Inspection·December 1, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. Based on interview and record review, the facility failed to ensure a designated smoking area was located an adequate distance from a resident's room to allow the resident the choice to open the window, for one of 24 residents (R48) reviewed for choices in a sample of 28. FINDINGS INCLUDE: The facility Resident's Rights document, The right to live in an environment that promotes and supports each resident's dignity, individuality, independence, self-determination, privacy and choice to be treated with consideration and respect. R48's most recent Minimum Data Set Assessment, dated October 6, 2022, documents R48's Cognition as 15:15, cognitively intact. On 11/28/22 at 8:13 A.M., R48 was in her resident room, lying in bed, watching television. R48 was alert, oriented (to time, place, person and purpose) and talkative. At that time, R48 stated, I can't open my windows because of the staff outside smoking all the time. I have told many (staff), many times. They finally moved the chair that was right underneath my window, but I still can't open my window for fresh air. The cigarette smoke is horrible. I really want to be able to open my windows and breathe fresh air. On 11/28/22 at 9:00 A.M., three (facility)staff members were seated outside of (R48)'s room, on the facility patio, smoking. On 11/28/22 at 9:45 A.M., V7/Certified Nursing Assistant stated, I know (R48) wants to be able to open her window. She likes the fresh air, but the cigarette smoke is bad. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 2 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on interview, observation and record review, the facility failed to ensure a resident with limited range of motion was provided appropriate treatment and services to maintain and/or prevent a further decrease for three of five residents (R8, R19 and R29) reviewed for limited range of motion in the sample of 28. Findings include: The facility's Prevention of Decline in Range of Motion policy (dated 02/02/22) documents the following: The facility in collaboration with the medical director, director of nurses and as appropriate, physical/occupational consultant shall establish and utilize a systemic approach for prevention of decline in range of motion, including the assessment, appropriate care planning, and preventative. 1. R8's current Physician's Orders document R8's diagnoses to include: Osteoarthritis, Gout, Weakness, Muscle Wasting and Atrophy of left and right thigh, Rheumatoid Arthritis, and Lack of Coordination. R8's Minimum Data Set Assessment (09/01/22), Section G Functional Status, documents R8 has impairment on both sides of her lower extremities. R8's current Care Plan documents the following focus: The resident has an ADL (activities of daily living) self-care performance deficit related to pain secondary to impaired mobility, range of motion limitations in bilateral lower extremities, muscle wasting, Osteoarthritis, Gout, Rheumatoid Arthritis, muscle weakness, and decreased activity tolerance. This same care plan documents the following Goal: Resident will participate in restorative AROM (active range of motion) and PROM (passive range of motion) programs 3 6 days per week. This same care plan also documents the following Interventions: Restorative AROM Fine motor: decreased range of motion in left shoulder; Restorative PROMS: Lower extremities 10 reps each extremity. R8's Restorative Nursing Assessment (dated 09/01/22) documents the following programs are recommended: AROM and PROM. On 11/28/22 at 10:50 AM, R8 was driving an electric wheelchair in the hallway towards the dining room. R8 stated she can no longer walk, and she is supposed to perform range of motion exercises throughout the week, but they are not consistently being performed. R8's Monthly Restorative Nursing Record forms (dated 06/22 - 11/22) does not document AROM and PROM exercises have not consistently been performed at least three times per week throughout this time frame. On 11/30/22 at 11:00 AM, V4 (Registered Nurse/Restorative) stated the following: The goal is for the resident to perform restorative program exercises at least three days per week. We used to have two full-time restorative aides, and the only thing they did was restorative. The two restorative aides we have now do restorative exercises, but also have other tasks assigned and there is just not enough time to get to every resident that is currently on a program. On 11/30/22 at 11:20 AM, V8 (Certified Nursing Assistant/Restorative Aide) stated the following: I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 3 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0688 Level of Harm - Minimal harm or potential for actual harm am one of the restorative aides but I also have other things assigned to me each day. In addition to restorative, I have a couple of showers to give each day. I assist residents with toileting when needed. I also help with meals. By the time I get through all of these things, there is just not enough time to get to all of the residents. V8 confirmed that range of motion exercises are not being conducted at a minimum of three days per week for R8. Residents Affected - Few 2. R29's current Physician's Orders document R29's diagnoses to include: Rheumatoid Arthritis, Muscle Weakness, Left and Right Knee Contracture, Left and Right Hip Contracture, and Lack of Coordination. R29's current Care Plan documents the following Focus: I have an ADL (activities of daily living) self-care performance deficit related to decreased range of motion in both shoulders, bilateral knees/hips, Dementia, Rheumatoid Arthritis, Fibromyalgia, Osteoarthritis, and muscle weakness. This care plan documents the following Goal: Resident will allow staff to perform PROM (passive range of motion) 3 - 6 days per week. This care plan also documents the following Intervention: Restorative PROM: 5 reps to right and left fingers, wrists, elbows, shoulders, hips, knees, ankles, arms