Inspection·September 10, 2025

F 0604 Level of Harm - Minimal harm or potential for actual harm w/c (wheelchair) for mobility, use of antidepressant and anti-anxiety medication, frequently incontinent of bowel and bladder. Has diagnosis of Dementia, TBI (Traumatic Brain Injury), Seizure disorder. Has poor safety awareness, BLE (Bilateral Lower Extremity) weakness. Attempts to transfer self/ambulate without assistance. This same document lists the following intervention, Trial lap buddy, order lap [NAME]. Residents Affected - Some R18's medical record did not contain a restraint assessment for positioning device. On 9/4/25 at 1:43pm, R18 was not interviewable. R18 was observed in his wheelchair with a positioning device applied on lap. R18 was asked if he was able to remove positioning device. R18 pointed at positioning device, but after several attempts, did not seem to understand instructions. R18 was not able to demonstrate that he is able to remove positioning device on his own. On 9/4/25 at 2:04pm, V34 (Minimum Data Set (MDS) Coordinator) stated they do not do restraint assessments because they do not have restraints here. V34 stated R5 and R18 did not have restraint assessments for the lap huggers (positioning device), and they do not have to assess the residents because when they stand the Velcro releases. 3. R3's admission Record documents a date of birth is 2/14/1944 and an admission date of 9/26/24. This same document lists the following diagnosis: unspecified fracture of upper end of left humerus, subsequent encounter for fracture with routine healing, aphasia following cerebral infarction, diabetes mellitus with diabetic polyneuropathy, and muscle weakness. R3's most recent Minimum Data Set, dated [DATE] documents R3's had a BIMS score of 99, indicating R9 could not complete the interview. Section P that a bed and chair alarm is used daily. R3's Care Plan documented a focus are for risk for falls with interventions in place that included: Bed and chair alarm to notify staff d/t (due to) weight bearing status right foot with a date Initiated of 05/05/2025. There was no physician's order or assessment in R3's medical records for any alarms used by R3. On 9/5/25 at 11:45AM, observed V21 (Certified Nurse Assistant/CNA Supervisor) demonstrating R3's wheelchair alarm and bed alarm in place and working. R3 did not say anything when questioned about the alarms. 4. R9's face sheet documents a date of birth is 5/28/51 and an admission date of 3/20/24. This same document lists the following diagnosis: anxiety, depression and altered mental status. R9's most recent quarterly Minimum Data Set, dated [DATE] documents R9 has a BIMS score of a 10 documenting R9 is moderately cognitively impaired. Section P documents that a bed alarm is used daily. R9's care plan documents a focus area of R9 is at risk for falls related to use of anti-depressant, PRN (as needed) opioid use, requires assist of transfers and is incontinent of bowel and bladder. The goal for this area is to have falls/injuries minimized through management of risk factors while maintaining maximum independence/quality of life through next review. The interventions include on 4/4/25 bed alarm to be on when in bed to alert staff of attempting to self-ambulate. There is no physician's order or assessments for R9's bed alarm located in R9's medical record. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 2 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0604 Level of Harm - Minimal harm or potential for actual harm On 9/5/25 at 1:00 PM, V1 stated that residents who have chair and bed alarms do not need orders, and they are just decided upon in interdisciplinary meetings as fall interventions. V1 stated that there are no assessments that go along with these alarms, and they are not considered a restraint. On 9/9/25 at 1:56pm, V1 (Administrator) stated they do not have a policy regarding physical restraints. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 3 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to use person centered behavior interventions and attempt less restrictive alternative treatments prior to administering as needed psychotropic medications for 1 of 3 residents (R5) reviewed for psychotropic medications in a sample of 26. Findings include:R5's admission record documents an admission date of 7/17/25 with the following diagnoses and a discharge date of 8/25/25 with the following diagnoses in part; other frontotemporal neurocognitive disorder, frontotemporal dementia, dementia in other diseases classified elsewhere, unspecified severity, with agitation, depression, unspecified, and