Health inspection·January 26, 2026

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many anyway. The Residents have extra blankets and jackets on, but they still all complain every day, how cold it is in there (Dining Room). Management makes us take them down to the Dining Room or we get into trouble, and they get mad at us, if we do not make the Residents go down there (Dining Room). Management is aware that it has been cold in the Dining Room for a couple of weeks and they finally a day or so ago, put a space heater on the wall, but it does not even do anything.On 1/24/26 at 9:59 am, V6 (CNA) stated, It is so cold in the Dining Room. We have to bundle them up and put extra blankets on our Residents, but it does not even help them. They are elderly and they like everything to be warmer than usual. I think we just got a new space heater in there (Dining Room), but honestly, it does absolutely nothing. It is way too small for that big room.On 1/24/26 at 9:09 am, V7 (CNA) stated, It has been cold in that Dining Room all winter. (V9/Maintenance Director) just put a new heater in and it does not feel any warmer. Residents are still asking for extra blankets. They are still making us take them to the Dining Room anyway. The door on the left side of the serving window does not feel like it is shut, and it has been that way for years. There is a huge draft that comes in from that.On 1/24/26 at 10:01 am, R5 stated, It is cold as h*** in that dining room. It was really, really cold as of yesterday. I have to wear a coat and blanket, it is terrible.On 1/24/26 at 10:04 am, R6 stated, I did not go to the Dining Room this morning because it is freezing. It used to be warm in there and I did not even need a jacket then. Now I have to wear a coat and gloves because it is cold as h***. It is ridiculous how cold it is in there. What's worse is, we usually get down to the Dining Room and have to sit and wait a while to get our food, and I sit there freezing while I am waiting.On 1/24/26 at 10:26 am, R3 stated, My room is warm, but that Dining Room is freezing. I have to always take a blanket with me. I do not like it that cold. Now I have a sore throat too.On 1/24/26 at 10:21 am, R7 stated, Oh it is freezing in the Dining Room. I have to wear a coat and cover with blankets because they do not turn the heat on. It is very uncomfortable to eat when you are cold.On 1/24/26 at 8:30 am, the Facility was serving the breakfast meal in the Facility Dining Room. On 1/24/26 at 9:58 am, from the nurse's station hallway into the Facility Dining Room doorway entry, the lower air temperature change was immediate. There was a cold draft from the door positioned to the left of serving window.On 1/24/26 at 9:55 am, R9 was sitting in the Dining Room and stated, It is colder than heck in here. I always have to wear a shawl, and I even have two blankets on right now. They put a new heater in, but it has not gotten any better. It makes it hard to eat when you are cold.On 1/24/26 at 10:14 am, V10 (Dietary [NAME]) stated, They just installed that wall heating unit, and it does not help at all. We are keeping the door to the kitchen open to help try and heat the dining room. We put blankets in the window seals to help with the drafts. So many of the Residents complain that they are cold. It really is cold in here for them.On 1/24/26 at 10:16 am, V11 (Dietary Cook) stated, All of the Residents complain about how cold it is in this dining room.On 1/24/26 at 10:18 am, V12 (Dietary Aide) stated, Everyone complains about it being freezing in this dining room. We have the doors open to the kitchen trying to help heat it (Dining Room), but it really does not help. They need to fix the original heater that broke in here because that little wall unit is not even helping at all.On 1/26/26 at 10:17 am, R8 stated, I am getting sick and tired of having to eat in the cold. I did not even finish my breakfast this morning because I had to get back to my room because it was so cold in the dining room. They got some new heater in there, but it does not even work. They have the old unit covered up over there; I just do not understand why they do not just fix that one. They have had it covered with a blanket for a couple weeks now. I can feel that draft coming in from that door while I am eating. I have to come down to eat now with two sweatshirts and a jacket on. If I end up getting sick over this, I am going to be mad. There are so many people in here that are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145774 If continuation sheet Page 2 of 5 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 145774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Havana 609 North Harpham Street Havana, IL 62644 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete complaining about the cold.On1/24/26 at 10:27 am, V9 (Maintenance Director) stated, I am the Maintenance Director. I also am the Housekeeping and Laundry Manager. The big heating unit in the Dining Room stopped working correctly. I have heard complaints that the Dining Room is colder than normal. I put in a work order, and my boss approved the wall mount heating unit. I just installed it, and I have the temperature control monitoring connected through an application on my phone. I do not have any maintenance records for the heating unit. If something were to go wrong with it, then I would get approval to call a local heating distributor. I only tempted the Dining Room on random normal temperature checks, I have not specifically been doing temperature checks in there (Dining Room) since the heating unit went out, so I do not have any documentation of the temperature checks. The door to the left of the serving window never gets used. It looks like it is not sealed correctly. V9 verified that rust and a draft was coming in through the door. V9 opened up the application on V9's phone, and the lowest temperature registered 57 degrees Fahrenheit on 1/23/26 through 1/24/26. We have not been using any other forms of heat sources until I just installed that wall unit.On 1/24/26 at 10:30 am, V9 performed temperature checks in four different areas of the Facility's Dining Room. The temperatures registered at 66.9 degrees Fahrenheit/F, 67.1 F, 67.3 F and 68.4 F. On 1/24/26 at 11:42 am, approximately 25 Residents were seated in the Facility Dining room with blankets and coats on prior to the lunch service meal.On 1/24/26 at 9:40 am, V1 (Administrator) stated, I was not aware of it being cold in the Dining Room, but we did just install a new heater in there.On 1/24/26 at 12:43 pm, V1 (Administrator) stated, I was not sure what was going on with the heating, and I was not really involved in it because (V9/Maintenance Director) was dealing with it with our corporate. Event ID: Facility ID: 145774 If continuation sheet Page 3 of 5 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 