Health inspection·May 7, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on interview, and record review the facility failed to provide sufficient staff to meet residents care needs for residents requiring assistance with care. This applies to 3 of 3 (R1, R2, R3) residents reviewed for staffing in the sample of 5. The findings include: R1's admission Record dated 4/7/2025 lists diagnosis of hemiplegia and weakness. R1's MDS (Minimum Data Set) section C dated 4/7/2025 shows a BIMS (Brief Interview of Mental Status) of 15 cognitively intact. On 5/7/2025 at 8:55AM, R1 said the previous day there were not enough staff that day. R1 said call light wait times were long and he had had a bowel movement around 4:00AM that day. R1 said staff came in at around 9:00AM but he didn't get cleaned up until almost 10:00AM by V4 Certified Nursing Assistant (CNA). On 5/7/2025 at 10:06AM, V4 said she is a CNA but was hired for restorative. V4 said for the last couple of weeks she has been pulled to the floor or to help in the kitchen doing tickets because they have needed help. V4 said she was working on 5/6/2025. V4 said she starts her shift at 8:00AM until 4:00PM Monday through Friday. V4 said when she came in on 5/6/2025 the staff were behind getting patients up and getting meal trays passed. V4 said she started helping pass meal trays and getting people up after breakfast. V4 said she did get [R1] up that morning and he told her he was waiting since 4:00AM. V4 said when she turned him, he did have stool already present and while turning him he continued to go more, which is normal for him. V4 said his bottom didn't have open areas or sores. V4 said they had some CNAs on the floor, but other CNAs were called in that were staff or agency and came in around 9:00AM-9:30AM to help. R2's admission Record dated 4/7/2025 lists diagnosis of weakness and dependence on other enabling machines and devices. R2's MDS section C dated 4/7/2025 shows a BIMS score of 15 cognitively intact. On 5/7/2025 at 9:15AM, R2 said the facility does not have consistency with staff. R2 said they work at the facility 2 or 3 shifts, and they don't return. R2 said the facility was short staffed yesterday [5/6/2025]. R2 said he has had to wait 30 - 45 mins to get his call light answered sometimes. R3's admission Record dated 4/7/2025 lists diagnosis of quadriplegia, weakness, and other reduced mobility. R3's MDS section C dated 1/31/2025 shows a BIMS score of 15 cognitively intact. On 5/7/2025 at 9:25AM and 2:18PM, R3 said the facility has short staffing and call light wait times can be up to 30 minutes on weekends, Sundays are the worst. R3 said staff do not round on him every 2 hours. R3 said facility staff check on him when he hits the call light or when they bring him medications, but they don't round on him every 2 hours. On 5/7/2025 at 10:45AM, V1 Administrator from the start of the day [5/6/2025] we had multiple calls in from the CNAs and we had to call in agency staff and staff to come help. V1 said it took about 60 - 90 minutes to get caught up. On 5/7/2025 at 12:42PM, V2 Director of Nursing (DON) said call lights should be answered within 5 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145958 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 145958 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few minutes, 10 minutes would be too long. V2 said they did have a shortage of CNAs yesterday [5/6/2025]. V2 said they did have to call in staff to help fill the assignments. V2 said residents should not be left in stool. The facility provided Resident Council Minutes from 4/7/2025 shows residents started they are unsatisfied with how long it takes floor staff to answer their call lights. The Resident Council Minutes from 3/3/2025 state residents expressed concerns with call lights not being answered in a timely fashion. The Resident Council Minutes from 2/3/2025 states residents requesting that the CNAs and nurses round their assigned rooms at the start of their shift to let the residents know that they are the person who will be taking care of them. The facility provided Activities of Daily Living policy not dated states, this facility provides each resident with care, treatment and services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145958 If continuation sheet Page 3 of 3