Inspection·March 18, 2024

F 0626 call R1 and then call us back. Level of Harm - Minimal harm or potential for actual harm R1's Behavior Note dated 2/23/24 at 12:39pm documents: at 10:05 am while giving R1 care R1 was inappropriate and grabbed aide's chest. Residents Affected - Few R1's Behavior Note dated 2/24/23 at 6:00pm documents: R1 was on the call light 27 times within 42 minutes this morning requesting R1's breakfast. Explained to R1 each time that breakfast was being prepared and that we would bring it to R1 when its available. R1's Health Status Note dated 2/25/24 at 9:30pm documents: R1 yelling/screaming shortly after putting on call light. Care provided. R1's Health Behavior Note dated 2/26/24 at 9:42am documents Certified Nursing Assistant's reported the following behaviors from this past weekend (2/23/24, 2/24/24 and 2/25/24), ringing call light and when CNA's responded R1 would say nothing or just laugh, not cooperating when CNA's were providing care (holding side rail and not rolling so care could be given), grabbing at CNAs breast, putting R1's light on then screaming instead of waiting for light to be answered, upsetting other residents, refusing care, and asked to be changed when R1 did not need to be changed. Staff reminded R1 of appropriate behavior and R1 would just laugh. R1's Behavior Note dated 3/10/24 at 12:29pm documents R1 continues to require cares in pairs during the shift due to noncompliance, requiring 3 or more staff for cares, R1 continues to have attention seeking behaviors, sexually inappropriate comments, R1 also has continued to have yelling/screaming and disruptive behaviors when R1's call light is not on and when it is on and not answered immediately. V3, R1's Power of Attorney has been called and several times during shift to attempt to keep V3 updated, and messages left. The note documents R1 has been awake most of shift and for the short time R1 did appear to be asleep BI-PAP was placed but removed shortly after by R1 and oxygen per nasal cannula (NC) placed at 6 liters put back on after BI-PAP removal. Attempts to redirect and educate R1 have been unsuccessful and R1's behaviors continue. R1's Health Status Note dated 3/10/24 at 4:00pm documents R1 remained on frequent checks and last checked on at 3:45pm. V3, (R1's Mother and Power of Attorney (POA)) here at the bedside and concerned that R1 appeared to have an increase in twitching to R1's left shoulder and seemed tired. Offered R1, R1's BI-PAP and R1 stated NO! NO! NO! Attempted to explain to R1 the importance of using BI-PAP and R1 continued to refuse. R1 refused after numerous attempts to allow staff to assess R1. R1 refused to allow V2 Director of Nursing (DON) to take R1's oxygen saturation and refused to allow us to obtain any vital signs. V3 requested R1 be sent out to emergency room for evaluation and treatment. V7 Physician updated and ok with sending R1 out and updated on R1's noncompliance with allowing an assessment to be performed. R1's Health Status Note dated 3/10/24 at 4:10pm documents call placed to emergency medical service (EMS) for transport. R1's Health Status Note dated 3/10/24 at 4:30pm documents EMS here for transport to emergency room. R1's Health Status Note dated 3/10/24 at 5:40pm documents V1 Administrator in Training and V2 Director of Nursing (DON) at Hospital emergency room (ER) and spoke with charge nurse and given copy of Involuntary Discharge (IVD) paperwork as well as list of facilities that we have attempted referrals and attempted to place R1, and most had denied. Explained to ER Nurse that we would not be accepting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 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 145842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/18/2024 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R1 back to the facility after discharge from hospital due to unable to meet R1's needs. ER Nurse verbalized understanding. Explained that V3, R1's Mom and Power of Attorney (POA), was also aware that facility was intending to Involuntarily Discharge resident. R1's Health Status Note dated 3/10/24 at 6:34pm documents call placed to V7 Physician and updated that facility was not intending to take R1 back upon discharge from hospital and V7 agreed with decision based on R1's care needs and agreed facility is no longer able to meet R1's needs. On 3/18/24 at 10:45am V2 Director of Nursing (DON) said, on 3/10/24 V3 R1's Mother and Power of Attorney (POA) was in the facility and requested that R1 be sent to the emergency room due to R1's shoulder twitching. V2 said, R1 was sent out per V3's request. V2 said, V3 was given a copy of the facilities bed hold policy and a copy put in R1's transfer packet. V2 said, V2 and V1 Administrator in Training (AIT) went to the emergency room and gave the emergency room charge nurse a copy of the involuntary discharge packet, and informed the nurse that the facility would not be taking R1 back. V2 said, V2 also call V7 Physician and informed V7 that V3 requested R1 be sent to the ER and that V3 and R1 were informed that they would not be re-admitting R1 to the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 3 of 3