Health inspection·April 29, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to protect a resident from misappropriation of resident property when a staff member removed a resident's cellular telephone from the facility and later disposed of the cellular telephone in a trash receptacle at a local park. Residents Affected - Few This applies to 1 of 3 residents (R1) reviewed for theft in the sample of 3. Findings include: The facility's final report to the State Survey Agency dated April 21, 2025 shows, Brief description of incident: R1 family stated R1's cell phone is missing from facility. R1 unable to identify any staff member that could be involved but an immediate search was completed. Disposition: R1's family called the facility and stated they have a phone tracking application downloaded on R1's phone and they were notified that R1's phone left the facility. R1's family retrieved the phone and returned it to R1. Upon interview with [V3] (CNA-Certified Nursing Assistant), she stated she accidentally grabbed R1's phone. [V3] stated she realized on her drive home that she had two phones and panicked. [V3] stated she was scared and threw the phone into a trash can at a nearby park. [V3] acknowledges she should have returned the phone to the facility, but she states she didn't know whose phone it was. [V3] apologized for her behavior The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE] with multiple diagnoses including, non-rheumatic aortic valve stenosis, difficulty walking, unsteadiness on feet, abnormal gait, COPD (Chronic Obstructive Pulmonary Disease), asthma, diabetes, morbid obesity, atrial fibrillation, congestive heart failure, heart disease, lymphedema, and osteoarthritis. R1's MDS (Minimum Data Set) dated April 1, 2025 shows R1 is cognitively intact, requires setup assistance with eating and oral hygiene, supervision with personal hygiene, partial/moderate assistance with showering and lower body dressing, and substantial/maximal assistance with toilet hygiene, bed mobility, and transfers between surfaces. R1 is occasionally incontinent of urine, and frequently incontinent of stool. On April 28, 2025 at 10:03 AM, V1 (Administrator) said, [R1's] family had an app to track [R1's] cell phone. The app showed the phone left our facility between 3:10 PM and 3:15 PM on April 20, 2025. I looked at timecards and narrowed it down to who had just left the facility. The family tracked [R1's] cell phone to a trash can at a park. They went and retrieved the cell phone from the garbage can. [V3] (CNA) claims that she was burnt out and tired and she grabbed it and panicked and threw it out. (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: 146034 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 146034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl at the Tillers 4390 Route 71 Oswego, IL 60543 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)