Inspection·April 17, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect a resident from employee to resident verbal abuse for 1 of 10 residents (R3) reviewed for abuse in a sample of 12. The findings include: R3's Face Sheet documents an admission date of 1/4/24 with diagnoses including Muscular Dystrophy, Adjustment Disorder with mixed anxiety and depressed mood, Multiple Sclerosis and Major Depressive Disorder. R3's Minimum Data Set (MDS) dated [DATE] documents that R3 has a Brief Interview for Mental Status (BIMS) score of 15 indicating that R3 is cognitively intact. On 4/16/25 at 10:25 AM, R3 stated the facility started a trial for vitamin IV (intravenous) bags and the first month she agreed to do it but the second month she refused it because she was having diarrhea and wasn't feeling the best. R3 stated when she refused the vitamin bag V2 (Director of Nursing) yelled at her and said she just cost the facility $1,000 dollars. R3 stated she reported it to V1 (Administrator) and he had a meeting to tell everyone what the trial for the vitamin bag was and how long it went on. R3 said the next day or so V2 apologized to her for yelling at her in the lunchroom in front of everyone. R3 said that R8 and V7 (Certified Nursing Assistant/CNA) witnessed V2 yelling at her in the dining room. On 4/17/25 at 8:26 AM, R3 stated she feels safe at the facility, but she does feel like she needs to tip toe around V2. R3 stated she doesn't think she will do it again because she thinks V2 knew what she did was wrong. R3 stated she was a little embarrassed but was more angry at the situation. On 4/16/25 at 2:20 PM, R8 stated she was at the table in the dining room when V2 came to the table and yelled at R3 for not taking the IV fluids. R8 couldn't remember what exactly she said, just that she yelled at her and it was about 1 month ago. R8 was alert to person, place, and time. On 4/16/25 at 10:33 AM, R5 stated he witnessed V2 yell at R3 for refusing the IV therapy. R5 was alert and oriented to person, place, and time. On 4/17/25 at 9:36 AM, V7 (CNA) stated she was in the dining room when V2 raised her voice and heard it. V7 stated R3 told V2 that she didn't want to do the IV drip because she didn't feel good. V7 stated V2 raised her voice to R3 and told her it was already paid for and she would have to charge it anyways because they already paid for it. V7 stated V2 did raise her voice at R3 and seemed angry with R3. V7 stated she was sitting across the dining room when it happened and she could hear V2, she also stated it was loud enough that people could probably hear it down the hallway. V7 stated she (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: 146045 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 146045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Helia Healthcare of Energy 210 East College Energy, IL 62933 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)