Inspection·November 26, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to acquire, obtain, provide, and dispense prescribed medications for one resident (R3) of three reviewed for medications on a sample list of three. Findings include: R3's Census Detail dated 11/25/25 documents that R3 was originally admitted to the facility on [DATE].R3's Medical Diagnoses List dated 11/25/25 documents that R3's medical diagnoses include symptomatic epilepsy with complex partial seizures, other seizures, hyperlipidemia, depression, history of cerebral infarction (stroke), Parkinson's disease, and hydrocephalus with a cerebrospinal fluid drainage device.R3's Physician Order Sheet (POS) dated 11/25/25 documents that R3 was prescribed Levetiracetam liquid in a strength of 100 milligrams (mg) per milliliter and was to receive 10 milliliters for a total of 1,000 mg twice daily for seizures. This same POS documents that R3 was prescribed Carbidopa-Levodopa 25-100 mg four times daily for Parkinson's disease. This same POS documents that R3 was prescribed Fluoxetine 10 mg daily for depression. This same POS also documents that R3 was prescribed Atorvastatin 40 mg daily for hyperlipidemia.R3's Medication Administration Record (MAR) for September 2025 documents that R3's Levetiracetam anti-seizure medication was not administered for either of the two doses on 9/18/25, with a special code of 7, indicating to see the nurses' progress notes for that date.R3's Nurses' Progress Notes dated 9/18/25 document that R3's anti-seizure medication Levetiracetam was on order.R3's MAR for September 2025 documents that R3's Atorvastatin (hyperlipidemia medication) was not administered on 9/14/25 with a special code of 7, indicating to see the nurses' progress notes. This same MAR documents that R3's Fluoxetine (antidepressant medication) was not administered on 9/14/25 with the same special code 7. This same MAR further documents that R3's Carbidopa-Levodopa (Parkinson's medication) was not administered for two doses on 9/29/25 with the special code 7.R3's Nurses' Progress Notes dated 9/14/25 document that R3's Atorvastatin and Fluoxetine were not available, were not in the medication storage room, and were not in the medication cart. R3's Nurses' Progress Notes dated 9/29/25-one entered at 12:03 p.m. and a second entered at 3:53 p.m.-document that R3's Carbidopa-Levodopa was on order.R3's MAR for October 2025 documents that R3's Levetiracetam anti-seizure medication was not administered for either of two doses on 10/3/25 and for the morning dose on 10/21/25, with a special code of 7, indicating to see the nurses' progress notes for those dates.R3's Nurses' Progress Notes dated 10/3/25 document that R3's anti-seizure medication Levetiracetam was not available for either of the two doses on 10/3/25. R3's Nurses' Progress Notes dated 10/21/25 document that R3's anti-seizure medication Levetiracetam was on order.On 11/25/25 at 2:48 p.m., V2, Director of Nursing, stated that the reordering process is supposed to work as follows: when any medication supply reaches 3 to 5 doses remaining, the nurse on duty is supposed to click a button in the computer for that medication, which automatically sends a note to the pharmacy to reorder the medication.On 11/26/25 at 9:48 a.m., V2, Director of Nursing, stated that there is a back-up procedure if a resident runs out of a needed medication. The (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 3 Event ID: 145772 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 145772 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Odd Fellow-Rebekah Home 201 Lafayette Avenue East Mattoon, IL 61938 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)