and legs 3 - 6 days per week for contracture prevention. R29's Minimum Data Set Assessment (dated 10/20/22), Section G Functional Status, documents R29 has impairments on both sides of her upper and lower extremities. R29's Restorative Nursing Assessment (dated 10/20/22) documents the following programs are recommended: AROM and PROM. On 11/28/22 at 10:32 AM, R29 was sitting in a high-back wheelchair in her room. R29 stated she is supposed to have range of motion exercises completed, but she hasn't had them completed for awhile. R29's Monthly Restorative Nursing Record (dated 07/22 - 11/22) documents range of motion exercises have not consistently been completed at a minimum of three times per week during this time frame. On 11/30/22 at 11:00 AM, V4 (Registered Nurse/Restorative) stated the following: The goal is for the resident to perform restorative program exercises at least three days per week. We used to have two full time restorative aides, and the only thing they did was restorative. The two restorative aides we have now do restorative exercises, but also have other tasks assigned and there is just not enough time to get to every resident that is currently on a program. On 11/30/22 at 11:20 AM, V8 (Certified Nursing Assistant/Restorative Aide) stated the following: I am one of the restorative aides, but I also have other things assigned to me each day. In addition to restorative, I have a couple of showers to give each day. I assist residents with toileting when needed. I also help with meals. By the time I get through all of these things, there is just not enough time to get to all of the residents. V8 confirmed that range of motion exercises are not being conducted at a minimum of three days per week for R29. 3. R19's Restorative Nursing Assessment, dated 10/6/22, documents an impairment of one side of upper and lower extremities. This form documents to continue restorative program: Passive Range of Motion will continue due to Contracture of left hand and resistance to having foam roller in place. R19's currant care plan documents to do passive range of motion three to six days per week to all extremities, including fingers and toes, five repetitions to each extremity to avoid further contract (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 4 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0688 Level of Harm - Minimal harm or potential for actual harm R19's Restorative Nursing Record, dated June 2022, documents that R19's Passive Range of Motion was not done from June 13th, 2022, through June 20th, 2022. R19's Passive Range of Motion, dated July 2022, was not done after 7/7/22. R19's Passive Range of Motion was not done from 8/8/22 through 8/14/22. R19's Passive Range of Motion was only completed eight times for the month of September 2022. R19's October 2022 Passive Range of motion was only completed on 10/2/22, 10/6/22 and 10/7/22. Residents Affected - Few On 11/30/22 at 11:20 AM, V8 (Certified Nursing Assistant/Restorative Aide) stated the following: I am one of the restorative aides, but I also have other things assigned to me each day. In addition to restorative, I have a couple of showers to give each day. I assist residents with toileting when needed. I also help with meals. By the time I get through all of these things, there is just not enough time to get to all of the residents. V8 confirmed that range of motion exercises are not being conducted at a minimum of three days per week for R19. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 5 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, facility staff failed to follow facility protocol for the administration of intravenous antibiotic therapy for one of one resident (R15), reviewed for intravenous therapy, in a sample of 28. Residents Affected - Few The facility policy, Intravenous Therapy, dated 2/1/22 documents, The facility will adhere to accepted standards of practice regarding infusion practices. Intravenous therapy is the administration of parental fluids or medications through an IV (Intravenous) catheter to treat a condition. Intermittent Medication Infusion: Review and verify practitioner's order for mediation and route of administration. Review chart for any allergies or previous reverse reactions to medications/solutions. Perform hand hygiene. [NAME] gloves. Prepare infusion by spiking the medication, priming tubing, ensuring all air is out of the tubing. Program IV pump and insert tubing into the pump as per manufacturer's instructions. Disinfect needleless connector with appropriate antiseptic agent as per facility protocol. Attach 10 ML syringe normal saline and confirm patency of vascular device as per protocol. Disinfect needleless connector again with appropriate antiseptic agent. R15's current Hospitalization Discharge Orders document that R15 was discharged from a local hospital on [DATE] with the following diagnoses: Peripheral Arterial Disease, Non-Healing Wound of Right Heel, Osteomyelitis. Also included are the following physician's orders: Entapenem (antibiotic)1 Gram in 100 Milliliters of Normal Saline via PICC (Peripherally Inserted Central Catheter) every 24 hours for 6 weeks. On 11/28/22 at 2:40 P.M., V6/Agency Registered Nurse (R15) prepared to administer R15's intravenous antibiotic. (R15) cleansed her hands with alcohol gel, and without applying gloves, spiked a 100 ML bag of Normal Saline and mixed Entapenem 1 Gram into the fluid and hung the solution via a pump at 200 ML/HR (Hour). V6/RN then exposed R15's PICC line, located in R15's right outer antecubital area. Without cleansing the port of (R15's) PICC line with an antiseptic agent, V6/RN attached a pre-filled syringe with 10 ML NS and administered it via IV push. V6/RN then disconnected the syringe, cleansed the PICC port with an alcohol swab, attached the IV tubing and started IV pump. V6/RN then left the room. At that time, V6/Registered Nurse verified she did not wear gloves for the administration of R15's intravenous antibiotic therapy nor did she cleanse the PICC line port prior to administering the Normal Saline flush. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 6 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to document a rational for the continued use of an antibiotic for one of one resident (R19) reviewed for unnecessary antibiotic use in a sample of 28. Residents Affected - Few Findings include: The facilities Antibiotic Stewardship Program, dated 2/1/22, documents that all prescriptions for antibiotics shall specify the dose, duration, and indication for use. This form also documents to monitor response to antibiotics, and laboratory results when available, to determine if the antibiotic is still indicated or adjustments should be made. Antibiotic orders obtained upon admission, whether new admission for or readmission, to the facility shall be reviewed for appropriateness. R19's current Physician Order Sheet documents to take Nitrofurantoin Macrocrystal (antibiotic) capsule 100 milligrams one time daily for urinary tract infection, prophylaxis. This form documents that R19's Nitrofurantoin Macrocrystal 100 mg capsule was ordered on 1/14/22, prophylaxis. There is no discontinue date documented in R19's medical record. On 11/29/22 at 2:00pm, V2, Director of Nursing, stated that there is no documentation for the continued use of R19's antibiotic therapy. V2 stated that R19 does not have an abnormal urinalysis to warrant the use of an antibiotic. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 7 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interview and record review, the facility failed to employ a Certified Dietary Manager. This failure has the potential to affect all 56 currently residing in the facility. Residents Affected - Many Findings include: The facility's Dietary Manager Job Description (undated) documents the following: Major Duties and Responsibilities: Oversees the budget and purchasing of food and supplies, and food preparation, services, and storage. Maintains a clean and sanitary environment. This policy also documents, Minimum requirements include: Certification as a dietary manager. Must also meet State requirements for food service managers or dietary managers. On 11/28/22 at 09:45 AM, a tour of the kitchen was conducted with V10, Dietary Manager. V10 stated he is the Dietary Manager, and has been for nearly six months. V10 stated he currently does not have the certification of Certified Dietary Manager. The facility's CMS (Centers for Medicare and Medicaid Services) Form 672 Resident Census and Conditions of Residents dated 11/29/22 and signed by V4 (Minimum Data Set Coordinator), documents 56 residents currently reside in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 8 of 9 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 145789 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Geneseo 704 South Illinois Street Geneseo, IL 61254 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on interview, observation and record review, the facility failed to ensure equipment in the kitchen was clean, opened food items were dated, and expired food items were discarded. This failure has the potential to affect all 56 residents currently residing in the facility. Findings include: The facility's Food Receiving and Storage policy (dated 02/01/22) documents the following: Food shall be received and stored in a manner that complies with safe food handling practices. Food Services, or other designated staff, will maintain clean food storage areas at all times. This same policy also documents, All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by date). Other opened containers must be dated and sealed or covered during storage. On 11/28/22 from 09:45 AM - 10:20 AM, a tour of the kitchen was conducted with V10, Dietary Manager. On 11/28/22 at 09:57 AM, the reach-in refrigerator contained the following: an opened, undated carton of thickened orange juice; an opened gallon of Vitamin D milk with a use by date of 11/22/22; a gallon of fat free milk with a use by date of 11/12/22; and two large bags of opened, undated lettuce. V10 confirmed the opened items were undated and the gallon of milks were expired. On 11/28/22 at 10:01 AM, the fan covers in the walk-in cooler were coated with dust and debris. V10 confirmed the fan covers were dirty and stated, They need to be cleaned. On 11/28/22 at 10:06 AM, the walk-in freezer had a large area of a sticky, black substance on the main walkway of the floor near the entrance to the freezer. V10 confirmed the substance on the floor and stated, It is difficult to clean because when you use water, it turns to ice. On 11/28/22 at 10:11 AM, the dry storage room contained the following: an opened, undated container of honey; an opened, undated container of pancake syrup; an opened, undated container of vanilla extract; an opened, undated container of cooking wine; an opened, undated container of white vinegar; an opened, undated container of apple cider vinegar; an opened, undated container of molasses; an opened, undated bag of crispy fried onions; and 5 cartons of thickened cranberry cocktail with a use by date of October 2022. V10 confirmed all of the opened, undated food items and the expired cartons of cranberry cocktail and stated, I am very disappointed in my staff. On 11/28/22 at 10:16 AM, the hot water spigot in the dining room had a large amount of hard, white build-up around the area where hot water is dispensed. V10 stated, That is lime scale build-up. The spigot needs to be cleaned. At this same time, the facility's ice/water machine in the dining room had a large amount of white build-up on the water dispensing spigot. V10 stated, The spigot needs de-limed. The facility's CMS (Centers for Medicare and Medicaid Services) Form 672 Resident Census and Conditions of Residents dated 11/29/22 and signed by V4 (Minimum Data Set Coordinator), documents 56 residents currently reside in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145789 If continuation sheet Page 9 of 9