anxiety disorder. R5's Minimum Data Set (MDS) dated [DATE], documents a Brief Interview for Mental Status (BIMS) of 99, indicating that R5 was not able to complete the interview. Section N-Medications documents that R5 receives antipsychotics on a routine basis only.R5's Care Plan documents R5 uses medications with black box warnings. With interventions including but not limited to: Clonazepam: Combined with opioids may result in profound sedation, respiratory depression, coma and death. Limit dosages to the minimum required and follow patients closely for signs and symptoms of respiratory depression and sedation. Initiated: 8/4/25.Escitalopram: Increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Risk must balance with clinical need. Reduction in suicidal risks in adults 65 and older. Date initiated:8/4/25. Haloperidol: Increased mortality in elderly patients with dementia-related psychosis. Not approved for patients with dementia related psychosis. Date Initiated: 8/4/25.R5's Care plan documents a focus of: demonstrates significant mood distress/depression related to depression diagnosis, with interventions including but not limited to; Emphasize relation skills to help increase coping. Focus on strengths and accomplishments to help R5 minimize dwelling on problems and perceived failures. Promote self-talk. Help R5 identify negative self-talk and its role in sustaining depression.R5's Care plan documents a focus of: has a history of aggressive, inappropriate, combative behavior, with a diagnosis of anxiety, with interventions including, but not limited to; communicating assertively that R5 must exercise control over impulses and behavior. Remind R5 of inappropriate behavior.R5's Care plan/behavior tracking records documents R5 will reduce combative behavior to zero weekly throughout the review. With interventions including, 1. Anticipate her needs and meet them timely. 2. Check often to see if she needs care, such as toileting or a drink. 3. Remind R5 we are here to help, and she is safe.R5's Care plan/behavior tracking records documents R5 will reduce signs and symptoms of anxiety with behavior disturbances to two times per week through next review. With interventions including, 1. Allow to express feelings and concerns. 2. Encourage to participate in activities. 3. Remind R5 we are here to help her, and she is safe.R5's Care plan/behavior tracking record documents that R5 will reduce signs and symptoms of depression to two times per week throughout the next review. With interventions including, 1. Allow to express her feelings/concerns. 2. Encourage to participate in activities. 3. Remind R5 we are her to help her, and she is safe.R5's Physician Order Sheet document an order for the following scheduled medications: Clonazepam oral tablet disintegrating tablet, give 0.5mg (milligram) tablet by mouth related to dementia, classified elsewhere, unspecified severity, with agitation, anxiety disorder, unspecified. Escitalopram Oxalate Oral tablet 10mg, give one 10mg by mouth one time a day related to depression, unspecified. The start date for both medications was 7/17/25. R5's Physician Order Sheet document an order for the following as needed medications: Clonazepam oral tablet 0.5mg, give 0.5mg as needed for anticonvulsant. Haloperidol Lactate Injection Solution, inject 5mg intramuscularly every 24 hours as needed for agitation, with a start date of 7/17/25. Haloperidol Lactate Injection Solution, Inject 5mg intramuscularly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 4 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few every 24 hours as needed for agitation, with a start date of 7/21/25 and an end date of 8/4/25. Haloperidol Oral Tablet 1mg, give 1mg by mouth as needed for agitation. Take 1mg nightly as needed for agitation, with a start date of 7/21/25 and an end date of 8/4/25. Haloperidol Oral Tablet 1mg, give 1mg by mouth as needed for agitation. Take 1mg nightly as needed for agitation, anxiety related to anxiety disorder, unspecified with a start date of 8/8/25 and an end date of 8/21/25. Hydroxyzine HCI oral tablet 25mg, give 25mg by mouth every 8 hours as needed for anxiety for 14 days, with a start date of 7/21/25 and end date of 8/4/25. Hydroxyzine HCI oral tablet 25mg, give 25mg by mouth every 8 hours as needed for agitation, anxiety related to anxiety disorder, unspecified. With a start date of 8/8/25 and end date of 8/21/25.R5's July Medication Administration record documents R5's as needed dose of Clonazepam was administered on 7/19/25 at 11:27am and 7/21/25 at 9:31pm.R5's July Medication Administration record documents R5's