Health inspection·March 1, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 record review and interview the facility failed to protect a resident from resident-to-resident verbal abuse for one of three residents (R3) reviewed for abuse in the sample of seven. Findings include: The facility's Abuse Prevention and Reporting policy dated 09/2024 documents, This facility affirms the right of our resident to be free of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental, and psychosocial well-being. Verbal abuse may be considered to be a type of mental abuse. Verbal abuse included the use of oral, written, or gestured communication, or sounds, to residents within hearing distance, regardless of age, ability to comprehend, or disability. R3's MDS (Minimum Data Set) assessment dated [DATE] documents R3 is cognitively intact. R3's current Care Plan documents R3 has verbal aggression with staff and peers. R3's Nursing Note dated 2-8-25 at 1:01 AM and signed by V4 (Licensed Practical Nurse/LPN) documents, (V4) witnessed (R4) making rude comments to (R3) as (R3) walked down the long hall on (name of hallway). (R3) stated that she felt threatened by (R4's) comments so (R3) walked down to her room grabbed her cellphone and dialed 911. The police arrived and spoke with both residents (R3 and R4) that were involved in the verbal altercation. R3's Social Service Note dated 2-13-25 at 12:38 PM and signed by V7 (Social Service Director) documents, (R3) reported that (R4) Cussed (R3) out in the dining room. R4's MDS assessment dated [DATE] documents R4 is cognitively intact. R4's current Care Plan documents R4 has the potential to be verbally aggressive related to ineffective coping skills and poor impulse control. R4's Social Service Note dated 2-11-25 at 1:28 PM and signed by V7 (Social Service Director) (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: 145811 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 145811 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Peoria Heights 1629 East Gardner Lane Peoria Heights, IL 61616 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)