Inspection·July 10, 2025

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to assess a resident with new onset pain, failed to document the new onset pain, and the facility failed to ensure the resident's provider received notification of new onset pain. This applies to 1 of 3 residents (R1) reviewed for injuries of unknown origin in the sample of 4. Residents Affected - Few The findings include: R1's admission Record (Face Sheet) showed an original admission date of 10/9/24 with diagnoses including, but not limited to, generalized osteoarthritis, overweight, dementia, and a fracture of the lower end femur (thigh bone, onset date 6/24/25). R1's 4/10/25 Quarterly Minimum Data Set (MDS) showed severe cognitive impairment with a Brief Interview for Mental Status (BIMS) score of 3 out of 15. R1's MDS showed she was dependent upon staff for toilet hygiene, bathing, lower body dressing, and all types of transfers. R1's MDS showed she received scheduled pain medication; however, she denied pain for the previous six days and she did not receive as-needed pain medication during the review period. R1's June 2025 Medication Administration Record (MAR)/Treatment Administration Record (TAR) showed twice-daily pain assessments. The pain assessments showed no documented pain until the PM documentation on June 22, 2025, (Sunday) at a rating of 3 out of 10. The MAR showed an order for Acetaminophen (an over-the-counter pain medication), two 650-milligram tablets to be given every 8 hours as-needed for pain. The MAR showed this medication was not given for the month of June 2025 until June 21, 2025, (Saturday) at 11:38 PM. The acetaminophen was documented as being given by V12 Nurse for a pain rating of 9 out of 10. R1's Progress Notes showed no entry for 6/21/25. R1's 6/22/25 Health Status Note (Nurse's Note) from 12:56 PM showed, CNAs (Certified Nursing Assistant) alerted this nurse that resident seemed to be having some right leg pain and is not tolerating bearing on that side. This nurse assessed resident, resident not tolerating range of motion well, winces and says 'no' .CNAs used [mechanical lift, crane type] for transferring resident from bed to chair. No fall or event noted that would indicate cause of increased pain. Message left for provider, DON (Director of Nursing, V2) notified, POA (Power of Attorney) notified of increased pain in right leg. (Authored by V5 Registered Nurse) The next chronological note from 6/23/25 (Monday) at 9:09 AM showed the nurse practitioner assessed R1 and ordered an X-ray of R1's right knee. (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 2 Event ID: 145789 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 07/10/2025 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)