as needed Haloperidol Lactate Injection was administered on 7/21/25 at 1:20pm, 7/22/25 at 6:57am, 7/24/25 at 1:40am, 7/27/25 at 8:09pm, and 7/28/25 at 7:25pm.R5's July Medication Administration record documents R5's as needed Haloperidol oral tablet was administered on 7/20/25 at 11:05pm, 7/22/25 at 3:25pm, and 7/28/25 at 12:28am.R5's July Medication Administration record documents R5's as needed Hydroxyzine HCI oral tablet was administered on 7/20/25 at 8:07am, 7/21/25 at 8:37am, 7/24/25 at 8:57am and 7/28/25 at 8:20am.R5's care plan/behavior tracking records for July 2025 are blank on the 7a-7p shift on 7/17, 7/18, 7/22, 7/23, 7/24, 7/25, 7/28, 7/29, and 7/30. These same documents record on the 7p-7a shift on 7/18-7/31 the only intervention attempted was to allow R5 to express her feelings and concerns.R5's progress notes document on 7/19/2025 at 2:30pm, Resident was being combative hitting staff, refusing to rest in bed and refusing to stay in w/c (wheelchair). PRN (as needed) clonazepam given at 11:29am. Ineffective. Spoke with Psych NP regarding increased agitation and anxiety. Per Psych NP orders PRN Haloperidol IM injection given at 1:20pm. Resident is resting in bed at this time. signs of agitation has decreased. Plan of care ongoing.R5's progress notes document on 7/28/2025 at 12:28am, Administration Note -Note Text: Haloperidol Oral Tablet 1 MG Give 1 mg by mouth every 24 hours as needed for agitation for 14 Days. Resident very restless, attempting to get out of bed. Administered per PRN orders.R5 progress notes document R5 had falls on 7/19/25, 7/23/25 and 7/26/25. R5 did not suffer any injuries with these falls. On 9/9/25 at 10:43am, V22 (Certified Nursing Assistant/CNA) stated she cared for R5 quite often, on a variety of different shifts. V22 stated by the time they got R5 at the facility, her dementia had really progressed. V22 stated R5 was extremely active of body, moving constantly, often in repetitive motions. V22 stated it was like R5's body did not connect with her brain. V22 stated R5 was very restless at night, she needed one on one supervision. V22 stated during the day activity and management tried to help with R5 if they could, she had started therapy right before she got COVID and that had been a ton of help. V22 stated therapy would help walk R5 because she was constantly trying to get up and she was not steady at all and had some falls. V22 stated walking helped her settle down so much. V22 stated R5 was total care and had to be extensively assisted with feeding, which did take a lot of time. V22 stated she could walk but not independently or safely, she had to walk with staff. V22 stated R5 could speak, but her brain wasn't working correctly due to her dementia. V22 stated R5 did not make sense and there was no redirecting or reassuring her. V22 stated she could be combative at times. V22 stated she was not sure what R5's behavioral interventions actually were, but if she had her, she would give her a pillowcase to fiddle with or fold. V22 stated sometimes she would give her the pillow without the pillowcase because she liked the sound that it made when she scratched it and would settle her down a little bit.On 9/9/25 at 11:21am, V15 (Licensed Practical Nurse/LPN) stated when R5 first came in she was very active. V15 stated R5 was not technically a one on one, but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 5 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few they had to keep eyes on her all the time. V15 stated R5 was constantly wanting to stand and fidgeting. V15 stated R5 was super restless, and she would pull stuff off the desks, get a hold of people walking past her and trying to stand and she was super unsteady trying to stand unassisted. V15 stated if she was very restless and someone was available, they would walk with her and that was very helpful. V15 stated she did not specifically remember what R5's behavior interventions were but they always had to have eyes on her and things out of her reach. V15 stated she had an as needed order for a Haldol injection and she had to call the psychiatric Nurse Practitioner to get a one time order once because she was very combative. V15 stated when R5 first came she spoke, but it was nonsensical. V15 stated there was no redirection or discussing feelings with R5, her level of cognition at that point just was not there.On 9/9/25 at 1:09pm, V14 (Director of Nursing/DON) stated she did not believe V33 (Psychiatric Nurse Practitioner) saw R5 in person at admission. V14 stated they do monitor medications, and the psychiatric medications people admit on, she stated R5 was admitted