Health inspection·June 27, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their abuse policy by not keeping a resident (R2) with dementia free from being hit by a cognitively intact resident (R1) for one out of four residents reviewed for physical abuse in a total sample of six. Findings include: R1 is a [AGE] year old with the following diagnosis: cirrhosis and lymphedema. R2 is a [AGE] year old with the following diagnosis: type 2 diabetes, dementia, and Alzheimer ' s disease. On 6/25/25 at 3:13PM, R1 stated R1 pushed R2 up against a wall when R2 would not stop touching R1's personal items. R1 reported R2 had a habit of drinking R1's pop and taking R1's clothing. R1 stated R1 asked R1 to stop each time R2 would do this but R2 would not stop due to being confused. R1 reported telling the staff about this behavior but staff did nothing to help R1. R1 stated R1 had enough and pushed R2 against a wall and they started to hit each other in the face while wrestling. R1 reported moving to a different room when R1 got back from the hospital. R1 reported having a small cut to the forehead but denied needing stitches. On 6/25/25 at 3:40PM, R2 did not respond appropriately to questioning due to mental status. R2 was able to state name and birth date correctly. R2 was unable to recall the altercation with R1. On 6/25/25 at 2:57PM, V4 (Nurse Manager) stated staff called V4 to the nurse's station because R1 reported having an altercation with R2. V4 reported R1 asked R2 to stop going through R1's belongings but R2 didn't so R1 hit R2. V4 stated R1 admitted to initiating physical contact first. V4 reported R2 is confused so R2 could not answer any questions as to what happened. V4 stated R2 has a habit of going through other's belongings due to R2 having dementia. V4 reported R2 is now in a room alone so R2 will not go through other belongings. V4 defined abuse as when someone is aggressive and does something that hurts someone else. V4 stated this incident would be considered physical abuse because the residents were hitting. On 6/26/25 at 10:19AM, V7 (Former Nurse) stated R1 came to the nurse's station bleeding and told staff R1 hit R2 because R2 kept going through R1's belongings. V7 reported R1 told V7 that R1 hit R2. V7 stated R1 is alert and oriented times three. V7 stated both R1 and R2 were bleeding from small lacerations on the head. V7 reported R2 is always confused and was not able to answer any questions on what happened during the altercation. V7 stated R2 has a habit of wandering and going through other (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 145927 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 145927 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Oasis 16000 South Wabash South Holland, IL 60473 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)