Health inspection·June 26, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview, observation and record review, the facility failed to ensure an allegation of verbal abuse was immediately reported to the Administrator for one of six residents (R4) reviewed for abuse in the sample of six. Findings include: The facility's Abuse Prevention Guidance Policy (revised 10/2022) documents the following: Employees are required to report any incident, allegation, or suspicion or potential abuse, neglect, exploitation, mistreatment or misappropriation of resident property they observe, hear about, or suspect to the administrator immediately, to an immediate supervisor who must then immediately report it to the administrator or to a compliance hotline or compliance officer. In the absence of the administrator, reporting can be made to an individual who has been designated to act in the administrator's absence. The facility's Abuse Investigation (dated 06/06/24) documents the following: (V2 former Director of Nursing) reported to this administrator that when she gave (V12 Certified Nursing Assistant/CNA) a write-up for improper time clock usage/break times, (V12) became angry saying that she was being picked on. (V12) went on saying that she was bringing her cell phone to record people when she works. When (V2) explained why she wasn't allowed to do that, (V12) stated that 'Everyone here is calling people f*cking b*tches and I'm going to record them.' When (V2) asked who was doing this and who was being called names, (V12) stated, 'There's a lot of people and it's toward the residents.' (V2) explained that this was an abuse allegation and she needed (V12) to be specific and give the employee names and the resident names, (V12) said, 'I am not telling you anything,' and (V12) left the facility. (V2) notified (V1 Administrator) and the investigation was started immediately. This same investigation documents, (V1) interviewed (V12). (V12) was very upset with the write-up that was given to her. (V12) was observed sitting outside for over 40 minutes while she was still clocked in. (V12) admitted to having already taking all three breaks and said she was trying to 'make up her time' she had missed. (V1) explained to (V12) that the write-up was a warning and that if it happened again, she would be suspended. (V12) became very angry saying, 'There's CNAs calling residents f*cking b*tch, but I get written up for this?' When (V12) was asked which CNAs and which residents, she said it was (V5 Unit Manager/CNA). When asked if there were other CNAs doing this, (V12) said no. When asked which resident (V5) had called names, (V12) said (R4). When (V12) was asked when this happened, she said she couldn't remember exactly. (V1) then re-educated (V12) on the abuse policy including identifying what, when and how to report allegations of abuse. This investigation also documents the following staff were interviewed and indicated they had witnessed V5 verbally abuse R4: V18, V22 and V23 (Certified Nursing Assistants). (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 2 Event ID: 145950 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 145950 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Generations at Rock Island 2545 24th Street Rock Island, IL 61201 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)