R1) first' and (V4) replied, 'This is a 24 hour facility, the next shift can do her.' The other residents family member looked at me like, 'I'm sorry'. (R1) ended up wetting herself because they don't want to take the time with her since she's a (mechanical lift). (V4) talks down to (R1). I took my sister outside to vape, and another CNA came out and said, 'I'm sorry you had to go through that. Nobody has the right to say shut up and quit crying.' (V10, CNA) has complained Page 1 of 3 145717 145717 04/24/2025 Nexus at Columbia 253 Bradington Drive Columbia, IL 62236

F 0550 Level of Harm - Actual harm Residents Affected - Few to (V1) many times about (V4) being rude and bullying the residents. I talked to (V1) about (V4) not wanting to take care of (R1), and (V1) said she had a lot of complaints about (V4) this weekend. I told (V1) I wanted (R1) off that hall because (V4) is rude, crude, harsh, and has no heart for these people. I told (V1) I am scared for my sister on the weekends. I cringe when I walk in and see her and my sister is always upset. She has been moved. Her (R1's) whole demeaner changed. The problem started when (R1) came back from the hospital and is now a (mechanical lift). I've never had a problem with any other staff besides (V4). She never has to wait 30 minutes to use the bathroom or they (other CNAs) will explain that they have to change someone else and then will help (R1). Now that she's extra work (due to the mechanical lift), they don't want to help her. I just love my sister and want her taken care of. V16 stated R1 resided on 100 hall on 4/20/2025, but had been moved to another hall. On 4/23/2025 at 11:25 AM, R1 stated, She (V4) was mean to me. She went off on me. I told her I had to go to the bathroom at a quarter to two. She said she's not going to, and that the next shift would have to. She had plenty of time. (V1) took care of it. That's why I moved to 400 hall. I cried to my sister about it. On 4/23/2025 at 11:45 AM, V9, CNA stated, It was 20 minutes before lunch on a Sunday. I was in the dining room. The CNA (not sure of her name) was almost yelling saying (R1) would have to wait until after lunch to go to the bathroom. Kind of caused a scene. There were other residents sitting around. I would have handled it differently. I felt like she should have quit yelling, but I'm not going to tell an older lady what to do. I mind my own business because I am new. On 4/23/2025 at 1:21 PM, V11, CNA, stated, This past weekend there was an issue. It was about taking (R1) to the bathroom. (R1) was heading to the dining room and started going back towards her room. I asked her where she was going. She said she had to use the bathroom. I said, 'Alright, let me go get (V4)' because (R1) is a hoyer. I told (V4) and (V4) said, 'She's going to have to wait, we have to get the trays passed'. I said, 'Why don't we just take her, if she has to go, she has to go. Let's just do it. I don't want someone telling me I have to hold my pee or poop.' (R1) stopped my sister, (V10) and we (V10 and V11) took her and got it done. I am sure she wet herself, but that's not unusual for her. (V4) then said (R1) had to stay in bed. I said 'no, let's get her back up. It takes a whole 5 seconds.' We got her up and went on about the day. (V4) was just adamant about those trays, but which is more important? Is it wrong to make (R1) wait? I personally wouldn't make her wait. On 4/23/2025 at 12:04 PM, V3, Director of Nursing (DON) stated, I was on call over the weekend. The only thing I know is (V2) said (R1's) sister was upset with her being on that hall because (R1) was having difficulty transferring, and felt the CNAs weren't taking care of her. It is my expectation that if someone has to use the bathroom, you take them. On 4/24/2025 at 8:00 AM, V16 stated, I hate to use the word abuse, because that's a strong word. I just feel like they don't want to spend the time since she's (R1) a (mechanical lift). I feel like it's more of a dignity issue because she talks down to her. Abuse is too harsh. (R1) gets nervous to ask to go to the bathroom. (V4) should prioritize her tasks. Someone in a wheelchair who needs to use the bathroom should come before laying someone down. (V4) talks to (R1) like she's a kid. 2. R4's Face Sheet, dated 4/24/2025, documents R4 has diagnosis of, but not limited to, Depression and Anxiety. R4's MDS, dated [DATE], documents R4 is cognitively intact. 145717 Page 2 of 3 145717 04/24/2025 Nexus at Columbia 253 Bradington Drive Columbia, IL 62236

F 0550 Level of Harm - Actual harm On 4/23/2025 at 1 PM, R4 was noticeably nervous, reluctant to answer questions, but stated, I don't want to get anyone in trouble. (V4) hollers a little. She says I'm taking up too much space. When asked to clarify, R4 pointed at some of her personal belongings in her room, including an Easter basket. R4 then stated, I guess she's not meaning to be mean, but it makes me feel a little depressed. Residents Affected - Few On 4/23/2025 at 11:32 PM, V10, CNA stated, I don't really know what went on. I just know (R1) and her sister (V16) were outside and (R1) told me all about it. She said she had to go to the bathroom and (V4) told her she had to wait. They were going on and on about how rude and mean (V4) is. She's just a big a** bully. It's (V4's) way or the highway, and it shouldn't be that way. We should treat them (residents) with respect. (R4) has had issues with (V4). (R4) has a staring problem. She's here for a reason. (V4) told her, 'Go on and mind your own business.' On 4/24/2025 at 10:32 AM, V3 stated it is absolutely the residents' rights to have personal belongings in their room and be provided timely bathroom assistance. V3 stated the incident between R1 and V4 should not have taken place in public in front of other residents due to dignity. The Facility's Resident Rights policy, dated 2/2024, documents, The objective of the accommodation of resident needs and preferences is to create an individualized, home-like environment to maintain and/or achieve independent functioning, dignity, and well-being to the extend possible in accordance with the resident's own needs and preferences. Responsibility: All staff. Policy: It is the facility's policy to identify and provide reasonable accommodation for resident needs and preferences except when it would endanger the health or safety of the resident or other residents. Residents have the right to retain and use personal possessions to promote a homelike environment and to support each resident in maintaining their independence. The facility will provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extend possible. 145717 Page 3 of 3