on all these medications, and they weren't monitoring her specifically. V14 stated they do monitor for side effects of medications. V14 stated medications with black box warnings have things to monitor for in the care plan, but they do not have a place where they chart what they are monitoring for. V14 stated when R5 first admitted she would do one on one with her at times. V14 stated R5 did speak in the beginning, but agreed her level of cognition was severely impaired. V14 stated they should be reevaluating interventions for residents.On 9/9/25 at 1:56pm, V17 (Physician) stated R5 was discharged from the hospital to continue both orders for one scheduled benzodiazepine tablet, one scheduled antidepressant tablet, one as needed benzodiazepine tablet, one as needed anti-psychotic tablet and one as needed anti-psychotic injection, and one as needed Anxiolytic/Sedative tablet, up to three times a day. V17 stated he continued the medications because R5 was allegedly already taking them at the assisted living. V17 stated the reason she was taking them was because she was displaying increased agitation, he stated he believed she also was combative and had self-injurious behavior. V17 stated he had seen R5 in person on July 17,2025 when she was admitted to the facility.On 9/9/25 at 2:35pm, V33 (Psychiatric Nurse Practitioner) stated she followed R5 at her previous assisted living facility. V33 stated R5 was much more active at assisted living, and managing her behaviors and medications were challenging. V33 stated they tried all different things with R5, she was much more physically aggressive, was flipping tables and things of that nature. V33 stated in assisted living, they do not have the staff that they have in long term care, sometimes they don't even have nurses, so their ability to use non-pharmacological interventions is limited. V33 stated the facility continued all her orders for R5 from the assisted living, she stated the reason for all the as needed medications in assisted living because they will taper them down to as needed with the goal of discontinuing them eventually. V33 stated normally she would not order all these as needed medications in a long-term care facility because they have more staff and different regulations. V33 stated she can give suggestions for behavior interventions. V33 stated after looking over her notes she had suggested behavior interventions appropriate to her cognitive abilities, she stated R5 was severely cognitively impaired. V33 stated behavior interventions should always be the first line treatment, appropriate interventions should be done and documented before use of as needed medications. V33 stated as needed medications should be the last resort for all patients. V33 stated she had not seen R5 in person until after she had declined, she stated she didn't have her notes in front of her, but she believed it to be around 8/15/25.On 9/9/25 at 2:40pm, V1 (Administrator) was asked if R5's behavior interventions were person centered and appropriate, V1 stated that was a good question and declined to answer any further. V1 stated they did not have any policies regarding the use of psychotropic medications or chemical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 6 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete restraints.Facility policy titled, Care Planning - Interdisciplinary Team with a revision date of September 2013, documents under policy statement: Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. According to https://reference.medscape.com/drug-interactionchecker, there are 7 significant interactions between the psychotropic medications that R5 was taking and require close monitoring: Escitalopram increases toxicity of Haloperidol by QTc interval. Use Caution/Monitor. Hydroxyzine and Haloperidol both increase QTc interval. Use Caution/Monitor. Hydroxyzine and Escitalopram both increase QTc interval. Use Caution/Monitor. Hydroxyzine and Clonazepam both increase sedation. Use Caution/Monitor. Hydroxyzine and Haloperidol both increase sedation. Use Caution/Monitor. Clonazepam and Haloperidol both increase sedation. Use Caution/Monitor. Haloperidol and Escitalopram both increase QTc interval. Use Caution/Monitor. Event ID: Facility ID: 145757 If continuation sheet Page 7 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure timely treatment and care in accordance with professional standards of practice after a fall for 1 (R1) of 3 residents in a sample of 26. This failure resulted in R1 not getting immediate treatment for a hip fracture after a fall. A reasonable person would experience feelings of