Health inspection·August 17, 2025

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to protect resident's right to privacy. This failure affected two of four residents (R1, R2) reviewed for resident rights on the sample list of four. Findings Include:The facility's Resident Rights Guideline policy dated October 2023 documents the practice of this facility is to provide an environment in which residents may exercise their rights, each day. Residents have certain rights and protections under Federal law and the facility will always protect these rights through care and related services. One example of a resident's rights is Privacy and Confidentiality. R1's Medical Diagnoses List dated August 2025 documents R1 is diagnosed with Schizoaffective Disorder, Bipolar Disorder, Anxiety Disorder, and Insomnia. R1's Minimum Data Set, dated [DATE] documents R1 is cognitively intact. R1's Behavior Tracking for July 2025 through August 2025 documents R1 exhibits behaviors of attention seeking, repetitive questions/statements, invading the personal space of others, pacing, inappropriate comments, false allegations, manipulation, and insomnia. R1 entered other resident's rooms or personal space 17 times in the last 30 days. R1's Care Plan dated 8/14/25 documents R1 exhibits behaviors of attention seeking, repetitive questions/statements, invading the personal space of others, pacing, inappropriate comments, false allegations, manipulation, and insomnia. Staff are to intervene as necessary to protect the rights and safety of others. R2's Medical Diagnoses List dated August 2025 documents R2 is diagnosed with Schizoaffective Disorder, Generalized Anxiety disorder, Depression, Insomnia, and Paranoid Personality Disorder. R2's Care Plan dated 6/6/25 documents R2 is cognitively impaired and has short term memory deficit. R2 requires substantial/dependent assistance with activities of daily living. R2 is incontinent and requires staff to provide perineal care at least every two hours. On 8/17/25 at 2:27 PM V9 Certified Nurses Assistant stated R1 has a lot of anxiety and needs constant attention and reassurance. R1 will follow staff into other resident's rooms and will not listen when you ask her not to do things. R1 will invade other resident's privacy and is hard to redirect. R1will get into staff or resident's faces when asking them repetitive questions. V9 stated R1 will often open the curtain to talk to staff while they are providing personal care for R1's roommate (R2). V9 stated staff will have to stop what they are doing to redirect R1 and she continues to invade R2's privacy. On 8/17/25 at 2:37 PM V7 Licensed Practical Nurse stated R1 is constantly invading others' privacy and personal space. On 8/17/25 at 2:51 PM V6 Licensed Practical Nurse stated R1 bothers other residents and invades their privacy. On 8/17/25 at 4:45 PM V2 Director of Nurses stated she was not aware of R1 continually opening R2's privacy curtain while staff are providing care and confirmed that is a violation of R2's right to privacy. Residents Affected - Few Page 1 of 2 146050 146050 08/17/2025 The Haven of Arcola 422 East Fourth Street Arcola, IL 61910

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 resident's right to be free from verbal abuse. This failure affected two of four residents (R1, R3) reviewed for resident rights on the sample list of four. Findings Include:The facility's undated Abuse policy documents Verbal Abuse is the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or families, or within their hearing distance, regardless of an individuals' age, ability to comprehend, or disability. Examples of verbal abuse include, but are not limited to, threats of harm, saying things to frighten a resident. R1's Medical Diagnoses List dated August 2025 documents R1 is diagnosed with Schizoaffective Disorder, Bipolar Disorder, Anxiety Disorder, and Insomnia. R1's Minimum Data Set, dated [DATE] documents R1 is cognitively intact. R1's Behavior Tracking for July 2025 through August 2025 documents R1 exhibits behaviors of attention seeking, repetitive questions/statements, invading the personal space of others, pacing, inappropriate comments, false allegations, manipulation, and insomnia. R1's Care Plan dated 8/14/25 documents R1 exhibits behaviors of attention seeking, repetitive questions/statements, invading the personal space of others, pacing, inappropriate comments, false allegations, manipulation, and insomnia. Staff are to intervene as necessary to protect the rights and safety of others. R3's Medical Diagnoses List dated August 2025 documents R3 is diagnosed with Bipolar Disease, Anxiety, and a Mild Cognitive Impairment. R3's Minimum Data Set, dated [DATE] documents R3 is cognitively intact. R3's Care Plan dated 2/11/25 documents R3 exhibits behaviors caused by anxiousness with agitation which leads to verbal outbursts, mocking, yelling and demanding of others, sleep disturbances, refusal of care and false allegations. On 8/17/25 at 2:27 PM V9 Certified Nurses Assistant stated R1 has a lot of anxiety and needs constant attention and reassurance. R1 will follow staff into other resident's rooms and will not listen when you ask her not to do things. R1 will invade other resident's privacy and is hard to redirect. R1will get into staff or resident's faces when asking them repetitive questions. V9 stated R3 has verbally threatened R1. On 8/17/25 at 2:00 PM V5 Certified Nurses Assistant stated R3 yelled at R1 and stated R1 should get the f*** (expletive) out of here or she will break R1's hand. On 8/17/25 at 2:51 PM V9 Certified Nurses Assistant stated R3 is always telling R1 to shut up and go away. On 8/17/25 at 5:15 PM R3 stated R1 makes her very anxious and annoys her. R3 stated R1 follows staff around the entire shift. R3 stated there are times where she has gotten so annoyed with R1, that she has threatened her. R3 stated R1's behavior causes her great anxiety. It is hard for her to be around R1 and she is trying to be better. On 8/17/25 at 4:45 PM V1 Administrator confirmed that R3, threatening R1, could be considered verbal abuse. V1 also confirmed R1's behaviors and repetitive questions put her at risk for abuse. 146050 Page 2 of 2