Health inspection·January 10, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident was transferred safely with a gait belt for 1 of 3 residents (R1) reviewed for safety in the sample of 3. This failure resulted in R1 sustaining a distal femur fracture. The findings include: R1's admission record shows she was admitted to the facility on [DATE] with multiple diagnoses including a history of falls and weakness. The 12/18/24 facility incident report documents the CNA (certified nursing assistant) was transferring a resident (R1) from a wheelchair to a bed using a gait belt. During the transfer, the resident's knees gave out, and the CNA lowered the resident to the floor. The same report notes R1 to be alert and oriented. R1's admission assessment and care screening of 12/22/24 showed her to be cognitively intact, risk for falls and had impairment to both of her lower extremities. The same assessment documents she required maximal assist for mobility including sit to stand/hoyer for transfers related to weakness in knees. R1's 12/27/24 nursing progress notes show she had returned from her scheduled orthopedics appointment and was to have diagnostic scans on her shoulders but was complaining of right knee pain. A scan of the right knee showed a fracture to the right knee and R1was given a knee brace for support. After follow-up with her primary care physician, an x-ray was ordered at the facility to verify the fracture. R1's 12/31/24 right knee x-ray report documents age-indeterminate fractures of the distal femur just proximal to the knee prosthesis and at the superior aspect of the patella (kneecap). The impression shows it to correlate with timing of trauma and pain. On 1/10/25 at 11:40 AM, R1 was sitting up in her wheelchair with a brace to her right leg, and a mechanical lift sling under her. R1 stated on the day of the incident it was late at night, and she should not have stayed up so late. R1 stated while transferring herself into bed, her knees gave out and she fell forward onto her knees. R1 stated the CNA was in the room but was just standing there and did not help her in anyway. R1 denied any previous falls in the facility. R1 stated she now has to use the mechanical lift to transfer due to a hairline fracture to her right leg. R1 stated she did not have any pain in her leg. (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: 145958 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 145958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bethany Rehab & Hcc 3298 Resource Parkway Dekalb, IL 60115 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)