discomfort and distress due to not receiving timely after fall care. This past noncompliance occurred between 8/25/25 and 8/26/25. Findings include: R1's admission Record documented an admission date of 4/27/2023 and diagnoses including chronic obstructive pulmonary disease, unspecified, gastrostomy status, dysphagia, unspecified, schizoaffective disorder, bipolar type, muscle weakness and moderate protein-calorie malnutrition.R1's Quarterly Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 07, indicating R1 had severe cognitive impairment. This same document under section GG0120 Mobility Devices documented a walker used for ambulation and section I5600 Active Diagnosis documented a diagnosis of malnutrition (protein or calorie) or at risk for malnutrition.R1's Final Incident Report dated 8/25/2025 with time of incident documented R1 had an unwitnessed fall in his room. R1 ambulated independently with walker at baseline. R1 reported pain to right groin with imaging ordered in house. Imaging obtained on 8/26/2025 with results showing a displaced fracture to right femoral neck. R1's Progress note dated 8/25/2025 at 1:24 PM by V15 (LPN) documented heard R1 yelling out. Upon entering room, resident was on the floor, leaning on his right elbow, walker to his left side with no injuries noted, but complain of right inguinal and thigh pain.R1's Progress note dated 8/26/25 at 4:15 PM documents, EMS (Emergency Medical Services) arrived and transferred R1 to the local hospital. On 9/3/2025 at 12:51 PM, V18 (Certified Nursing Assistant/CNA) stated, she did work on 8/25/2025 when R1 had fallen in his room. V18 stated, she heard R1 hollering out from his room while she had been at the nurse's station. V18 stated, she went into R1's room with V24 (CNA) and found R1 on the floor. V18 stated, she requested V15 (Licensed Practical Nurse/LPN) to come to R1's room. V18 stated, V15 assessed R1 with V24 and then helped him back to bed. V18 stated, R1 had been complaining of pain in his groin area and unable to stand or do baseline activities. V18 stated, she notified V15 of R1's not being able to perform his normal functions multiple times after his fall and V15 stated, R1 would have to wait. V18 stated, no imaging was completed the day of the fall.On 9/3/2025 at 1:02 PM, V15 (Licensed Practical Nurse/LPN) stated, she had been working the day R1 had his fall event on 8/25/2025. V15 stated, V18 (CNA) and V24 (CNA) requested for her to come to R1's room. V15 stated, R1 had been on his right side in the floor when she entered his room. V15 stated, R1 had been helped back to bed by her and V24, she then notified V16 (Family) and V17 (Physician) of R1's fall. V15 stated, V17 ordered imaging pictures be taken of R1's right hip related to pain from the fall. V15 stated, she contacted the imaging company to schedule them to come to the facility for pictures. V15 stated, the imaging company returned a call and notified her that they would not be able to come to the facility until the next day. V15 stated, she did not notify the doctor that the imaging company could not come that day. V15 stated, R1 did still have pain throughout her shift and was unable to complete his baseline activities. V15 stated, she had been back to R1's room several times that day to see if he wanted to get out of bed. V15 stated, R1 probably should have been sent to the local emergency room for further evaluation that day after the imaging company could not complete the order, but she did not send him. On 9/4/2025 at 11:09 AM, V2 (Assistant Director of Nursing/ADON) stated, she had been notified that R1 had fallen on 8/25/2025 in the afternoon. V2 stated, she thinks R1 had been reaching for his crayons when he fell out of bed. V2 stated, per V15's (LPN) nursing note documented R1's fall, with notifications to V17 Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 8 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0684 Level of Harm - Actual harm Residents Affected - Few (Physician) and V16 (Family) and order for imaging pictures to be performed. V2 stated, on 8/26/2025 around 4:00 PM the imaging company arrived in the facility to complete imaging pictures for R1 and R1 had still been in pain after pictures were taken, so she contacted V16 (Family) via phone to discuss sending R1 to the hospital for further evaluation. V2 stated, V16 agreed to have R1 sent to the local emergency room. V2 stated, R1 was transferred to the local hospital by ambulance around 4:15 PM on 8/26/2025. V2 stated, the imaging order for R1 should have been initially order stat (immediate) and if the imaging company could not come out to