Health inspection·May 13, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 resident's rights to be free from verbal and physical abuse from another resident. This failure affected three of five residents (R4, R5, R8) reviewed for abuse in the sample of eight. Findings Include: The facility's Abuse Prevention and Reporting- Illinois policy dated August 2023 documents the facility affirms the right of its residents to be free from abuse. The policy defines Abuse as the willful infliction of injury. Willful means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Physical Abuse as the infliction of injury on a resident. Physical abuse includes hitting, slapping, and other similar behaviors. The policy defines Mental Abuse as the use of verbal or nonverbal conduct which causes or has the potential to cause the resident to experience humiliation, intimidation, fear, shame, agitation, or degradation. Verbal Abuse is defined as the use of oral, written, or gestured communication to residents within hearing distance regardless of age, ability to comprehend, or disability. Verbal abuse can include harassing, mocking, insulting, or ridiculing a resident. Resident-to-resident altercations that include any willful action that results in physical injury, mental anguish or pain must be reported in accordance with regulations. 1. The Serious Injury and Communicable Disease Report dated 4/22/25 documents R4 and R5 were involved in an altercation. At approximately 7:45 PM on 4/22/25, R4 attempted to touch the watch on R5's arm. R5 responded by grabbing R4's wrist which created a skin tear to R4's right wrist. R4's Medical Diagnoses List dated May 2025 documents R4 is diagnosed with Dementia with Psychotic Features, Mental Disorder, Anxiety, Bipolar Disease, Psychotic Disorder with Delusions, Violent Behavior, and Altered Mental Status. R4's Minimum Data Set, dated [DATE] documents R4 is severely cognitively impaired. R4's Care Plan dated 2/12/25 documents R4 wanders and is at moderate risk for abuse. R5's Medical Diagnoses List dated May 2025 documents R5 is diagnosed with Dementia with Agitation, Generalized Anxiety Disorder, and Insomnia. R5's Minimum Data Set, dated [DATE] documents R5 is severely cognitively impaired. (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 5 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 05/13/2025 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)