Inspection·January 24, 2024

F 0550 Level of Harm - Actual harm Residents Affected - Few stop at least 10-15 times and said, I've told you before that I (R3) don't like that but V6 wouldn't turn it down. V6 started yelling at R3, telling R3 I'm the nurse and you (R3) are going to die. V5 reports that V14 CNA was approximately 100 feet away, and overheard V6 yelling at R3 so V14 came down the hall to see what was going on. V5 stated at that point V5 left the room to report an abuse allegation. After the phone call and on the way back to R3's room, V6 was outside of R3's room throwing things and kicking the medication cart. V6 then came back into R3's room and shoved an inhaler in R3's mouth. R3 told V6 I don't want that; I need a nebulizer but V6 instructed R3 to open R3's mouth. R3 was sitting up on the side of the bed at this point and V6 started hitting R3 on the back 4-5 times, like you would a baby. R3 instructed V6 to stop because V6 was hurting R3 but he continued to do it a couple more times. V5 stated, I'm not sure if that is abuse or not but to me(V5), when you ask to stop being touched and someone continues to do it, that is a problem in my eyes! V5 stated another incident happened on 1/20/24. V5 explained R3 was in respiratory distress with an oxygen level in the 70's and V6 did the same thing and turned the oxygen up to 10 L. R3 was fearful, V6 was not listening to R3. At that point on 1/20/23, R3 was sent to the hospital. V5 reports that R3 asked V5 not to let V6 touch R3 because R3 was not comfortable with how V6 treated R3. V6 made R3 do the inhaler, and nebulizer before V6 would even call to send R3 to the hospital, even though R3 kept requesting to be sent. V5 exclaimed, all I know is I'm very concerned about resident safety due to having a nurse that is doing questionable things. On 1/22/24 at 8:56 pm, V13 CNA stated R3 told V13 that R3 felt unsafe with V6 due to V6 turning R3's oxygen up to 10 L and then walking away, on 1/20/24. V13 explained, it's been over 24 hours now and R3 still feels unsafe and is requesting a CNA in the room with R3 whenever V6 is in there. V13 stated R3 told V13 that V6 was shoving pills down (R3's) throat, inhaler in (R3's) mouth when (R3) wasn't wanting the stuff. On 1/22/24 at 9:34 pm, V14 CNA confirmed V5's above statement of events. V14 also stated R3 reported to V14, that on a different night, R3 was having breathing trouble and had requested a nebulizer but instead V6 turned up R3's oxygen, then told R3, I (V6) told you (R3); you were going to be okay. V14 stated R3 has told V14 that R3 don't like or trust (V6) and has requested a CNA be with R3 anytime V6 has to go into R3's room. On 1/23/24 at 1:24 pm, V6 stated V6 has had a couple incidents with R3 where R3 was having breathing issues and refusing care/treatment. V6 explained, when an oxygen level is in the 50's, without treatment (R3) will die and (R3) wasn't wanting anything other than a nebulizer but I (V6) did both the nebulizer and inhaler, turned up (R3's) oxygen and then (R3) was fine. V6 explained V6 was frustrated. V6 stated after the first incident on 1/18/24, V6 was told the customer is always right and to basically do what they ask so a couple of days later, (R3) was short of breath again and (R3's) {oxygen} levels were again in the 50's and she was wanting to go to the hospital so V6 sent R3 to the hospital after giving R3 an inhaler, nebulizer and increasing R3's oxygen to 10 L. R3's Hospital History and Physical dated 1/20/24 by V27 Hospital Physician documents R3 has a history of COPD is on 3-4 L oxygen at baseline, presents with a chief complaint of feeling short of breath. R3 reports a new male nurse was putting R3's CPAP on and cranked it up to 10L which was very uncomfortable for R3, causing R3 to feel more short of breath however this has since improved. R3 received two breathing treatments per EMS (Emergency Medical Services) in route to the hospital as well as Solu-Medrol {Steroid} 125 mg (milligrams). R3 reports R3 is now breathing at R3's baseline. R3 was not having any of this breathing distress prior to improper management of the CPAP. R3 is upset at this male nurse for cranking up the CPAP to a very high setting, which caused R3 to feel like R3 could not breathe. Symptoms have resolved and the episode was likely related to anxiety after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 2 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0550 inappropriate CPAP use. Level of Harm - Actual harm The facility's Residents' Rights for People In Long Term Care Facilities dated November 2018 documents; you have a right to make your own decisions, your facility must treat you with dignity and respect and must care for you in a manner that promotes quality of life, you have the right to request, refuse, and/or discontinue any treatment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 3 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect a resident from potential further abuse during an abuse investigation for one of four residents (R3) reviewed for respiratory care in the sample list of six. Residents Affected - Few Findings Include: R3's MDS dated [DATE] documents R3 is alert and oriented. On 1/22/24 at 7:30 pm, R3 stated V6 had turned R3's oxygen up too high last week and would not listen to R3 about turning it down so V5 CNA (Certified Nursing Assistant) ended up reporting it to V1 AIT (Administrator in Training). R3 stated R3 is still waiting to talk to V1 about it. On 1/22/24 at 8:05 pm, V5 CNA (Certified Nursing Assistant) stated on 1/18/24 around 9:15 pm there was a situation between V6 Agency RN (Registered Nurse) and R3 that occurred with V5 and V17 CNA present which resulted in V5 and V17 both reporting