145774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Havana 609 North Harpham Street Havana, IL 62644 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 one of three Residents (R1) reviewed for Verbal Abuse from a Facility staff perpetrator. Findings include:The Facility Abuse Prevention and Reporting Policy, dated 12/2025, documents: the Facility affirms the right of our Residents to be free from abuse; Facility prohibits abuse; establishes a resident sensitive and resident secure environment; and orienting and training employees on how to deal with stress.The Facility's Final Abuse Investigation Report, dated 12/22/25, documents, on 12/16/25 at approximately 6:00 pm, a verbal abuse altercation between R1 and V8 (Agency Certified Nursing Assistant/CNA). The Abuse Investigation Report also documents: R1 is a [AGE] year-old, has altered cognitive deficits (Brief Interview for Mental Status/BIMS-score 12/15) and admitted to the Facility with diagnoses including Right Femur Fracture and Chronic Obstructive Pulmonary Disease. V8 (Agency CNA) swore at R1 and disregarded R1's hip pain when transferring. The Investigation Report documents that V8 had a poor attitude while V8 was working in the building and V14 (R1's Spouse) witnessed the interaction and stated that V8 was very rude and impatient with R1. V8 was escorted out of the building and placed on Do Not Return status.V8's (Agency CNA) Employee File, documents V8 was terminated (Do Not Return) on 12/16/25 due to witnessed verbally abusing a Resident. V8's Employee File does not document Abuse Training.The Facility Certified Nursing Assistant Job Description, dated 7/2023, documents: to provide Residents to safeguard the health, safety and welfare in accordance with the Facility's established policies and procedures and applicable laws and regulations; assure that the highest degree of quality care is maintained at all times; be sensitive to Residents' families and respond in an appropriate professional way; carry out assignments for Resident care; follow established safety precautions when performing tasks; must demonstrate ability to deal tactfully with staff, residents and family members; and knowledge of Public Health Department regulations.On 1/24/26 at 8:34 am, V4 (Registered Nurse) stated, (R1) was here short term for rehabilitation. (V8/CNA) was cussing at (R1) with (V14/R's Spouse) in the room. (V14) pulled (R1) out of the Facility before the end of (R1's) rehabilitation over that incident with (V8).On 1/24/26 at 12:43 pm, V1 (Administrator) stated, I received a phone call that (V8/CNA) was berating and swearing at (R1) in front of (V14/R1's spouse). We walked (V8) out of the building and because (V8) was an Agency CNA, we placed (V8) on the Do Not Return list. I had reports that (V8) was being rude and using profanity. We do not allow that behavior. Event ID: Facility ID: 145774 If continuation sheet Page 4 of 5 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 145774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/26/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Havana 609 North Harpham Street Havana, IL 62644 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on interview and record review, the Facility failed to provide a properly maintained transportation van causing safety risks for one of three Residents (R3) during transportation with weather risks (rain) and after sundown.Findings include:The Facility Transportation Driver Job Description, dated 7/2023, documents: is responsible for safety of Residents at all times; monitors Resident safety on the bus; responsible for general upkeep including conducting preventative maintenance, delivering vehicle to authorized service facility, maintains vehicle according to the requirement of the Facility, including completing all required paperwork; follow all safety procedures and protocol as dictated by local policy, federal and state regulations and standard practice; reports all hazardous conditions, defective equipment and incidents to the supervisor immediately; and maintains accurate activity and vehicle report logs.The Facility Grievance Tracking Logs, dated 12/2025 and 1/2026, document issues with headlights on 1/8/26. The Tracking Log does not document a date of resolution follow-up notification.On 1/24/26 at 9:09 am, V7 (Certified Nursing Assistant/CNA) stated, I was here when (R3) and (V15/R3's Daughter) got back from the van ride. (R3) and (V15) were so upset. (V15) was crying about it.On 1/25/26, at 8:45 am, V3 (Transportation Driver) stated, I started with the company on 11/3/25 and I knew the headlights were not working at that time. I had a late appointment back in November, when I had to drive in the dark and I was told to just keep the bright lights on because the headlights were very dim. Somewhere around Christmas time, I got a phone call around 7:00/7:30 pm, that (V9/Maintenance Director) and I had to transport a Resident to a hospital over an hour away. It was dark out and we had to drive without the headlights working properly. I almost hit three deer. (V9) was with me and knew that the headlights did not work correctly. Then on 1/25/26, I had to transport a Resident (R3) to an appointment that was again over an hour away and we had to drive back in the rain, and it was dark. (V15/R3's daughter) was with us in the van. The windshield wipers were broken and we had no headlights, so I had to go about 40 miles an hour on the interstate. It was so scarry. (V15) was scared too, it was awful. They got new headlights a day or so after (V15) complained, but the headlights still are not fixed. I have been driving around with the new headlight box sitting in my van. (V9) attempted to change the headlights but apparently a panel needs removed in order to fix them, so they have to take them into a professional for service. (V9) has so much to do and is over so many departments, (V9) has not had a chance to get them fixed. I drive the transportation van, and it has almost 300,000 miles and there are lights on the dashboard that stay lit. I am still driving the van, but I do not want to drive after dark with it. On 1/24/26 at 1:29 pm, V9 (Maintenance Director) verified that the Facility transport van headlights were burnt out. V9 could not provide maintenance records for the transportation van. On 1/24/26 at 10:42 am, V9 (Maintenance Director) stated, I was notified after (V15) complained about the headlights not working during a van ride to (R3's) appointment. I tried to change the headlights, but it is too complicated because dashboard panels and other things need removed, and a professional needed to replace them.On 1/24/26 at 12:43 pm, V1 (Administrator) provided a receipt, dated 1/24/26, for the headlight replacement. Event ID: Facility ID: 145774 If continuation sheet Page 5 of 5