Inspection·March 24, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a resident was free from physical abuse for 2 of 3 residents (R1, R2) reviewed for abuse in the sample of 6. This failure resulted in R1 being kicked in the genitals and R2 being pushed to the ground and sustaining a fracture of his left femur. The findings include: R1's face sheet showed he was admitted to the facility 4/23/2021 with diagnoses to include acute kidney failure, obstructive uropathy, benign prostatic hyperplasia, and major depressive disorder. R1's medical record showed he had an inguinal hernia repair 3/13/25 and could return to normal activity 3/17/25. R1's 2/17/25 assessment showed he has no cognitive impairment and exhibits no behaviors. On 3/22/25 at 10:12 AM, R1 was sitting in his room watching television. R1 was calm and pleasant. R1 declined to discuss the incident with the surveyor. R1's 3/20/25 Nursing Progress Note showed, Resident [R1] states [R2] kicked him, and he pushed him back and resident [R2] fell down. [R2] denied all treatment and said he was not hurt. R2's face sheet showed he was admitted to the facility 6/19/23 with diagnoses to include alcohol dependence, epilepsy, Wernicke's encephalopathy, and mood disorder. R2's facility assessment dated [DATE] showed he has severe cognitive impairment and exhibits hallucinations and delusions. R2's care plan initiated 3/14/24 showed, The resident requires psychotropic medication to help manage and alleviate: Agitation and aggressive behavior . R2's 3/22/25 Nursing Progress Note showed, Late entry on 3/20/25, I heard an altercation went to observe resident laying on the floor when resident tried to sit notice his left leg was awkwardly placed. 911 called and the DON (Director of Nursing), ED (Emergency Department) and brother, other resident stated that resident kicked him, and he pushed him back. R2's acute care hospital notes dated 3/20/25 showed, . CT (Diagnostic Scan) of the left hip showed: Displaced fracture of the proximal femoral shaft . On 3/22/25 at 10:15 AM, V3 CNA (Certified Nursing Assistant) said, . [R2] gets confused and doesn't understand why he is here. [R2] is ambulatory and roams the halls . He gets aggressive with other residents but usually just verbally . If you don't intervene fast enough a fight could start because he won't back down from anybody . (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: 145818 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 145818 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rock River Health Care 707 West Riverside Boulevard Rockford, IL 61103 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)