an allegation of verbal/mental abuse to V1 AIT (Administrator in Training). V5 stated actually the allegation was reported to V1 by four different staff members, all whom had witnessed a part of it. V5 stated V6 was roughly providing cares to R3, not listening to R3's wishes, then started yelling at R3. V5 stated V6 then forcefully lifted R3 from a lying position to a sitting position and started hitting R3 on the back. V5 explained that V6 was the only nurse in the facility at the time but V1 instructed V6 to clock out and leave the unit pending the investigation. V5 stated V1 talked to all staff that were present, over the phone, but did not come into the facility and talk to any residents about the allegation, then allowed V6 back onto the floor to continue R6's job duties. On 1/23/24 at 9:34 am, V1 stated the abuse investigation was still ongoing and had not been completed yet. At this time, V1 provided the in progress abuse investigation folder that contained witness statements from staff but nothing from residents, along with the initial report to IDPH (Illinois Department of Public Health). On 1/23/24 at 12:23 pm, V1 stated the abuse allegation was made on Thursday, 1/18/24 and the initial sent in. At that time, V6 was asked to clock out pending an investigation and was off the floor for 30-40 minutes. V1 stated V1 had talked to all staff witnesses over the phone and found that abuse did not happen so V6 was allowed back to work. V1 stated V1 did not talk to R3 or any other potential resident witness until today, 5 days after the incident. On 1/23/24 at 1:24 pm, V6 confirmed the incident/alleged abuse between R3 and V6 and that V1 instructed V6 to leave the unit. V6 stated V6 was only suspended/off the unit for 30-45 minutes before V6 was informed by V1 that V6 could return to work. V6 stated V6 also worked every day following, getting off work the morning of 1/22/24. The facility January 2024 Nursing Schedule documents V6 was scheduled and worked as the only nurse in the facility 1/18/24 - 1/21/24, from 6:00 pm - 6:00 am. The facility's Abuse Prevention Program dated 11/28/2016 documents the facility will take steps to prevent mistreatment, exploitation, neglect and abuse of residents and misappropriation of resident property while the investigation is underway. Employees of this facility who have been accused of mistreatment, exploitation, neglect, abuse or misappropriation of resident property will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 4 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0610 Level of Harm - Minimal harm or potential for actual harm immediately removed from resident contact until the results of the investigation have been reviewed by the administrator or designee. Employees accused of alleged mistreatment, exploitation, neglect, abuse or misappropriation of resident property shall not complete their shift as a direct care provider to residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 5 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to complete wound assessments, complete wound treatments as ordered, perform hand hygiene to prevent cross contamination of the wound, and notify the physician of not having treatment supplies for two of three residents (R5, R6) reviewed for wounds in the sample list of six. Residents Affected - Few Findings Include: The facility's Skin Condition Monitoring Policy dated January 2002 documents upon notification of a skin lesion, wound, stasis ulcer, or other skin abnormality, the charge nurse will assess and document the findings. Any skin abnormality will have a specific treatment order for frequency. Documentation of the skin abnormality must occur upon identification and at least weekly thereafter until the area is healed. Documentation of the area must include the following: characteristic: size, shape, depth, color and presence of granulation tissue or necrotic tissue, the treatment and response to treatment, and prevention techniques. The facility's Hand Hygiene Policy dated 12/7/18 documents all staff will wash hands, as washing hands as promptly and thoroughly as possible after resident contact and after contact with blood, body fluids, secretions, excretions and equipment or articles contaminated by them is an important component of the infection control and isolation precautions. The facility's Notification for Change in Resident Condition or Status Policy dated 12/7/17 documents the nurse supervisor/charge nurse will notify the resident's attending physician or on-call physician when there has been a need to alter the resident's medical treatment. The facility's Dressing Change Policy dated July 2007 documents to set up a clean area for supplies, wash hands, apply gloves, remove soiled dressing, remove and discard soiled gloves, wash hands, open dressing packages, put on gloves, cleanse the wound per physician orders, apply the ordered treatment using an applicator, tongue blade, cotton ball or gauze square, apply the dressing without touching the wound or side of dressing, secure the dressing, remove your gloves and discard in a plastic bag, wash hand. If there are multiple wounds, change each dressing separately to avoid contamination from one site to the other. 1. R5's admission assessment dated [DATE] documents Vascular wounds to the right and left lower leg but there is no assessment of the wound(s); size, shape, drainage, peri wound condition, wound bed condition, etc. R5's Progress Notes from 1/10/24 - 1/22/24 do not document the characteristics of the wound(s). The facility's ongoing Weekly Wound Tracking sheets do not document any wound measurements since R5 was readmitted to the facility from the hospital on 1/10/24. R5's January 2023 Physician Orders document an order for contact isolation due to LLE (Left Lower Extremity) MDRO (Multidrug Resistant Organisms) with a treatment order of Cleanse LLE wound with normal saline or sterile water, pat dry and apply petroleum gauze then alginate ag {with silver}, cut to size of the wound bed and cover with a thick absorbent pad and wrap with rolled gauze every Monday, Wednesday, Friday and PRN (as needed). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 6 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0684 Level of Harm - Minimal harm or potential for actual harm R5's Wound Culture Result dated 12/28/23 documents Pseudomonas Aeruginosa, Methicillin Resistant Staph Aureus (MRSA) and Enterococcus Faecalis in exudate of a non-documented site. Attached to the Culture Results is a Hospitalist History and Physical Report dated 1/5/24 that documents R5 has lymphedema with left lower extremity leg ulcer with MRSA infection, Blood cultures were negative however wound culture grew heavy Pseudomonas, Scant MRSA, and Scant Enterococcus. Residents Affected - Few On 1/22/24 at 12:40 pm, V4 LPN (Licensed Practical Nurse) and V28 CNA (Certified Nursing Assistant) gathered needed supplies to complete R5's wound treatment. At this time, V4 stated R5's right leg is healed so the facility is only applying lotion to the area but the left leg remains open. V4 also stated R1 has MRSA in the left leg wound, and that last week, the facility ran out of the alginate ag and was having to use regular alginate. V4 stated V11 Wound NP (Nurse Practitioner) was not notified of R5's right leg being healed, and that they were no longer doing the ordered dressing, or that the facility ran out of the alginate with silver and was using regular alginate. After donning PPE (Personal Protective Equipment), V4 and V28 entered room entered R5's room. V4 sat gathered supplies on top of a over bed table without cleaning or disinfecting/sanitizing it. R5 was lying in bed with R5's LLE wrapped in gauze from R5's toes to R5's mid-shin. The gauze was saturated with yellow colored drainage that had soaked through to the bedding. V4 donned gloves and used one pair of scissors to cut off the soiled dressing. R5's entire lower left leg, from mid-shin/calf to the toes was a reddish purple color with a large open area to the shin, inner ankle and top of the foot. The ankle and top of the foot wounds were both superficial with a red wound base. V4 stated those were blisters that had popped. The large area to the front of the shin was approximately 0.1 cm deep with multiple deeper areas that were covered in white/tan colored slough. V4 explained the facility doesn't normally measure R5's wounds, that V11 does that but since V11 hasn't been to the facility since R5 returned from the hospital, V4 would measure them. R5's shin wound measured 15 cm (centimeters) by 12 cm. The ankle measured 5.5 cm by 8 cm. The foot measured 4.5 cm by 8 cm. All wounds were measured without changing gloves or performing Hand hygiene between going from wound to wound. After all wounds were measured, V4 changed gloves and performed hand hygiene, then redonned gloves and proceeded to cleanse all wounds while wearing the same gloves and without hand hygiene. After the wounds were cleansed, V4 washed V4's hands and donned a clean pair of gloves. V4 dried each wound, again without changing gloves or performing hand hygiene between wounds. V4 changed gloves and washed hands then used a new pair of scissors to cut the alginate and placed it over each open wound then cut the petroleum gauze and placed it over the alginate. A piece of petroleum gauze fell to the floor and there was not more in the room so V4 opened the room door, dug around in V4's uniform pocket for keys to the treatment cart, which was in the hall outside of resident's room, opened the treatment cart to obtain more petroleum gauze then re-entered R5's room and proceeded to open the package, cut the gauze and apply it to the wound without changing gloves or performing hand hygiene. V4 then applied the thick absorbent pad over the primary dressings then wrapped the leg/foot with rolled gauze. V4 ran out of gauze. V4 removed gloves, washed hands, reapplied gloves and then opened the room door, dug around in V4's uniform pocket for the keys to the treatment cart, obtained another roll of gauze, re-entered R5's room and completed the dressing without changing gloves or performing hand hygiene. Once V4 finished with the treatment to R5's left leg, V4 instructed V28 to apply lotion to R5's right leg. which V28 did. R5's right leg was discolored a dark brown/purplish color from the mid-shin down to the toes, but the skin was intact. On 1/22/23 at 2:45 pm, V4 stated V4 spoke to V11 to get the treatment order clarified and the petroleum gauze was to have been applied first, just the way the treatment was written, then the alginate on top of that so I guess I did it wrong. V4 stated V4 forgot to update V11 about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 7 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0684 facility running out of the alginate ag last week. Level of Harm - Minimal harm or potential for actual harm 2. R6's January 2024 Physician Orders document an order to cleanse the skin tear to the left anterior leg with normal saline or sterile water, apply petroleum gauze to the wound bed, and cover with dry clean dressing daily. Residents Affected - Few R6's Medical record did not contain any wound assessments or documentation regarding R6's left shin wound. The facility's ongoing Weekly Wound Tracking Report last dated 1/10/24 documents R6 has a skin tear to the left shin measuring 6.5 cm (centimeters) by 1.5 cm by 0.1 cm. On 1/22/24 at 2:25 pm, V4 LPN and V12 CNA entered R6's room to complete the ordered dressing change. R6 was lying in bed with an island dressing to the left shin. V4 washed hands, donned gloves and removed the dressing. V4 removed gloves, washed hands and reapplied gloves, then cleansed the wound with normal saline. After cleaning the wound, V4 measured R6's wound per request. The wound measured 6.5 cm by 1.0 cm. V4 changed gloves, but did not wash V4's hands, then pulled a pair of scissors out of V4's uniform pocket and proceeded to cut the petroleum gauze with them and apply the gauze to the wound. V4 then Changed gloves but did not wash V4's hands then retrieved a pen from V4's uniform pocket to date the island dressing then applied it to the wound. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 8 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm Based on observation, interview and record review, the facility failed to notify the physician of a pressure ulcer to obtain an appropriate wound treatment, assess and document the pressure ulcer, notify the resident representative of a pressure ulcer and prevent cross contamination of the wound during a treatment for one of three residents (R2) reviewed for wounds in the sample list of six. This failure resulted in R2's MASD (Moisture Associated Skin Damage) progressing to an unstageable pressure ulcer. Residents Affected - Few Findings Include: R2's ongoing diagnoses listing documents R2 has TBI (Traumatic Brain Injury), Morbid Obesity, and Hemiplegia and Hemiparesis following unspecified Cerebrovascular Disease affecting Right Dominant Side. On 1/22/23 at 11:22 am, V10 (R2's POA (Power of Attorney) stated R2 was at the hospital on 1/21/23 and the nurse there said R2 has an open area on R2's buttocks. V10 also stated the nurse reported R2 also has another big area that is ready to break open. V10 stated V10 had never been notified by the facility that R2 had any wounds. R2's Hospital Notes dated 1/22/24 at 1:01 am document R2 has a 1 cm (centimeter) open sore to the coccyx, and a reddened area below the coccyx that is not yet open. The facility's ongoing Weekly Wound Tracking Form documents on 1/3/24 and 1/10/24, R2 had MASD to the buttocks but does not document any characteristics of the area. Wound Assessment and Plan Notes by V11 Wound NP (Nurse Practitioner) for R2 document the following: 1/3/24 -Initial visit for MASD to buttocks with onset date of 1/3/24. Peri wound Macerated with Minimal exudate. Treatment Order: cleanse area, pat dry well. Apply an Antifungal powder and a zinc barrier Cream 20% or greater apply every shift and PRN (as needed). This area has a fungal appearance to it with redness, scalloped edges and satellite lesions noted. 1/10/24 - discontinuing the Antifungal powder, new treatment is for zinc barrier cream 20% or greater every shift and PRN. Neither of the Wound Assessment and Plan Notes include measurements of the MASD area. On 1/22/24 at 2:55 pm, V4 and V7 BOM (Business Office Manager)/CNA (Certified Nursing Assistant) entered R2's room to complete the ordered treatment. R2 was rolled to the side and upon removing R2's brief, R2's entire buttocks was caked in a thick white substance with a flaky appearance. V4 attempted to cleanse the area with Normal Saline but the substance would not come off. V4 then had to use a washcloth with soap and warm water to remove the substance and stated, it looks like someone put zinc and Nystatin {Antifungal} on (R2). V4 explained, R2 use to have an order for that but now we are just to use zinc. After the substance was cleansed off, R2 had three different open areas to the buttocks area that V4 measured. The left buttocks had a 0.5 cm by 0.7 and approximately. 0.1 cm deep open area. The wound bed was not visible as it was covered in yellow slough (unstageable). V4 stated that was not there last week so it must have just developed over the last couple of days. R2 also had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 9 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0686 Level of Harm - Actual harm Residents Affected - Few an area to the left inner buttocks measuring 6.5 cm by 0.6 cm that V4 stated is a self inflicted scratch, that was scabbed over. On the right buttocks, R2 had a 7.2 cm by 4.4 cm superficial open area, in the middle of larger reddened/discolored area, with a beefy red wound base. V4 applied the zinc ointment, which was pink in color, with V4's gloved finger to all three open areas, without changing gloves or performing hand hygiene between wounds. V4 stated V11 will be at the facility on 1/24/24, and that R2's treatment will need changed as zinc is not an appropriate treatment for an unstageable pressure ulcer. At this time, V4 stated the facility don't measure wounds generally, we just go by what the wound provider documents. V4 stated V4 does not know if we are supposed to or not explaining, I'm the only facility nurse and we have no DON, so there is no guidance. As of 1/24/24, R2's Progress Notes do not document V10 was notified of the MASD on 1/3/24 or any changes to R2's skin condition since then. These notes also do not document that V11 Wound NP (Nurse Practitioner) was notified of the MASD progressing to an unstageable pressure ulcer or to get a new treatment order. On 1/24/24 at 1:00 pm, V25 MDS (Minimum Data Set)/Care Plan Coordinator stated when a resident develops a wound or the condition of the wound deteriorates, the staff should be calling the physician to obtain a new treatment order, not wait until they are in the facility. V25 also stated wounds should be monitored and documented on at least once a week and families should be notified of a new and/or worsening wound. The facility's Decubitus Care/Pressure