Inspection·July 29, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some my tube was real red. Some of the nurses would put gauze around it, others would not. I was supposed to have flushes while I had it in my belly. They were supposed to do flushes twice a day. I did not get flushes but once a day. Sometimes I did not get flushed once. I never looked to see if there was moldy stuff in my g-tube. I just know the tube area of my belly hurt and I couldn't get them to do anything, most of the time. (The nursing home staff) just kept saying I had to wait until August to get the g-tube out. May to August to find somebody to remove it. (The group home) got someone to do it today. It is out and I am thankful to (Group Home) nurses.On 7/24/25 at 7:30 am V2, Director of Nursing confirmed she had not notified the physician of these changes in R15's condition.On 7/29/25 at 12:58 pm V19, Medical Director/Physician stated the facility should have informed V19, MD that there was an issue getting an appointment to remove R15's g-tube. V19, MD also stated An infection in R15's great toe, he was not made aware of either. We have an in house podiatrist. The (V2), DON should have put (R15) on the list. If he (V21, Podiatrist) was not available, I am in the facility Friday or Saturday. Had I been updated with these issues, I can assure you they would have been taken care of.2. R30's current Diagnoses sheet documents the following: Other Acute Osteomyelitis (infection in the bone), Right Hand, Acquired Absence of Right Finger (s).R30's current Physician Order Sheet (POS) documents the following orders dated 6/12/25 (on admission): Cefepime (antibiotic) HCI Intravenous Solution 1 GM/50ML (gram per milliliter) , Use 1 gram intravenously in the morning for cellulitis for 10 Administrations (6/23/25 last dose per scheduled). R30's Same POS order dated 6/27/25 documents Resident to be referred for surgical removal of IJ (Internal Jugular) central line (Peripherally Inserted Intravenous Central Catheter). R30's Same POS documents to monitor the central line insertion site for signs of infection, and update md (physician) if needed. R30's Minimum Data Set, dated [DATE] documents R30's Brief Interview of Mental Status score as 14 out of a possible 15, indicating no cognitive impairment.The facility facsimile dated 6/30/25, (three days after the physician order above), documents a referral was sent to a distant hospital for R30's removal of the IJ, Central Intravenous line.The facility facsimile dated 7/11/25, (eleven days after the physician order above), documents a referral was sent to another distant hospital for R30's removal of the IJ, Central Intravenous line. The facility facsimile dated 7/16/25, documents a referral was sent to a local hospital for R30's removal of the IJ, Central Intravenous line.On 7/22/25 at 3:00 pm R30 was awake in bed with a latex glove over her right hand dressings. Fourth digit cotton dressing visible through the gloves. R30's right index finger is not present, recent amputation. A cotton gauze is visible through the latex glove. R30 then pulled the right upper seam of her blouse over and showed the surveyor R30's right subclavian intravenous PICC line dressing. R30 stated The DON (V2, Director of Nursing) said I can not have the PICC line removed until September because it was inserted in (Out of State) Rehab Center. R30 stated I don't see why it takes so long to get an appointment. On 7/24/25 at 7:30 am V2, Director of Nursing (DON) confirmed R30's IJ, PICC line has not been removed after her IV antibiotic was completed. V2, DON stated An appointment is scheduled in September. A hospital in (State) originally placed this and other Illinois providers and hospital declined to remove it. I called (Named three hospitals). None of the hospitals would see her, to remove the PICC line. I probably should have notified the doctor of the delay in getting her an appointment for removing it (R30's PICC). On 7/29/25 at 12:58 pm V19, Medical Director/Physician stated he should have been notified of the delay in R30's PICC line removal. When I was informed last week that State was in the building and asking about the delay in (R30's) PICC line removal, I came in to see her immediately on Friday. I understand the PICC line was put in at a hospital in (Out of State). I looked at it, to see if I could remove this. I could not. I ordered a chest x-ray and have consulted with hospital here in (City (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 2 of 6 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 07/29/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Name) to see if they will remove (R30's) PICC line. I should have been notified sooner. She was only on antibiotics a short time after admission to (This LTC facility). The PICC line should have been removed when the antibiotics were complete. I am not sure why the hospital put a PICC line in for such a short duration of antibiotics. I don't usually see this situation. I should have been notified. I could have intervened sooner. I am working at resolving this locally so she does not have to wait until the September appointment that was set up by the DON.The facility undated policy Significant Condition Change and Notification directs staff to notify the medical practitioner for incidents that require the potential for needed medical practitioner interventions. Event ID: Facility ID: 145842 If