complete the pictures then V16 (Family) should have been contacted to discuss further evaluation which would include R1 being sent to the local hospital. On 9/4/2025 at 11:24 PM, V28 (Imaging Company) stated, there is documentation on 8/25/2025 at 1:37 PM for R1 to receive an image order to the right hip. V28 stated, the order was not ordered stat (immediate). V28 stated, around 4:30 PM the technician on 8/25/2025 documented unable to complete order due to workload. V28 stated, at 5:05 PM, V31(Imaging Technician) documented V15 (LPN) notified images would not be completed today for R1 via phone. V28 stated, V31 (Imaging Technician) arrived in the facility on 8/26/2025 around 4:00 PM to complete R1's order. V28 stated, V31 completed the imaging picture and requested the picture to be read stat. On 9/4/2025 at 1:10 PM, V1 (Administrator) stated, R1 had been self-ambulatory during his stay in the facility. V1 stated, her understanding of R1's fall event on 8/25/2025 had been he self-reported by hollering out from his room and V15 (LPN) went down to R1's room to check on him. V1 stated, R1 did have some hip pain after his fall and V15 ordered a imaging picture through the imaging company. V1 stated, the imaging company came in on 8/26/2025 around 4:00 PM to complete the imaging pictures and there was a fracture shown and R1 had been sent out to the local hospital. V1 stated, the normal expectations after a fall event with pain would be to get an imaging picture ordered immediately and if the company could not come in to complete the order, the nurse should contact the physician to discuss further evaluation. V1 stated, V15 did not order the imaging pictures to be done stat. On 9/5/2025 at 1:28 PM, V17 (Physician) stated, he had been notified of R1's fall event from 8/25/2025. V17 stated, around 1:37 PM he received a text message to order imaging of the right hip for R1. V17 stated, he had not been notified of a pain assessment for R1, that R1 could not bear-weight or there was a delay in imaging. V17 stated, V15 (LPN) should have completed a better assessment of R1 after his fall event. On 9/09/2025 at 10:02 AM, V23 (CNA) stated, he did work the day R1 had his fall on 8/25/2025. V23 stated, R1 had been independent in ambulation. V23 stated, he heard R1 hollering for help from his room but does not recall what time. V23 stated, when he entered R1's room, R1 had been on his hands and knees in the floor with his crayons next to him. V23 stated, he called out for V15 (LPN) to come to R1's room to assess him. V23 stated, after V15 assessed R1, they helped him into his bed. V23 stated, he is not aware if R1 had any pain. V23 stated, later that same day, R1 used his call light for resident care. V23 stated, he attempted to help R1 up out of his bed to stand and R1 could not bear any weight on his right leg. V23 stated, R1 said he could not stand. V23 stated, he did notify V15 but not aware of any interventions at that time. V23 stated, he worked the next day on 8/26/2025 and V16 (Family) had hit R1's call light for him to get assistance to get dressed. V23 stated, at that time, R1 was telling V16 that he could not get up. On 9/9/2025 at 10:13 AM, V24 (Director of Nursing/DON) stated, she did not work on 8/25/2025 when R1 had his fall. V24 stated, she had not been notified of the fall event the day of. V24 stated, when she had been notified on 8/26/2025, she went down to assess R1. V24 stated, R1 did have pain to his right lower leg upon assessment. V24 stated, V16 (Family) was in the room during the assessment and asked about the imaging results to R1's right hip. V24 stated, she reviewed R1's chart and did not see any imaging results. V24 stated, she requested for R1 to be administered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 9 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0684 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete pain medication while she contacted the imaging company to follow up on R1's order. V24 stated, when she contacted the imaging company is when she found out that the order had been for yesterday. V24 stated, it is the facility policy that V17 (Physician), families and herself are to be notified of resident fall events. V24 stated, R1's imaging order should have been completed on 8/25/2025 and when imaging had notified V15 that they would not be able to complete it that day, R1 should have been sent out to the local emergency room for further evaluation.The local Hospital emergency room imaging report for R1's right hip related to fall with pain and unable to weight-bear, dated 8/26/2025 documented an acute fracture of the right femoral neck with acute angulation.Prior to the survey date, the facility took the following actions to correct the non-compliance:1. On 8/26/2025, all nursing staff in-serviced on all falls to be reported to Director of Nursing and Assistant Director of Nursing, fall management, resident reports pain with a fall event or other incident should have an immediate imaging order placed, and if imaging company is unable to arrive at the facility the same day as order, staff will notify physician and family. Staff signed on in-service sheet including V15. 