Health inspection·March 21, 2024

F 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4.) R1's electronic census documents R1 was readmitted from the hospital on 1/31/24. Residents Affected - Some R1's Physician's Order dated 2/2/24 documents an Occupational Therapy Clarification Order - Skilled Occupational Therapy 5 times a week for 4 weeks to include therapeutic exercise, self care, neuromuscular reeducation, therapeutic activities, wheelchair management and safety awareness. R1's Physician's Order dated 2/2/24 documents as of 1/1/24 Physical Therapy Clarification Order - Skilled Physical Therapy 3 times a week for 4 weeks to include therapeutic exercise, therapeutic activities, neuromuscular reeducation and gait training. R1's Occupational Therapy Plan of Care dated 2/2/24 documents the frequency and duration as five times a week for four weeks. R1's Physical Therapy Plan of Care dated 2/1/24 documents the frequency and duration as three times a week for four weeks. On 3/20/24 at 2:59 PM, V5 Registered Nurse stated she feels like R1 was getting stronger with the therapy. On 3/20/24 at 3:01 PM, V4 Licensed Practical Nurse/Minimum Data Set float nurse stated that R2 is not receiving any restorative programs at this time according to the task manager in the computer. 5.) R2's electronic census documents R2 was readmitted from the hospital on 1/25/24. R2's Physician's Order dated 1/30/24 documents as of 1/29/24 Speech Therapy Clarification Order - Skilled Speech Therapy 5 times a week for 4 weeks for Dysphagia to include Oral Pharyngeal exercises, therapeutic feedings, diet texture analysis and develop and train compensatory techniques. R2's Speech Therapy Plan of Care dated 1/29/24 documents the frequency and duration as five times a week for four weeks. On 3/20/24 at 2:59 PM, V5 stated that [NAME] was getting speech therapy and they got her to start eating foods orally. They are hoping to get her completely off of the tube feedings. V5 confirmed that R2 is not receiving any speech therapy right now. On 3/21/24 at 9:21 AM, V6 R2's husband confirmed that R2 was receiving speech therapy and that it helped her start eating again. Based on observation, interview and record review the facility failed to ensure therapy services were provided for five (R1, R2, R3, R4 and R5) of five residents reviewed for therapy services from a (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: 146039 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 146039 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastview Healthcare & Senior Living 100 Eastview Place Sullivan, IL 61951 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)