continuation sheet Page 3 of 6 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 07/29/2025 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review the facility failed to address resident's care needs to obtain appointments in a timely manner, resulting in a delay in the removal of a gastrostomy feeding tube and a delay in podiatry services for an infection for (R15). R15 is one of three residents reviewed for infections/ medical devices in the sample list of 27.These delays resulted in R15's transfer to the local hospital, for antibiotic treatment of G-tube infection, and ingrown toenail infection.Findings include:1. R15's current diagnoses list documents the following: Gastrostomy Status (abdominal, surgical G-Tube feeding catheter), Unspecified Severe Protein Calorie Malnutrition.R15's Physician Order Note dated 5/16/25 documents V19, Medical Director/Physician gave the facility a verbal order as follows: Ok for resident to have her enteral (abdominal surgically inserted, Gastrostomy feeding tube) tube removed.R15's Minimum Data Set, dated [DATE] documents R15's Brief Interview of Mental Status score as 13 out of a possible 15, indicating no cognitive impairment.R15's Health Status Note dated 5/28/25 (12 days after the order above to remove the G-tube) documents the following Resident GI (Gastrointestinal) appt (appointment) made for peg tube (type of gastrostomy feeding tube) removal for 8/5/25 (two months and 11 days after V19 MD ordered). Resident aware and appt placed in transportation calendar.R15's Physician Progress note dated 6/14/25, signed by V19, Medical Director/Physician (MD) documents R15 complained of ache and burning at the G-tube site. V19 diagnosed R15 with Cellulitis (bacterial infection of the skin) of the Abdomen. The same Physician Progress note documents an antibiotic medication order to treat the Cellulitis as follows: Ceftin 250 milligrams, Oral, twice daily, for five days.R15's Progress Note date 7/18/25 at 1:22 pm documents R15 was discharged from the facility, to a group home with a group home staff member.R15's Hospital emergency room Note dated 7/18/25 at 4:19 pm (two hours and 57 minutes after discharge from the facility) documents the following: C/O (complaint of) feeding tube infection, infected big toe on right foot, and sore on buttocks. Patient (R15) left (discharged from) (proper name of the facility) Rehab today to go to (Proper name of a group home). Staff there (group home) noted redness around feeding tube. Patient does not use feeding tube anymore and has appointment 8/5 to have it removed. She has had redness 4-5 months. States the sore on her toe and bottom have also been present for months but while she was there, she wanted to have them looked at. Alert to her norm. Patient is a (full mechanical lift) at baseline. Denies any fever, chills, SOB (shortness of breath), or other new illness symptoms. Feeding tube looks like it has mold or other dark substance inside of it. She reports it is supposed to be flushed 2 times daily but that does not always happen. She recently went to the dentist in Chicago to have her teeth pulled and they pushed (administered via G-tube) whatever was in her tube, up inside her. She told them it hurt but they continued.R15's follow -up facility discharge notes dated 7/18/25 at 7:04 pm (five hours and 18 minutes after discharge from the facility), signed by V2, Director of Nursing (DON) confirms R15's left the facility with her G-tube in place, had minimal irritation around g-tube site due to gastric fluids and an ingrown right great toenail. The same note documents The facility had attempted to reach out and schedule an appointment but have not been able to coordinate that, we were awaiting the rounding date for our in house podiatrist to address toe.On 7/23/25 at 8:45 am V5, Group Home Registered Nurse (RN) stated that they completed R15's admission assessment, at the Group home on 7/18/25 after R15 discharged from the long-term care facility. V5 stated V5 found concerns with R15's infected looking great toe, which was red with dried yellow drainage. V5, RN also stated she found R15's g-tube site was red and irritated, and there was what looked like mold inside g-tube. V5, RN said V5 sent R15 to the local Hospital emergency room and the hospital prescribed antibiotics, Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 4 of 6 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 07/29/2025 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 - Actual harm Residents Affected - Few to treat infected g-tube site and ingrown great toenail. V5 also stated V5, RN was able to get an appointment for R15 to have her G-tube removed today (7/23/25). V5, RN stated We have her scheduled, to see the podiatrist for further treatment of ingrown toenail. On 7/23/25 at 4:43 pm R15 stated I was supposed to get my g-tube out in May. The Speech therapist said I did not need it any longer because I could eat just fine and could swallow. For four weeks they were to leave it in and just do flushes. They did that back in April. Then, I was told by the DON that they couldn't find a doctor that would take the g-tube out because it was stitched into me. I even reminded them I needed an appointment to take it out. They said they found a doctor, who can't take it out until August 5. I just got it out yesterday because the (Group Home) people got me an appointment to take it out right away. I