Health inspection·April 9, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to perform a PASRR (Pre-admission Screening and Resident Review) rescreen after the emergence of a newly diagnosed severe mental illness for two of two residents (R19 and R54) reviewed for PASRR screening, in the sample of 32. Findings include: The facility policy, Guidelines For PASRR Process, dated 5/17/2023 documents, PASRR is a federally mandated process that requires all states to pre-screen all residents regardless of their payer source or age who are seeking admission to a Medicaid funded nursing facility. PASRR has three goals (including) To ensure residents receive the required services for mental illness. Residents who are confirmed to have Mental Illness are evaluated to determine the need for specialized services, and appropriate placement options are reviewed. 1. R19's (facility) Face Sheet documents that R19 was admitted to the facility on [DATE] with the following diagnoses: Generalized Anxiety Disorder, and Schizoaffective Disorder, Bipolar Type. R19's Notice of PASRR, dated 4/10/23 documents, No Level 11 required- No Serious Mental Illness. 2. R54's (facility) Face Sheet documents that R45 was admitted to the facility on [DATE] with the following diagnoses: Bipolar Disorder Generalized Anxiety Disorder and Major Depressive Disorder. R54's Notice of PASRR, dated May 13, 2024 documents, No level 11 required- No Serious Mental Illness. On 4/7/25 at 2:27 P.M., V8/Social Services Director verified that R19 and R54 had not had a PASRR rescreen upon the emergence of a newly diagnosed severe mental illness. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 2 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0688 Level of Harm - Minimal harm or potential for actual harm Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, interview, and record review, the facility failed to ensure restorative services were being provided for one of two residents (R9) reviewed for restorative and range of motion in a sample of 32. Residents Affected - Few Findings include: The Facility's Range of Motion (ROM) Policy and Procedure, not dated, documents, The Restorative Nurse and/or Nurse Designee will complete a ROM (range of motion) risk assessment for all residents that are admitted to the facility to determine if they have any ROM deficits and/or are at risk for development of a reduction in their current ROM status. Residents that have been assessed to have a reduction in their ROM will be placed in appropriate ROM programming to increase ROM and/or to prevent further decrease in their ROM status. The facility acknowledges that some residents may develop deterioration in their ROM status due to the resident's clinical condition and the reduction in their range of motion is unavoidable. The Restorative Nurse will initiate tracking sheets to record the days/minutes that the ROM programming was completed. R9's Restorative: PROM (passive range of motion) will be able to tolerate up to 10 repititions, 2 sets of PROM to all extremities daily. R9's PROM 30 day look back documents that R9's PROM was not done on the following dates: 3/9/2025, 3/11/2025, 3/26/2025. R9's Care Plan documents R9 would benefit from a splint/brace Restorative Nursing Program as evidenced by the following risk factors and potential contributing Diagnosis: Centrilobular Emphysema, Quadriplegia, Severe Malnutrition, history of fracture of thoracic vertebrae, history of fracture of left femur, contractures of bilateral lower extremities, Anemia, Depression, Metabolic Encephalopathy. Apply my left resting had splint for 6-8 hours daily (day shift) while up in chair, apply right resting hand split at night (night shift) for 6-8 hours when in bed for contracture management unless my disease process causes unavoidable deterioration thru next review. On 4/6/2025 at 10 AM, R9 was in bed, in her room. R9 had bilateral hand contractures and bilateral leg contractures. R9 stated she does not get physical therapy anymore and no one helps her or offers her restorative therapy. R9 was not wearing splint brace on left or right hand. R9 stated while she was in physical therapy she was able to open her hands better and was able to pedal the mechanical bike. R9 was unable to lift her legs and was struggling to use her hands as well. R9 only has use of a few fingers on each hand. On 4/7/25 at 1:50 PM, R9 did not have splint/brace on left or right hand. On 4/8/25 at 1:00 PM, V17 (Assistant Physical Therapist) stated, (R9) has seen me several times since she admitted to the facility back in 2022, but (R9) has insurance that only allowed me to have six visits with her. I know we made a lot of progress and I know we have not had a restorative nurse for close to a year now. I feel that with a successful continuation with restorative therapy (R9) would have more success with her legs, and hands. On 4/8/25 at 1:30 P.M., V1 (Administrator) stated We have had restorative nurses hired but we have had a difficult time with keeping one on staff who is not on medical leave or leaves the position shortly after they have started over the last year. CNAs (certified nursing assistant) should be doing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 3 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0688 the restorative tasks for (R9). Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 4 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to provide medications as ordered for one of five residents (R40) reviewed for medication administration, in a sample of 32. Residents Affected - Few FINDINGS INCLUDE: The (undated) facility's Drug Administration policy, documents, Medications are administered as prescribed, in accordance with good nursing principals and practices and only by persons legally authorized to do so. Medications are administered in accordance with written orders of the attending physician. R40's (hospital) After Visit Summary, dated 8/13/25 includes the following diagnoses: Suicidal Ideations and Major Depressive Disorder. This same form includes the following medication orders: Sertraline (Anti depressant) 100 MG (Milligrams) Take two tablets every day. R40's Medication Administration Record, dated August 13, 2024 through August 30, 2024 includes no nursing documentation that R40's prescribed Sertraline were added to R40's Medication Administration Record or administered from 8/13/24 through 8/28/24. On 4/8/25 at 2:38 P.M., V2/Director of Nurses confirmed that R40 did not receive the prescribed Sertraline from 8/13/24 until 8/29/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 5 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on interview and record review the facility failed to provide evening snacks for seven of seven residents (R7, R8, R15, R28, R33, R45, R55) reviewed for evening snack provision in the sample of 32 residents. Findings include: The facility's HS (evening/hour of sleep) Snacks policy, dated 8/8/2024, documents the following: Snacks are available to residents to offer nourishment at HS. The Food & Nutrition department will send snacks to the nursing stations at HS. Residents may be offered snacks such as graham crackers, cookies, fig newtons, pudding, applesauce (according to the resident's diet order and/or preferences.). The Food & Nutrition department will maintain a system or snack list for labeling & delivering snacks to those residents that receive scheduled snacks as part of their plan of are/preference. Resident Council Meeting Minutes, dated 10/28/24, documents concerns that Snacks and Coffee are not being passed out. On 4/7/25 at 9:45am, during the Survey Group Meeting, every attending resident stated that evening snacks are not being given to residents very often. R7 stated, We don't get evening snacks very often. R33 stated, Sometimes we do get (evening snacks) and sometimes we don't. R28 stated, They either don't bring them or they are delivered late, when we're asleep and we can't eat them. On 4/8/25 at 1:15pm, R8, R15 and R55 verified evening snacks are not being offered on a regular basis. On 4/8/25 at 2:50pm V16 Dietary Manager stated evening snacks should be passed every day around 6:30pm. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 6 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 2. R7's medical record includes the following diagnoses: Type 2 Diabetes Mellitus; Left-sided Hemiplegia, Hemiparesis due to Cerebral Infarction and Morbid Obesity. Residents Affected - Few R7's current Care Plan includes the following: I am on enhanced barrier precautions for Wounds to bilateral heels. Enhanced precautions will be maintained. Follow Enhanced Precaution Guidelines when providing care and coming in direct contact with potentially infected material or devices that put me at risk. Direct Care activities include dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs , assisting with toileting and incontinence care. Follow the enhanced precautions guidelines. On 4/8/25 at 9:10am, Enhanced Barrier Precautions signage was in place at R7's door and PPE/Personal Protection Equipment was available in the hall outside R7's door. On 4/8/25 at 9:10am V6 CNA/Certified Nursing Assistant and V7 CNA entered R7's room and did not don gowns prior to or throughout incontinence care for R7. On 4/8/25 at approximately 1:15pm, V3 Assistant Director of Nursing/Infection Preventionist stated staff are to wear gowns when performing incontinence cares for any resident under EBP/Enhanced Barrier Precautions. Based on observation, interview and record review the facility failed to donn personal protective equipment during cares for two of 12 residents (R7, R27) reviewed for enhanced barrier precautions in a sample of 32. Findings include: The facility's Guidelines for Enhance Barrier Precautions-EBP, undated, documents that enhanced barrier precautions are defined as the use of PPE (personal protective equipment) gowns and gloves during high-contact resident care activities that generate opportunities for transfer of MDRO's (Multi-drug Resistant organisms) in the form of blood or body fluids, onto the hands and/or clothing of the rendering caregiver. This form also documents examples of High Contact Resident Care activities at which EBP is to be practiced are dressing care/changes/management of dressings, changing briefs and assisting with toileting. 1. R27's current Physician Order Sheet, documents to cleanse the right great toe with wound cleanser, then apply a medicated dressing and cover with bordered gauze daily. This form also documents Enhanced Barrier Precautions due to AV (arteriovenous) shunt fistula and wounds. On 04/08/25 9:00 AM, V3, Infection Preventionist/Licensed Practical Nurse, used hand sanitizer, applied gloves, then removed R27's dressing to his right great toe. R27's right great toe wound had a serosanguinous drainage noted, with slough noted in the center of the wound. V3 went back to the treatment cart, removed her glove, used hand sanitizer, applied gloves and cleansed R27's right toe wound. V3 removed her gloves, used hand sanitizer, applied gloves and applied medication and dressing to R27's wound. On 04/08/25 at 12:00pm, V3 verified that R27 is on Enhanced Barrier Precautions and PPE is to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 7 of 8 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 145989 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parker Nursing & Rehab Center 516 West Frech Street Streator, IL 61364 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 0880 worn with direct care. V3 verified that she did not wear a gown during R27's wound care. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145989 If continuation sheet Page 8 of 8