Inspection·February 11, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, observations, and record reviews the facility failed to prevent verbal and mental abuse for 4 out of 6 residents (R3, R4, R6, R7). This failure resulted in R3, R4, R5 and R7 experiencing psychosocial harm. Using the reasonable person concept, R3, R4, R6 and R7 experienced psychosocial harm with feelings of shame, embarrassment, humiliation or insignificance. Findings include: 1 R3 was admitted to the facility on [DATE] with diagnosis of, in part, atherosclerosis of extremities (bilateral legs), unsteadiness on feet, and unspecified displace fracture of right humerus. R3's MDS dated [DATE], documents she is cognitively intact, and requires partial/moderate assistance from staff for upper and lower body dressing as well as putting on/taking off footwear. R3's Care Plan dated 12/3/24, documents she requires assistance with activities of daily living (ADL's) related to (r/t) weakness, arthritis, history of falls, fracture of right humerus, osteoporosis and for staff to provide privacy and offer choices where available. The Care Plan continues to document R3 is at risk for falls r/t weakness, arthritis and for staff to provide a safe environment. On 1/28/25, R3's statement for the facility's investigation on alleged abuse occurring 1/24/25, documented that V3 was inappropriate with her by not helping her get out of bed and dressed because she did not want to get dressed in the bathroom. R3 stated V3 said she couldn't help because she had to do something else. On 2/10/25 at 9:40 AM, R3 stated V3 had treated her poorly a couple weeks ago. R3 stated she needed help getting up and dressed so she requested help from V3. R3 stated V3 told her she needed to get dressed in the restroom. R3 stated she told V3 she didn't want to get dressed in the restroom because there's no room but V3 told her she didn't have time and made her get dress in there. R3 stated that V3 was forceful and very rushed while putting stockings on her in the restroom, then left her in her chair to eat breakfast with just her undershirt on. R3 stated she asked V3 if she could help her put a button up shirt over her undershirt but V3 told her no, she didn't have time. R3 stated V3 left her feeling exposed and cold without her button up on. On 2/10/25 at 9:29 AM, R2 stated V3, Certified Nursing Assistant (CNA), left a couple weeks ago and did not treat the lady next door (R3) properly. R2 stated she wouldn't have allowed V3 to take care of her family the way she took care of R3. R2 stated that V3 wouldn't allow R3 to get dressed in her room, that she needed to go in the restroom to get dressed but R3 told V3 there wasn't enough room (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: 146043 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 146043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Axiom Gardens of Nashville 485 South Friendship Drive Nashville, IL 62263 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)