Health inspection·November 20, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to identify, report and investigate a fall; and failed to implement post fall interventions for one of three residents (R5) reviewed for injuries/accidents in the sample list of 15. Findings include:R5's Minimum Data Set, dated [DATE] documents R5 has severe cognitive impairment, is always incontinent of bowel and bladder, requires substantial/maximal staff assistance with bed mobility and transfers, and dependence on staff for toileting hygiene. R5's Quarterly Assessments form dated 7/14/25 documents R5 has an unsteady gait, is confused, and is at high risk for falls. R5's active Care Plan documents a problem dated 9/24/25: R5 likes to sit on the floor. This care plan documents a problem, dated 9/14/24, is at high risk for falls related to history of falls and weakness, and interventions include room change to North building for increased observation/monitoring, attempt to anticipate needs, check/change offer frequent toileting, call light in reach, encourage call light use, and call don't fall sign in room. R5's Nursing Note dated 9/5/2025 at 6:28 PM documents nurse (V32 Registered Nurse (RN)) found R5 sitting on his bottom in his room next to his chair with his knees to his chest and scratching at the baseboard of the wall. R5 was asked if R5 fell and R5 responded, No I (R5) am trying to clean the wall. R5 was assessed for injuries with no injuries noted. R5 agreed to get back into his wheelchair and was taken to activities. V2 Director of Nursing (DON) was notified that R5 placed himself on the floor.The facility's undated fall log with date range August 2025 - November 2025 does not document R5 fell on 9/5/25. There is no documentation that R5 found on the floor on 9/5/25 was reported to R5's family or physician, or that the facility investigated and developed new interventions. R5's Nursing Note dated 10/5/25 at 7:46 AM documents at approximately 5:00 AM an unidentified Certified Nursing Assistant (CNA) heard a sound from R5's room and found R5 on the floor mat next to R5's bed. It appeared that R5 had slid down from the bed. R5 was assessed and alert, denied hitting his head. Approximately 30 minutes later R5 had a new large hematoma (swelling/bruising) and skin tear on his right forearm. Due to R5 being on aspirin R5 was sent to the hospital for evaluation. R5's 10/5/25 fall investigation file, provided by V2 DON on 11/19/25 at 1:35 PM V2 DON, did not include documentation that staff were interviewed to determine when R5 was last observed and toileted prior to his fall. R5's Care Plan Summary Note dated 10/6/25 at 12:40 PM documents the interdisciplinary team reviewed R5's 10/5/25 fall and determined the root cause as attempting to self-transfer to get up for the day. The post fall intervention was for R5 to be added to the early morning get up list. On 11/19/25 at 12:31 PM R5 was lying in bed with head of bed elevated, R5's call light was on top of his night stand which was behind R5 and out of his reach. R5 stated he had slid out of his wheelchair while sitting on a pillow and recently fell out of his wheelchair and bumped his arm. There was golf ball sized hematoma to R5's right inner forearm, near elbow. R5 was unable to give any additional details regarding his falls. R5 stated R5 uses his call light. R5 was asked where his call light was. R5 searched his (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: 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 11/20/2025 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)