2. On 8/26/2025 the Administrator and Director of Nursing will complete random education checks to ensure staff is knowledgeable on the process of obtaining immediate imaging for residents who fall with complaints of pain for a minimum of 5 times per week for 4 weeks.3. On 8/26/2025 implemented all fall reports to be reviewed, daily during the morning meetings and a weekly review to be completed with the interdisciplinary team on Thursdays to ensure all identifying changes, implementing new processes and monitoring changes. All items to be discussed in Quality Assurance meetings.4. On 8/26/25, the facility's Quality Assurance Committee met to review the above referenced fall. The Committee approved of the corrective Action Plan that had been submitted and reviewed the status of the plan without corrections. Event ID: Facility ID: 145757 If continuation sheet Page 10 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to assess and provide pain medication after a fall for 1 (R1) of 3 residents reviewed for pain in a sample of 26. This failure resulted in R1 not receiving any pain medication for a hip fracture for several hours after a fall. A reasonable person would experience feelings severe pain and discomfort due to not receiving pain relief medication. This past noncompliance occurred between 8/25/25 and 8/26/25. Findings include:R1's admission Record documented an admission date of 4/27/2023 and diagnoses including chronic obstructive pulmonary disease, unspecified, gastrostomy status, dysphagia, unspecified, schizoaffective disorder, bipolar type, muscle weakness and moderate protein-calorie malnutrition.R1's Quarterly Minimum Data Set (MDS) dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 07, indicating R1 had severe cognitive impairment.R1's Physician Order Summary documented Acetaminophen Oral Suspension. Give 5 ml via gastrointestinal tube every 6 hours as needed for mild pain related to muscle weakness (generalized) with a start date of 07/22/2024.R1's Progress note dated 8/25/2025 at 1:24 PM by V15 (Licensed Practical Nurse/LPN) documented heard R1 yelling out. Upon entering room, resident was on the floor, leaning on his right elbow, walker to his left side with no injuries noted, but complain of right inguinal and thigh pain.R1's Final Incident Report dated 8/25/2025 with time of incident documented R1 had an unwitnessed fall in his room. R1 ambulated independently with walker at baseline. R1 reported pain to right groin with imaging ordered in house. Imaging obtained on 8/26/2025 with results showing a displaced fracture to right femoral neck.The local Hospital emergency room imaging report for R1's right hip related to fall with pain and unable to weight-bear, dated 8/26/2025 documented an acute fracture of the right femoral neck with acute angulation.On 9/3/2025 at 12:51 PM, V18 (Certified Nursing Assistant/CNA) stated, she notified V15 (Licensed Practical Nurse/LPN) of R1's continued pain and not being able to perform his normal functions multiple times after his fall. V18 stated, V15 stated to her, R1 would have to wait. On 9/5/2025 at 10:32 PM, V15 (LPN) stated she did not give any pain medication to R1 after his fall event on 8/25/2025 or during her shift that day.On 9/5/2025 at 12:27 PM, V16 (Family) stated R1 did have a fall on 8/25/2025. V16 stated at the time of the fall when they contacted him, R1 had been having pain in his right groin/inner thigh. V16 stated, he came to visit R1 on 8/26/2025. V16 stated, R1 told him he was in pain when he asked him if he was hurting by pointing to his right inner thigh/groin area. V16 stated, he would assume that the facility would give R1 pain medication as ordered.On 9/4/2025 at 11:09 AM, V2 (Assistant Director of Nursing/ADON) stated she had been notified that R1 had fallen on 8/25/2025 in the afternoon. V2 stated, on 8/26/2025 around 4:00 PM the imaging company arrived in the facility to complete imaging pictures for R1 and R1 had still been in pain, so she contacted V16 to discuss sending R1 to the hospital for further evaluation. V2 stated, V16 