Inspection·June 22, 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 interviews and record review, the facility failed to follow its abuse policy to ensure one resident (R1) remained free from physical abuse by another resident (R2) in a sample of three reviewed. This failure resulted in R1 sustaining lacerations to the forehead and swelling to the left eye. findings include: R1 is an [AGE] year-old, originally admitted on [DATE] with medical diagnoses that include and are not limited to: Parkinson's Disease, senile degeneration of the brain, and Alzheimer's disease. Minimum data set (MDS) dated [DATE] reads: Cognitive Skills for daily decision making: severely impaired. Per abuse, neglect, exploitation, and trauma assessments dated: 10-31-2019 and 3-7-2025, read: high risk for abuse: R1 has a diagnosis of delusional disorder, gets easily annoyed with others, especially during care, and will push staff and yell. R2 is a [AGE] year-old, originally admitted on [DATE] with medical diagnoses that include and are not limited to: dementia unspecified severity, with other behavioral disturbance, anxiety disorder and non-st elevation myocardial infarction. Minimum data set (MDS) dated [DATE] reads Brief interview for mental status (BIMS), results read of 4/15 impaired cognition. Per abuse, neglect, exploitation and trauma assessments dated: 6-23-2023 and 3-14-2025, read: high risk for abuse: R2 has a diagnosis of dementia, anxiety and other psychotic diagnoses. On 6-22-2025 at 1:40 pm V14 (Registered Nurse) said, on 5-31-2025, I worked 3-11 and 11-7, I had in my assignment R1 and R2. R2 was in by the nurse station after dinner and told me: My son-in-law is the owner of this place, have everything ready, I am going home. I called R2's wife without an answer, R2 appeared to be more confused than normal. I took R2 to his room, and he went to bed without any concerns. he slept well. On 6-1-2025, at about 6:00 am I was passing my medications and I went into R1-R2's room. I did not see R2 in his bed; I looked in the bathroom since R2 can ambulate to the bathroom independently, but he was not there. The curtain between the beds was pulled, and I was not able to see R1's bed. I went towards R1 bed and I saw R2 standing next to R1's bed holding a pillow in his hand R2's, I asked R2 if everything was ok. R2 answer I am going to kill him. At that time, I noticed R1 had a left eye swelling and lacerations to the forehead; the injuries were new. R1 did not have them at 4:30 am when I saw R1 and R2 sleeping. I asked R2 what he was doing by R1's bed, but he did not answer me. I asked R2 to please come with me I asked him to sit down in his bed, I immediately removed R2 from R1's proximity. I called for help without leaving the room. I applied ice to R1's face since I noticed some swelling to the left eye and a laceration to the forehead. (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: 145835 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 145835 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bella Terra Wheeling 730 West Hintz Road Wheeling, IL 60090 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)