Inspection·December 2, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few status note dated 10/14/25 at 5:34 PM Late Entry; Resident fell at approximately 2:00 PM after attempting to sit back in wheelchair after getting bag of popcorn off table unassisted. Resident hit right side of head on dresser, no redness, swelling, or open areas noted. Resident did receive a skin tear to left wrist. This writer cleaned area, applied steristrips and bandage. No other areas of concern. R3's health status note dated 10/27/25 at 3:08 PM documents: At approximately 2:50 PM, resident fell to floor, landing on buttocks after attempting to stand. There is no apparent injury at this time.R3's health status note dated 10/31/25 at 5:36 AM documents: late entry: resident fell in room on buttocks while trying to get to bed from wheelchair at approximately 6:30 PM on 10/30/25 which was witnessed by staff. Staff denied resident hitting head. Resident has a small dime sized abrasion to hip area above the right buttock. No other injuries noted. R3's health status note dated 11/02/25 at 10:30 AM documents: nurse called to resident's room due to resident was on the floor. Upon entering R3's room R3 noted to be lying on his left side facing towards his window. His legs were out stretched, with the wheelchair to the back of his body. Resident assessed and denies any pain and is able to move all extremities without difficulty or pain and denies hitting his head. R3's health status note dated 11/4/25 at 5:29 PM documents: CNA informed this nurse that resident had an unwitnessed fall in large dining room. R3 states he fell out of his wheelchair but is unsure what happened. There are no injuries noted. R3's health status note dated 11/05/25 at 5:49 PM documents: late entry: at approximately 4:30 PM resident fell onto the floor while attempting to walk to get into his wheelchair from his bed. R3 received an abrasion/skin tear noted to right arm above the elbow. R3's health status note dated 11/09/25 at 2:19 AM documents: this nurse was down the hall when a CNA called writers name down the hall. This nurse walked down the hall and resident was noted to be lying on his back on the floor in front of his wheelchair. This nurse asked R3 what happened. R3 stated, I slid out of my wheelchair. This nurse assessed resident immediately. This nurse and 2 CNAs assisted resident back into his wheelchair and then into his bed for a full assessment. R3 does not complain of pain, just stated he was a little sore no injuries noted at this time. R3's health status note dated 11/11/25 at 3:39 AM documents: this nurse (V10 Licensed Practical Nurse/LPN) was notified by a CNA that resident was in the floor in his room. This nurse immediately went to assess resident. Upon entering the room resident was noted to be sitting up on the floor on his buttocks in front of his wheelchair. This nurse asked R3 what happened, R3 stated, yes I know what happened, I fell. This nurse and 2 CNAs assisted resident into his bed and full assessment performed. There were no obvious injuries noted upon assessment, no new skin issues related to the fall. R3 has no complaints of pain or discomfort at this time. R3's call light placed within reach and neuro checks initiated due to unwitnessed fall. R3's neuro checks were within normal limits. On 11/26/25 at 12:27 PM, R3 was laying in his bed moving his legs back and forth, his bed was not in a low position, there was no fall mat present, his wheelchair was a few feet from his bed. there was no nonskid mat in his wheelchair, just a black nylon type material cushion. There were no snacks or drinks on his bedside table. There were no nonskid strips anywhere in the room.On 11/26/25 at 12:27 PM, R3 stated he had to go to the bathroom, when asked by the surveyor if he could turn the call light on, R3 just laid there and stated he had to go to the bathroom. R3 would not activate the call light even with prompting.On 11/26/25 at 4:12 PM, R3 was lying in bed, his bed was not in the low position. R3's wheelchair was approximately three feet from his bed and did not have any bright colored tape on the chair, the wheelchair was black with a black and blue colored cushion in the wheelchair with the black side up. There was no nonskid mat in R3's wheelchair or anywhere noticeable in his room.On 11/29/25 at 3:33 PM, R3 was lying in his bed, the bed was in a low position and there was a fall mat next to the bed. R3's wheelchair was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145813 If continuation sheet Page 2 of 3 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 145813 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Metropolis Rehab & Hcc 2299 Metropolis Street Metropolis, IL 62960 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 approximately 3.5 feet from his bed and did contain a cushion in the wheelchair, there was no nonskid mat in the wheelchair. There were no snacks in R3's reach.On 11/29/25 at 3:50 PM V5 (CNA) stated she does not know too many of R3's fall interventions, some that she does know are keep his call light in reach and a fall mattress next to his bed. V5 stated, R3 will try to get out of his wheelchair sometimes and sometimes he'll slide out of his wheelchair.On 11/29/25 at 4:55 PM V4 (CNA) stated some of R3's interventions are: his bed should be in the low position, they keep his call light in reach but more often than not he does not use it even before he came back from the hospital. Now since he returned from the hospital he has not been as alert. R3 has also had a fall mat for a while.On 11/29/25 at 5:08 PM V3 (LPN)) stated R3 is not as alert now as he was prior to going to the hospital. V3 stated, earlier he was trying to throw his legs over the edge of the bed. V3 stated, they were able to catch him and gave him a snack and he seemed satisfied with that. V3 stated, the day he returned from the hospital he fell again. V3 stated, R3 does not use his call light very often if ever, V3 stated, he did not use it very often if ever prior to going to the hospital either. V3 stated, with his ammonia levels, his confusion is just going to get worse. V3 stated, when R3 returned from the hospital they moved him from the 200 hall to the 300 hall. V3 stated, the 200 hall has more staff walking up and down that hall. On 11/30/25 at 9:30 PM, V7 (Registered Nurse) stated R3 is not doing as well since he returned from the hospital. V7 stated, R3 would propel himself in his wheelchair with his feet mainly. V7 stated, she would imagine the intervention in the care plan should have been to keep his bed in the low position when in bed. R3 stated, she would believe the 200 hall is the most well traveled hall by staff. V7 stated, she would not expect a resident with confusion that is a high fall risk to be left unsupervised in any dining room.On 12/01/25 at 7:35 PM V11 (CNA) stated they would toilet R3 every two hours and take him to activities to help keep him busy. V11 stated, R3 thought he could do more than he thought he could, R3 did have knee replacement not too long ago. V11 stated, she does not remember R3 using his call light. V11 stated, she does not remember ever seeing any bright colored tape on R3's wheelchair.On 12/2/25 at 5:01 PM, V2 (Director of Nursing) stated when they have a resident with falls they would after each fall, investigate the root cause of the fall, find an appropriate intervention and put that intervention in place. V2 stated, she would expect the interventions that were initiated would be put into place and utilized. On 12/02/25 at 5:01 PM, V2 stated the facility does not have a fall policy. Event ID: Facility ID: 145813 If continuation sheet Page 3 of 3