Health inspection·October 7, 2023

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 ensure a resident (R1) was not subjected to verbal abuse by an employee. R1 is one of three residents reviewed for abuse on the sample list of five. Findings include: On 10/7/23 at 11:24am V3 Certified Nursing Assistant (CNA) said, on 9/20/23 at 2:00pm V4 Certified Nursing Assistant (CNA) was preparing R1 for a shower in R1's room. V3 said, V3 heard V4 tell R1 that if R1 doesn't stop yelling, V4 will drown R1 in the shower. V3 said, V4 gave R1 a shower, and brought R1 back to R1's room. V3 said, V3 than heard V4 tell R1 to shut the (expletive) up, because R1 was yelling out. V3 said, V3 immediately went and told V2 Director of Nursing (DON). On 10/7/23 at 1:15pm V1 Administrator said, on 9/20/23 V1 was notified of an allegation of abuse between R1 and V4 Certified Nursing Assistant (CNA). V1 said, V1 interviewed V3 Certified Nursing Assistant (CNA) who informed V1 that on 9/20/23 at 2:00pm V4 Certified Nursing Assistant (CNA) was preparing R1 for a shower, V4 stated V4 was going to drown R1 if R1 didn't stop screaming. V1 said, V3 further informed V1 that upon V4 bringing R1 back to R1's room, V4 told R1 to shut the (expletive) up, because R1 was yelling. V1 said, V1 interviewed V4 who admitted telling R1 to shut the (expletive) up. V1 said, as the result of the investigation, it was determined that V4 committed verbal abuse by admitting using inappropriate tone with R1 and telling R1 to shut the (expletive) up. R1 Facility Census documents R1 was admitted to the facility on [DATE] and has the following medical diagnoses; Type 2 Diabetes Mellitus, Hyperlipidemia, Protein-Calorie Malnutrition, Anxiety Disorder, Major Depressive Disorder, Hypothyroidism, HTN, Osteoarthritis, Noninflammatory Disorders of Uterus, Pulmonary Fibrosis, Cholelithiasis, Solitary Pulmonary Nodule, Constipation, Dementia, and Abnormalities of Gait and Mobility. R1's Minimum Data Set (MDS) dated [DATE] documents R1's Brief Interview for Mental Status (BIMS) score 0, severe impairment and is total dependence two-person physical assist with all Activities of Daily Living (ADL). The Facility's Final Investigation Report dated 9/25/23, for R1 incident which occurred on 9/20/23 documents V4 Certified Nursing Assistant (CNA) was preparing R1 for a shower, V4 reportedly stated V4 was going to drown R1 if R1 didn't stop screaming. Upon returning R1 from the shower to R1's room, V4 reportedly told R1 to shut the (expletive) up, because R1 was yelling. The Facility's Abuse, Neglect, Exploitation, Mistreatment and Misappropriation of Resident Property Page 1 of 2 146049 146049 10/07/2023 Iroquois Resident Home, The 200 Fairman Avenue Watseka, IL 60970

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revised 12-1-2022 documents, Preface: It is the policy of the facility to encourage and support all residents, staff, visitors, volunteers, and resident representatives in reporting any suspected acts of abuse, neglect, exploitation, involuntary seclusion, or misappropriation of resident property from abuse, neglect, misappropriation of resident property, and exploitation. This includes but not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the residents medical symptoms. i. Verbal abuse is defined as the use of oral, written, or gestured communication, or sounds, to residents within hearing distance, regardless of age, ability to comprehend, or disability. 146049 Page 2 of 2