Inspection·August 22, 2025

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review , the facility failed to implement their abuse prohibition policy to ensure the safety of a resident when an employee is accused of abuse and was permitted to remain in the facility, the facility also failed to ensure a resident had an initial abuse screening and initial abuse care-plan and failed to revise the care-plan for 1 of 1 resident (R3) in a sample of 5 reviewed for Abuse. Findings include:On 8/19/2025 at 10:30am R3 said that on 8/5/2025 at about 12:30am, she requested pain medication from V8 (Nurse) and that V8 said she did not have any pain medication available, and she would administer the medication when available. Upon returning to her room R3 said she overheard the nurse at the station reading her chart out loud stating, I see why her legs are burned. R3 said she felt bad and did not come out of her room anymore that night. R3 reported this to V15 (Social Service), which she was told by V1 (Administrator) that V8 would not work on this unit anymore. On 8/17/2025 at 12:30am R3 said she ask the (Certified Nursing Assistant-CNA) to inform the nurse she needed pain medication, at about 2:30am V8 entered her room and informed her she did not have any medication and her medication would be delivered in the morning, R3 said she was surprised to see V8 working on the unit, she did not want to speak to her any longer and proceeded to lay in the bed until the day shift arrived feeling lied to and belittled. On 8/21/2025 at 12:30pm V14 (MDS/ Care plan Coordinator) said that R3 should have an abuse care-plan put in by the social service department and should have an abuse screening.On 8/21/2025 at 1:00pm V15 said that R3 informed her that V8 was overheard reading her chart out loud and refused to give her pain medication, V15 said I then put in a concern form for both accusations. V15 said that R3 does not have an initial abuse screening and should have one and does not have an initial abuse care plan and no care-plan updates for the following abuse accusations because she was auditing and updating all the abuse care-plans and had not gotten to her yet. On 8/21/2025 at 2:00pm V8 said that on 8/5/2025, the Certified Nursing Assistant-CNA informed her that R3 wanted pain medication, R3 then arrived at the nurse's station and asked why she was reading her chart out loud, I then informed R3 that she did not have any pain medication, and it would be delivered. I was informed by V1(Administrator) that I was accused of mental abuse by reading a chart out loud and not administering pain medication when a resident asks and was suspended, I was not informed that I could not work on that unit anymore that is why I worked that unit on 8/17/2025 I thought the allegations were unfounded my name was on the schedule for that unit.On 8/21/2025 at 10:00am V7 (Nurse scheduler) said she was informed on 8/8/2025 not to put V8 back on unit A and her name is there in error, I did not inform her to return to that unit. On 8/21/2025 at 1:40pm V2 (Director of nursing-DON) said that on 8/5/2025 V8 had been informed not to work on that unit anymore and had not been informed to work on A-unit that night and should not have worked on that unit. R3 should have an abuse screening upon admission, an abuse care-plan and care plan updates as needed. I expect the nurses to treat all residents with dignity and respect and administer medications as ordered. On 8/19/2025 at 1:00pm V1 said that on 8/5/2025 R3 had made a concern form that V8 was Residents Affected - Few (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 4 Event ID: 145758 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 145758 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Glenwood 19330 South Cottage Grove Glenwood, IL 60425 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)