just came back to this group home last week on the 18th. I kept telling the facility nurses my belly hurt around the tube. I even told them when I came back from oral surgery that my stomach hurt when they gave me medicine in my tube (unable to confirm). They did it anyway, that day. The skin around my tube was real red. Some of the nurses would put gauze around it, others would not. I was supposed to have flushes while I had it (G-tube) in my belly. They were supposed to do flushes (insert water to ensure patency and clean) twice a day. I did not get flushes but once a day. Sometimes I did not get flushed once. I never looked to see if there was moldy stuff in my g-tube. I just know the tube area of my belly hurt, and I couldn't get them to do anything, most of the time. (The nursing home) just kept saying I had to wait until August to get the g-tube out. May to August to find somebody to remove it. (The group home) got someone to do it today. It is out and I am thankful to (Group Home) nurses. R15 also stated My big toes were both terribly painful and red when I went to the emergency room the day I discharged . I asked the nurses to look at my toes over and over again. I saw the podiatrist for my ingrown toenails in late May or early June. He clipped them back and said he would see me again if I had any more problems with my ingrown toenails. I am diabetic and have to have the podiatrist do them (clip toenails). The CNA's can't. I talked to the DON(V2), and she said I was on the list to be seen. He (V21, Podiatrist) comes to (long term care facility name). I was in so much pain. The DON said she would put me on the list every time I talked to her. I could not have been on the list; I had to suffer and wait. I would get Tylenol and my tramadol at night, or I would not be able to sleep with my toes hurting. When I went to the emergency room after discharging from the facility, they gave me antibiotics for my toes and my G-tube infections. My toes are feeling better but still hurt. (The Group Home Staff) got me a podiatrist appointment after I finish my antibiotic the end of the week.On 7/24/25 at 7:30 am V2, Director of Nursing stated I had done a full skin assessment on (R15) the day before (7/17/25) she discharged (7/18/25) to the group home. At that time, her (R15's) g-tube site and R15's toes were not infected. They were just a little red and she complained of pain, per her usual. (R15) had no skin breakdown on her buttocks. V2, DON also stated (R15) was scheduled to have her G-tube removed August 5, 2025. That seems like a long time, now that you mention it. It was the first available appointment I could get. I did not tell the doctor (V19, MD) the appointment was that far out. I did not even think to do that. (R15) was on the list to be seen by the podiatrist and had been seen previously by the podiatrist. I will find documentation and provide it.On 7/25/25 at 1:40 pm V10, Certified Nursing Assistant (CNA) stated she provided care for (R15) often. About four or five days prior to (R15's) discharge to the Group home, R15's big toe had green drainage. I notified the nurse (unidentified) at the time. I do not remember if the toe was swollen or red. (R15) did complain it was hurting her. I reported that too. V10, CNA then stated (R15)'s buttocks were always somewhat irritated, especially when she was on her period. She was on her period the week before her discharge. CNAs can't put the zinc paste on residents. We would have to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145842 If continuation sheet Page 5 of 6 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 07/29/2025 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete tell the nurse. We often told them (unidentified nurses) (R15's) butt (buttocks) was red and irritated so they would take care of it. (R15) always wanted us (CNAs) to do it when we provided her incontinence care. I know she would complain it was painful for her. I never saw any open areas down there. Her G-tube area was always red and irritated. The nurses would put gauze on that. They would slit two pieces of gauze and put one up and one down, so it made like a hole where the skin got really irritated. The gauze would sometimes come off. You could see some bloody looking drainage on the gauze. Not all the time though. I was scheduled to provide care for R15 the day she discharged . (R15) was complaining her toe hurt, her buttocks hurt, and the g-tube skin was irritated. I didn't really look at the tubing, so I am not sure if there was anything abnormal about the actual tube. I reported to the nurse (unidentified) she was complaining of pain (On the day of discharge 7/18/25).On 7/29/25 at 12:58 pm V19, Medical Director/Physician stated he expects the facility to notify him of a resident change in condition to prevent a delay in treatment. V19 confirmed he had treated R15 for cellulitis of the abdomen 6/14/25. V19 stated the facility should have informed him that there was an issue getting an appointment to remove R15's g-tube. V19 also stated An infection in R15's great toe, he was not made aware of either. We have an in-house podiatrist. The DON should have put (R15) on the list. If he (V21, Podiatrist) was not available, I am in the facility Friday or Saturday. Had I been updated with these issues; I can assure you they would have been taken care of. Event ID: Facility ID: 145842 If continuation sheet Page 6 of 6