Inspection·November 12, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few like. This nurse called POA back at 1700 (5:00pm), POA did not answer but called this nurse back at 1710 (5:10pm).This nurse confirmed with POA again that res is at brother's house in (name of city) and that res left facility on his own and would be returning to facility this evening/tonight. POA stated ‘(R1) is at his brother in laws house which is in 9name of city) and his brother will be bringing him back to the facility later. POA also states he walked to his brother's house from the facility on his own.R1's incident description in the electronic health record tiled Elopement, dated 10/19/25, documents the above Progress Note dated 10/19/25 at 4:47pm. Under Immediate Action Take documents INT (intervention): Resident to have personalized redirection (paint, talk about the Steelers, call brother-in-law) when wandering and room change to make resident more comfortable. RCA (Root Cause Analysis): Resident states he was upset about his roommate's family being mean to him so he walked to his brother in laws house.Several attempts to interview R1 were made and unsuccessful throughout the survey. R1 did not respond to questions asked.On 10/30/25 at 1:45pm, V3 (Regional Director of Clinical Services) stated the was aware R1 completed a Brief Interview for Mental Status (BIMS) and staff were able to get a score of 13, but that is not typical for R1. V3 stated R1 usually does not say too much, but due to several factors, including mental health diagnoses, it all depends on his level of comfort with the person engaging in conversation with. V3 stated on 10/1925, R1's family reported his roommate's family was being mean to R1. V3 stated R1 has schizophrenia and previously lived at a sister facility. V3 stated often R1 would have to be moved to a room alone because he thought his roommate was out to get him. V3 stated R1 did not wear a electronic monitoring device prior to 10/19/25 because he did not try to elope.On 11/6/25 at 11:00am, V10 (family member) stated R1 just showed up at the house a little before the police came. V10 stated they did not pick R1 up from the facility. V10 stated they usually pick R1 up on Sundays for football, they just had not made their way to the home yet. V10 stated they did the same thing in the previous facility he lived in. V10 stated they hadn't let anyone know R1 was there yet because they were just trying to figure out what was going on. V10 stated R1 stated his roommate's family was being mean to him. V10 stated R1 has never tried to leave a facility prior to this incident.On 11/6/25 at 11:18am, V9 (CNA) stated V1 grew up about a mile away from the facility and the house he was found at was where he grew up. V9 stated she was here the day that R1 eloped. V9 stated staff searched the inside and outside of the building twice, she stated she told staff and police R1 grew up around here and where they might find him.On 11/6/25 at 1:54pm, V6 (Licensed Practical Nurse/LPN) stated on 10/19/25, she noticed prior to lunch R1 was very restless. V6 stated she remembered lunch was being served late that day and R1 did not normally eat in the dining room, but she got him to come out there. V6 stated at about 2:15pm, R1 came up to her and told her he still hadn't received a tray. V6 stated he does not normally talk to her much, especially when he is anxious, so she told them to get his tray as soon as possible. V6 stated she knew at about 2:30pm he received his tray, and she saw him eating it. V6 stated she was passing meds around the dining room and had observed him eating, she stated she noticed R1 had left the dining room around 3:00pm. V6 stated she did not see R1 leave the dining room and could not say what time he had left, but she would estimate it was about 20 minutes. V6 stated she immediately initiated the elopement protocol, which involves search the entire facility inside and out, and doing a head count. V6 stated she did this twice and then notified the police. V6 stated she tried to call R1's family twice and there was no answer, and their inbox was full. V6 stated they did not answer until after the police had located the resident and had already contacted the facility. V6 stated it was normal for R1 to go with family on Sundays to watch football, but no one had notified her that they were taking him. V6 stated to her knowledge the wander guard system was working but R1 was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145863 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 145863 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Marion 1301 East Deyoung Marion, IL 62959 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete wearing a wander guard at that time. V6 stated R1 was a risk for elopement, but he had never tried to leave the building before. V6 stated R1 would pack his things and say he was leaving with his family but never tried to exit. V6 stated his family brought R1 back later that evening.On 11/6/25 at 2:05pm, V7 (LPN) stated she was working 100 hall, and R1 was on 200 hall at the time of the elopement. V7 stated she remembered R1 asking for a tray, which was unusual and then about 20 minutes later they noticed he was missing. V7 stated to her knowledge the wander guard system was working.On 11/6/25 at 2:15pm, V8 (CNA/Certified Nursing Assistant) stated he was working the day that R1 eloped. V8 stated it was around 3:00pm the nurse noticed R1 was missing and made everyone check all the rooms and the outside of the facility multiple times and then the police were called. V8 stated V6 (LPN) had already had staff keeping an eye on R1 because he had been restless that afternoon.On 11/6/25 at 2:56pm, V3 (Regional Director of Clinical Services) stated they immediately reassessed R1's elopement risk, moved him from the 200 hall to the 400 hall and put a electronic monitoring device on him. V3 stated they had identified the problem and already had a plan of correction in place.The facility policy titled Elopements, with a revision date of 2/2025, documents in the section titled policy statement Staff shall investigate and report all cases of missing residents. Prior to the survey date, the facility took the following actions to correct the noncompliance:QAPI (Quality Assurance and Performance Improvement) committee met on 10/20/25 with V1 (Administrator), V2 (Director of Nursing), and V3 (Regional Director of Clinical Services) in attendance. The QAPI Ad Hoc form notes documents as follows:1. R1 was immediately located and returned safely to the facility. Resident was assessed head to toe upon return, no injuries were noted. Vital signs stable. Physician and responsible party were notified of incident.R1 elopement risk status and interventions have been updated.Counseling and education provided to all staff involved regarding elopement prevention and response protocols.2,The Social Services Director will conduct a facility-wide audit of all residents with elopement risk factors or active elopement care plans.Reviewing of staff rounding and supervision schedules in all high risk areas.3. Facility immediately re-educated of all staff on facility Elopement Prevention and Response Policy.Facility immediately initiated an elopement investigation and placed safety interventions and care plan updated for R1.Interdisciplinary team to review all elopement incidents and near misses during QAPI meetings to identify trends.4. V2 or designee will complete weekly audits 5 times a week for 4 weeks, then monthly x 3 months to ensure: Elopement risk assessments and care plans are current. Staff are following elopement interventions and protocols. If trends or concerns are identified, additional corrective actions and staff education will be implemented.5. Ongoing monitoring through QAPI tracking logs and Performance Improvement meetings to evaluate effectiveness and sustain improvement. Event ID: Facility ID: 145863 If continuation sheet Page 3 of 3