Health inspection·April 17, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to report an allegation of abuse involving two (R9, R10) residents out of four residents reviewed for abuse in a sample list of 11 residents. Findings include: The facility policy titled Abuse, Neglect, Exploitation and Misappropriation Program -Reporting and Investigating reviewed September 2024 documents residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This same documents if the Administrator cannot immediately refute the allegation relating to resident to resident abuse, neglect, exploitation, and/or misappropriation, the Administrator initiates a thorough investigation, completes and submits initial reports to the required agencies, and notifies local authorities. R10's Minimum Data Set (MDS) dated [DATE] documents R10 as severely cognitively impaired. This same MDS documents R10 requires supervision with eating, dependent on staff for toileting, dressing, personal hygiene, bed mobility and transfers. R9's Minimum Data Set (MDS) dated [DATE] documents R9 as cognitively intact. R9's Electronic Medical Record (EMR) documents R9 can self-propel in his wheelchair about the facility. R9, R10's abuse summary report documents facility staff reported to V1 Administrator that R9 was allegedly touching and kissing R10. This same report documents there were no observations of inappropriate contact observed by other staff present in the dining room (on 4/7/25). On 4/17/25 at 2:40 PM V1 Administrator stated V18 Certified Nurse Aide (CNA) reported to V1 that R9 had put his hand on R10's inner thighs and that R9 had kissed R10 on the side of her neck. V1 stated V18 CNA reported that V18 had removed R10 from the area immediately. V1 Administrator stated V1 did review the camera footage and interview staff and other residents who were present. V1 stated he did not report this allegation of sexual assault to the State Agency. V1 Administrator stated the facility Abuse Policy does state any allegation of abuse must be reported unless it can immediately be refuted. V1 Administrator stated he started an investigation on 4/7/25 but did not report anything to the State Agency. 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 3 Event ID: 145753 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 145753 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Bella of Danville 1701 North Bowman Danville, IL 61832 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)