Areas Policy dated May 2007 documents this policy is to ensure a proper treatment program has been instituted and is being closely monitored to promote the healing of any pressure ulcer, once identified. Upon notification of skin breakdown, a newly acquired skin condition report will be completed and forwarded to the Director of Nursing. The pressure area will be assessed and documented on the Treatment Administration Record. Documentation should include size, stage, site, depth, drainage, color, odor, and treatment (upon obtaining from the physician). Notify the physician for treatment orders. Documentation of the pressure area must occur upon identification and at least once each week on the TAR (Treatment Administration Record). Re-evaluate the treatment for response at least every two to four weeks. Most pressure areas will respond to treatment in this amount of time. If no improvement is seen, contact the physician for a new treatment order. The facility's Dressing Change Policy dated July 2007 documents to apply topical medication per physician's order using an applicator, tongue blade, cotton ball or gauze square. The facility's Notification for Change in Resident Condition or Status documents to promptly notify the appropriate individuals including but not limited to the physician and resident guardian if there is a significant change in the resident's physical/emotional/mental condition and the need to alter the resident's medical treatment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 10 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Actual harm Based on observation, interview and record review, the facility failed to follow physician orders for respiratory care including oxygen, BiPAP and C-PAP usage, change oxygen tubing and humidifier bottles as ordered and document resident complaisance/non-compliance of respiratory care for four of four residents (R1, R2, R3, R4) reviewed for respiratory care in the sample list of six. This failure resulted in psychosocial harm of R3. R3 was sent to the hospital after having a panic attack and remains fearful of facility staff's action related to R3's respiratory care. Residents Affected - Few Findings Include: 1. R3's January 2023 Physician Orders document the following orders: oxygen at 2-5 L (liters) per NC (Nasal Cannula) or vented mask, change oxygen tubing and humidifier once a week (scheduled for Sundays), and BiPAP (BiLevel Positive Airway Pressure) with 6 LPM (liters per minute) oxygen bled into it. R3's ongoing diagnoses list includes the following diagnoses: COPD (Chronic Obstructive Pulmonary Disease), Chronic Respiratory Failure with Hypoxia, Dependence on Respirator or Ventilator, and Dyspnea. R3's MDS (Minimum Data Set) dated 12/24/24 documents R3 is alert and oriented. On 1/22/24 at 8:50 am, R3 is asleep in bed wearing oxygen but not the BiPAP. Oxygen is running at 3.5 L/NC and the BiPAP machine is sitting on the overbed table. The oxygen tubing and humidifier bottle are not dated. On 1/22/24 at 7:30 pm, R3 was lying awake in bed with oxygen running at 4.5 L/NC. R3 stated since getting the new BiPAP machine on 1/19/24, R3 has only had it on once because you can't find anyone to put it on you correctly. R3 explained, something is not right with it, and it makes my oxygen levels drop. R3 also stated over the weekend, V6 Agency RN (Registered Nurse) cranked R3's oxygen level up to 10 L/NC because R3 was short of breath. R3 reports R3 told V6 to turn the amount of oxygen down but V6 wouldn't. R3 stated, R3 ended up going to the emergency room because of this. R3 started getting real anxious; shaking and increased respirations with the use of accessory muscles when talking about the incident. R3 stated this has happened twice now and because of V6's actions, R3 does not want V6 in R3's room or taking care of R3 without someone else in here to be a witness, he (V6) scares me (R3). R3's January 2023 MAR/TAR (Medication Administration Record/Treatment Administration Record) does not document that R3's oxygen tubing or humidifier were changed as ordered on 1/7/24 and 1/14/24. This MAR/TAR also documents R3 has used the BiPAP daily other than 1/14/24 and 1/19/24, it is signed out as refused. On 1/23/24 at 1:24 pm, V6 confirmed R3 had breathing problems on 1/20/24 and V6 turned R3's oxygen up to 10L/NC and sent R3 to the hospital per R3's request. R3's Hospital History and Physical dated 1/20/24 by V27 Hospital Physician documents R3 has a history of COPD is on 3-4 L oxygen at baseline, presents with a chief complaint of feeling short of breath. R3 reports a new male nurse was putting R3's CPAP on and cranked it up to 10L which was very uncomfortable for R3, causing R3 to feel more short of breath however this has since improved. R3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 11 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0695 Level of Harm - Actual harm Residents Affected - Few received two breathing treatments per EMS (Emergency Medical Services) in route to the hospital as well as Solu-Medrol {Steroid} 125 mg (milligrams). R3 reports R3 is now breathing at R3's baseline. R3 was not having any of this breathing distress prior to improper management of the CPAP. R3 is upset at this male nurse for cranking up the CPAP to a very high setting, which caused R3 to feel like R3 could not breathe. Symptoms have resolved and the episode was likely related to anxiety after inappropriate CPAP use. 2. R2's ongoing diagnoses listing documents R2 has TBI (Traumatic Brain Injury), Morbid Obesity, Hemiplegia and Hemiparesis following unspecified Cerebrovascular Disease affecting Right Dominant Side, Acute and Chronic Respiratory Failure with Hypoxia, and Sleep Apnea. R2's