Health inspection·May 30, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure proper and safe administration of medications in accordance with facility policy for 2 (R1, R3) of 3 residents reviewed for pharmacy services in the sample of 13. Findings Include: 1. R1's Transfer/Discharge Report documented an admission date of 2/24/2025 and included diagnoses of bradycardia, heart failure, hypertension, type 2 diabetes mellitus with other circulatory complications, weakness and unsteadiness on feet. R1's Minimum Data Set (MDS) assessment dated [DATE] documented a Brief Interview for Mental Status (BIMS) score of 15, which indicates R1 is cognitively intact. R1's Care Plan had no documentation of self-administration of medications being a goal or focus area for R1. V2 (Adult Protective Specialist) stated, she had direct care with R1 for the past year. V2 stated, R1 had been staying at this facility temporarily until another placement could be arranged. V2 stated, she came to visit R1 on 5/23/2025 around 8:00 am in the morning. V2 stated, when she walked into R1's room, she had been lying in her bed, covered up with blankets and a pillow resting over her head. V2 stated, R1 does prefer to sleep this way. V2 stated, when she entered R1's room, she noticed a medicine cup with medications sitting on R1's assistive device chair cushion. V2 stated, she woke R1 up and R1 stated, she did not know they had left her medications for her this morning, but they normally leave her medications for her because she does not like to get up in the mornings and go to the dining room. On 5/29/2025 at 10:57 AM, R1 stated she does get medication administered to her by the facility. R1 stated, the facility nurses will leave her medication, including eye drops at her bedside without telling her they are there. R1 stated, the nurses say she is too hard to wake up in the mornings. R1 stated V2 did come to visit her on 5/23/2025 sometime after 8:00 AM and woke her up. R1 stated, V2 did observe her medications in a medicine cup sitting on her assistive device cushion. R1 stated her nurse that morning was V6 (Registered Nurse/RN), and she did not wake her up to give her the medications. R1 stated, the facility nurses had been leaving her medication at her bedside more frequently than before. On 5/29/2025 at 12:39 PM, V6 (RN) stated she did work R1's hall on 5/23/2025. V6 stated, she did (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: 146021 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 146021 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nature Trail Health and Rehab 1001 South 34th Street Mount Vernon, IL 62864 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)