agreed to have R1 sent to the local emergency room. V2 stated, R1 was transferred to the local hospital by ambulance around 4:15 PM. V2 stated, R1 had no documentation of pain medication given until Acetaminophen Oral Suspension (Acetaminophen) 5 milliliters for 8/10 pain on 8/26/2025 at 10:59AM.On 9/5/2025 at 1:28 PM, V17 (Physician) stated, he had been notified of R1's fall event from 8/25/2025. V17 stated, around 1:37 PM he received a text message to order imaging of the right hip for R1. V17 stated, he had not been notified of a pain assessment for R1, that R1 could not bear-weight or there was a delay in imaging. V17 stated, V15 (LPN) should have completed a better assessment of R1 after his fall event. On 9/9/2025 at 10:13 AM, V24 (Director of Nursing/DON) stated she had been notified on 8/26/2025 that R1 had a fall event the day before and she went down to assess R1. V24 stated, R1 did have pain to his right lower leg upon assessment. V24 stated, she requested for R1 to be Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145757 If continuation sheet Page 11 of 12 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 145757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Carbondale 120 North Tower Road Carbondale, IL 62901 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)

F 0697 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete administered pain medication while she contacted the imaging company to follow up on R1's order. V24 stated, pain should be assessed for all residents who have had a fall and R1 should have received pain medication with verbalizing pain to his right hip.R1's August Medication Administration Record (MAR) documented no pain medication was given on 8/25/2025. R1's MAR documents R1 received Acetaminophen Oral Suspension (Acetaminophen) 5 milliliters for 8/10 pain on 8/26/2025 at 10:59AM.The facility's Pain Management Policy (adapted/revised 2022) documented under Purpose: To facilitate resident independence, promote resident comfort and preserve resident dignity. The purpose of this policy is to accomplish that mission through an effective pain management program, providing our residents the means to receive necessary comfort, exercise greater independence, and enhance dignity and life involvement. General Guidelines: The facility will achieve these goals through: Promptly and accurately assessing and managing pain to the greatest extent possible. Encouraging residents to self-report pain. Aggressively assessing pain in non-verbal and cognitively impaired residents. Increasing comfort and reducing to depression and anxiety in residents. Optimizing the residents' ability to perform activities of daily living. Monitoring treatment efficacy and side effects. A standard format for assessing, monitoring and documenting pain in both cognitively intact and cognitively impaired residents will be utilized. As part of a comprehensive approach to pain assessment and management, pain will be considered the fifth vital sign at the facility, along with temperature, pulse, respiration, and blood pressure. For the purposes of this policy, pain is defined as whatever the experiencing person says it is, existing whenever the experiencing person says it does.Prior to the survey date, the facility took the following actions to correct the non-compliance:1. On 8/26/2025, all nursing staff in-serviced on all falls to be reported to Director of Nursing and Assistant Director of Nursing, fall management, resident reports pain with a fall event or other incident should have an immediate imaging order placed, and if imaging company is unable to arrive at the facility the same day as order, staff will notify physician and family. Staff signed on in-service sheet including V15.2. On 8/26/2025 the Administrator and Director of Nursing will complete random education checks to ensure staff is knowledgeable on the process of obtaining immediate imaging for residents who fall with complaints of pain for a minimum of 5 times per week for 4 weeks.3. On 8/26/2025 implemented all fall reports to be reviewed, daily during the morning meetings and a weekly review to be completed with the interdisciplinary team on Thursdays to ensure all identifying changes, implementing new processes and monitoring changes. All items to be discussed in Quality Assurance meetings.4. On 8/26/25, the facility's Quality Assurance Committee met to review the above referenced fall. The Committee approved of the corrective Action Plan that had been submitted and reviewed the status of the plan without corrections. Event ID: Facility ID: 145757 If continuation sheet Page 12 of 12