January 2023 Physician Orders document the following orders: BI-PAP wear while sleeping as resident tolerates/allows. Maintain BI-PAP pressures at 20/10 cm (centimeters) H2O (water) and maintain E-PAP (Expiratory Positive Airway Pressure) Rate at 14. Bleed oxygen in at 3L oxygen per minute, oxygen at 2-6 L/minute, document when resident refuses the BiPAP and change oxygen tubing and humidifier weekly (scheduled for Sundays). On 1/22/24 at 8:30 am, R2 was sitting up in bed wearing oxygen running at 3 L/NC. The tubing and humidifier were not dated. The facility's ongoing Grievance Log documents grievances by V10 (R2's POA (Power of Attorney)) on 1/4/24 and 1/10/24 for the facility not applying R2's BiPAP when R2 is sleeping. R2's January 2024 MAR/TAR does not document that the oxygen tubing or humidifier were changed on 1/7/24 or 1/14/24. This MAR/TAR does not document if R2 wore or refused R2's BiPAP on 1/2/24, 1/3/24, 1/14/24 and documents it was refused only on 1/15/24, 1/16/24 and 1/17/24. On 1/22/24 at 11:22 am, V10 stated the facility is not putting R2's machine on R2 at night and when R2 is sleeping. V10 explained, the facility will ask R2 to put it on when R2 is awake, which R2 will not do but that V10 has instructed the facility staff on several occasions to put it on R2 after R2 falls asleep. V10 stated the facility is telling V10 they put it on R2 but V10 has never seen it on R2, even though V10 comes to the facility, at all hours of the day/night. I (V10) fear for (R2's) life because it is nothing but lies. They aren't caring for (R2) as they should. V10 also stated on 1/21/24 around 12:00 am, V10 came to the facility to check on R2 because V10 and R2 had been talking on the phone and R2 was very short of breath. Upon arriving, V10 observed R2's oxygen being unplugged, therefore R2 was not getting any oxygen. R2 was very short of breath and R2's oxygen level was in the 70's. V10 stated that once V6 Agency RN (Registered Nurse) plugged the oxygen in again, R2's oxygen levels began to raise back into the 90's%. V10 explained that during the time without oxygen, R2 was so out of it, (R2) couldn't even tell me (V10) that (R2) wasn't getting oxygen. On 1/22/24 at 4:22 pm, V6 stated R2 is supposed to wear oxygen all the time. V6 confirmed on 1/21/24, R2's oxygen tubing had come disconnect from concentrator so R2 was not getting oxygen. V6 does not know how long R2 had been without the oxygen. On 1/22/24 at 9:15 pm and 10:40 pm, R2 was asleep in bed with oxygen running at 4L/NC but was not wearing the ordered BiPAP. On 1/23/24 at 12:20 pm, 12:45 pm, 1:18 pm, 1:51 pm and 2:08 pm, R2 was asleep in bed without the ordered BiPAP in place. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 12 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0695 On 1/23/24 at 1:24 pm, V6 confirmed V6 works the night shift on Sunday's when the oxygen tubing and humidifiers are to be changed. V6 stated V6 has never done that but should have, V6 was just too busy. Level of Harm - Actual harm Residents Affected - Few On 1/24/24 at 8:51 am, V10 stated V10 arrived at the facility at 2:15 pm on 1/23/24. V10 explained R2 was asleep in bed at that time without the BiPAP in place. 3. R4's MDS (Minimum Data Set) dated 1/10/24 documents R4 is alert and oriented. R4's ongoing diagnoses listing contains the following diagnoses: Unspecified Asthma with Exacerbation, Acute Respiratory Failure with Hypoxia, Cerebral Palsy, and COPD (Chronic Obstructive Pulmonary Disease). R4's January 2024 Physician Orders document an order for oxygen at 2-5 L/NC as needed to keep SPO2 levels above 90% and to change the oxygen tubing and humidifier bottles weekly (scheduled for Sundays). R4's January 2024 MAR/TAR does not document that the oxygen tubing or humidifier bottle was changed on 1/7/24 and 1/14/24. On 1/22/24 at 8:50 am, R4 was lying in bed with oxygen running at 5L/NC. The tubing and humidifier bottle were not dated. On 1/22/24 at 9:45 am, R4 was sitting up in the wheelchair by the Nurses Station wearing oxygen at 3L/NC. At this time, R4 stated R4 uses oxygen at 3L/NC. When questioned about the oxygen being at 5L/NC earlier this morning, R4 stated that is what happens when V6 Agency RN (Registered Nurse) works. (V6) always turns it way up, saying it will help me (R4). (V6) had it turned up to 10 at one point and I (R4) told him he had to turn it down. R4 explained, R4 has COPD so having oxygen that high doesn't help, it hurts me. R4 said V6 did that a could of days ago too. On 1/22/24 at 4:35 pm, V6 stated when someone has COPD, they aren't supposed to have high oxygen levels but over V6's 30 years of being a nurse and practicing, V6 has found that if you bump up the oxygen when someone is having difficulty breathing and give them some breathing treatments then bring the oxygen back down it helps them. V6 stated R4 was having difficulty breathing so V6 bumped R4's oxygen level up. V6 does not recall how high V6 turned it up to, but it could have been up to 10 L. On 1/23/24 at 1:24 pm, V6 confirmed V6 works the night shift on Sunday's when the oxygen tubing and humidifiers are to be changed. V6 stated V6 has never done that but should have. 4. R1's January 2024 Physician Orders document an order for Oxygen at 2 L per nasal cannula to maintain oxygen level above 90%, change oxygen tubing and humidifier bottle weekly (scheduled on Sundays), and CPAP nightly as resident tolerates/allows. Bleed oxygen in at 2 LPM. On 1/22/24 at 8:30 am, R1 was lying in bed with an oxygen concentrator next to the bed. The concentrator was hooked up to the CPAP machine. There was no water in the undated humidifier bottle and the oxygen tubing was not dated. R1 stated R1 uses the CPAP machine every night but doesn't need to use oxygen during the day anymore. R1's January 2024 MAR/TAR does not document the ordered CPAP was worn on 1/2/24 and 1/14/24 or a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 13 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0695 reason why it wasn't. This MAR/TAR also does not document that the oxygen tubing and humidifier changed were changed on 1/7/24 and 1/14/24. Level of Harm - Actual harm Residents Affected - Few On 1/23/24 at 1:24 pm, V6 confirmed V6 works the night shift on Sunday's when the oxygen tubing and humidifiers are to be changed. V6 stated V6 has never done that but should have. The facility's Oxygen Therapy Policy dated March 2019 documents oxygen is administered to promote adequate oxygenation and provide relief of symptoms of respiratory distress. Oxygen may be used provided there is a written order by the physician. The order must state liter flow per minute, mask or cannula, and the time frame to be used. Oxygen tubing/mask/cannula are to be changed weekly. If humidification is indicated, document changes and cleaning of them on the treatment sheet at the time of the occurrence. The facility's undated Nursing Documentation Guidelines documents when a treatment is refused, the staff needs to document: the date and time the treatment was attempted, the residents response and reason for refusal, name of the person attempting to administer the treatment, document that the resident was informed of the purpose of the treatment and the consequences of not receiving the treatment, all pertinent observations, and the date and time the physician was notified, as well as the physicians response. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 14 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to have 24 hour a day nurse coverage and failed to have enough nurse staffing to ensure medications were administered as ordered. This failure has the potential to affect all 30 residents who reside at the facility. Findings Include: R5's MDS (Minimum Data Set) dated 1/12/24 documents R5 is alert and oriented. On 1/22/24 at 9:36 am, R5 stated sometimes our night medications are late. Last Thursday night (1/18/24), I (R5) don't know what happened but they {staff} said the nurse wasn't available and then last night, the same nurse had to send someone to the hospital so my 8:00 pm medications weren't given to me until about 12:00 am. R3's MDS dated [DATE] documents R3 is alert and oriented. On 1/22/24 at 7:30 pm, R3 stated on 1/21/24, V6 did not give R3, R3's 8:00 pm medications until around 11:00 pm. R3 also stated V6 had turned R3's oxygen up too high last week and would not listen to R3 about turning it down so V5 CNA (Certified Nursing Assistant) ended up reporting it to V1 AIT (Administrator in Training). On 1/22/24 at 8:05 pm, V5 CNA (Certified Nursing Assistant) stated on 1/18/24 around 9:15 pm there was a situation between V6 Agency RN (Registered Nurse) and R3 that occurred with V5 and V17 CNA present which resulted in V5 reporting an allegation of verbal/mental abuse to V1 AIT (Administrator in Training). V5 explained that V6 was the only nurse in the facility but V1 instructed V6 to clock out and leave the unit pending the investigation. V5 stated the facility was without a nurse for over an hour before V6 was allowed to return to the facility and continue V6's job duties. V5 stated residents were calling and asking for their medications because V6 was still passing resident's 8:00 pm scheduled medications at that time. V5 stated V5 and V17 had to tell the residents that they were going to have to wait for their medications, because there wasn't a nurse available. On 1/23/24 at 1:24 pm, V6 confirmed medications were given much later than scheduled Thursday (1/18/24) - Sunday (1/21/24) due to residents having different problems that were time consuming. V6 stated V6 couldn't remember which residents were late with medications but stated there was a lot of residents as V6 was still passing medications at 11-12 pm, that were scheduled at 8:00 pm. V6 also confirmed the incident between R3 and V6 and that V1 instructed V6 to leave the unit, which I (V6) never do and should not have done because I (V6) was the only nurse in the building. V6 stated the facility was without a nurse for 30-45 minutes before V6 was informed V6 could return to work. On 1/24/24 at 8:26 am, V1 confirmed V6 was off the floor pending an abuse investigation on 1/18/24 from 9:55 pm until V6 was allowed to return to work at 10:36 pm, resulting in the facility not having a nurse for 41 minutes during V6's suspension. The facility's assessment dated [DATE] documents the facility will be staffed according to resident's needs and required staffing guidelines and with consideration of continuity of care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 15 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0725 The facility's Resident Room and Bed Roster dated 1/22/24 documents 30 residents reside at the facility. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 16 of 19 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 145842 B. Wing (X3) DATE SURVEY COMPLETED A. Building 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to have a nurse serving as Director of Nursing (DON.) This failure has the potential to affect all 30 residents residing at the facility. Findings Include: On 1/22/24 from 8:00 am - 4:30 pm and 7:00 pm - 11:00 pm, there was no nurse working as the DON (Director of Nursing). At 2:55 pm, V4 LPN (Licensed Practical Nurse) stated the facility does not have a DON and that V4 is the only facility nurse therefore there is no guidance being provided for nursing staff. On 1/23/24 from 9:00 am - 4:30 pm there was no nurse working as the DON. On 1/23/24 at 3:30 pm, V1 AIT (Administrator in Training) stated the facility has not had a DON since February 15, 2022. The Facility assessment dated [DATE] documents the facility will employee other nursing personnel; those with administrative duties for 8-16 hours a day. The facility Resident Room and Bed Roster Form dated 1/22/24 documents 30 residents reside at the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 17 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review, the facility failed to maintain a complete and accurate medical record for one of four residents (R3) reviewed for respiratory care in the sample list of six. Residents Affected - Few Findings Include: On 1/22/24 at 7:30 pm, R3 stated over the weekend, R3 was short of breath and had called for the nurse, V6 Agency RN (Registered Nurse) to give R3 a breathing treatment. R3 stated when V6 entered R3's room, V6 cranked R3's oxygen level up to 10 L/NC. R3 stated this has actually happened twice now. On 1/22/24 at 8:05 pm, V5 CNA confirmed R3 had an episode on 1/18/24 and again on 1/20/24 where R3 was in respiratory distress; very short of breath and requesting a PRN (as needed) nebulizer treatment. V5 stated that V6 Agency RN (Registered Nurse) ended up turning R3's oxygen up to 10 L (liters) per nasal cannula, and giving R3 an inhaler along with the nebulizer. V5 stated R3 was sent out to the hospital on 1/20/24 because of this but returned later in the night. R3's Progress Notes from 1/17/24 - 1/23/24 does not document any episodes of respiratory distress or actions taken. There is a Progress Note dated 1/21/24 that documents the hospital called and R3 has been discharged but there is no documentation of the events that lead to R3's hospitalization or when that occurred. On 1/23/24 at 1:24 pm, V6 confirmed R3 has had a couple incidents of respiratory distress which lead V6 to having to give extra oxygen and PRN treatments. Those incidents were on 1/18/24 and 1/20/24. V6 stated V6 should have documented that in the Progress Notes but isn't sure if V6 did or not. R3's January 2024 MAR (Medication Administration Record) does not document any PRN medications being given on 1/18/24. The facility's undated Medical Records Policy documents the facility shall have a medical record system that facilitates the retrieval of information regarding individual residents. The resident record shall be kept current, complete, legible and available at all times. Record entries shall be made by the person providing or supervising the service or observing the occurrence that is being recorded. The MAR shall be maintained to contain the date and time each medication is given, name of the drug, dosage and by whom administered it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 18 of 19 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flanagan Rehabilitation & Hcc 201 East Falcon Highway Flanagan, IL 61740 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview and record review, the facility failed to maintain the facility in a safe, structurally intact, environment. This failure has the potential to affect all 30 residents residing at the facility. Residents Affected - Many Findings Include: On 1/22/24 at 8:40 am, the bottom of the hallway wall outside of the shower room was crumbled, approximately 6 inches up off the floor and 4 feet long. There were large chunks of a concrete looking substance lying on the floor, in the hallway, under a shower bed that was pushed up against the wall. At this time, V4 LPN (Licensed Practical Nurse) stated V4 started working at the facility in November 2023 and noticed the wall crumbling in December 2023. At this time, V26 CNA (Certified Nursing Assistant) stated V26 has worked at the facility for 3.5-4 years and that the wall has been like that a long time, 6-12 months. On 1/22/24 at 9:12 am, V1 AIT (Administrator in Training) stated the wall outside of the shower room has been an ongoing issue. It crumbles, (V8 Maintenance Director) fixes it, then it crumbles again. It probably needs fixed again. On 1/22/24 at 2:20 pm, V2 Housekeeping Supervisor/Unit Aide stated the wall by the shower was damaged when a pipe broke. V2 explained the broken pipe was fixed and the shower was retiled but then the wall started crumbling. V2 explained it has been crumbled like it is for a couple of months now. V2 stated V2 isn't sure if the wall itself has ever been fixed. On 1/23/24 at 9:28 am, V8 provided Maintenance Work Order Logs that document on 8/9/23, the shower wall and baseboard behind the door needs redone. At this time, V8 stated in August 2023, the grout in the shower was cracked and allowing water to leak into the wall so that bad part had to be cut out and then the shower was retiled. V8 explained that water would literally leak out into the hallway. V8 stated the outside/hallway wall did not look like it does now, and was not crumbling, at that time. V8 stated V8 does not know how long the wall has been like it is because V8 was moved to the dietary department in November 2023 and just returned to the Maintenance Department a couple of weeks ago, and that is when V8 noticed the wall crumbling. V8 explained that there is normally a shower bed that is placed up against the wall that would obstruct the view of the crumbling wall, even though it isn't there today. V8 stated the wall needs to be fixed, but trying to get dry wall ordered can be difficult, because orders have to go through the Regional Director. V8 stated V8 doesn't think the wall is concrete, even though the crumbles appear to be concrete. V8 thinks the crumbling wall is made of a thick firewall dry wall. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 19 of 19