Inspection·February 2, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the Facility failed to answer call lights in a timely manner for 3 of 3 (R1, R5, R6) residents reviewed for call lights in the sample of 6. Findings include: 1. R1's Face Sheet documents R1 was admitted to the facility on [DATE] with diagnoses including hypertension, muscle weakness, depression, urinary retention, dysphagia, displaced intertrochanteric fracture of left femur, and unspecified abnormalities of gait and mobility. R1's Minimum Data Set (MDS) dated [DATE] documented R1 was moderately cognitively impaired and ambulated via wheelchair and walker. R1's Care Plan dated 4/14/23 documents R1 has a self-care deficit and assistance will be provided to meet needs, including assistance with dressing/undressing, assistance with meals as needed, and assistance with oral/dental hygiene. On 2/1/24 at 1:00 PM, R1 was sitting in her wheelchair in her room. She stated call light response times vary, but sometimes they take a really long time. 2. R5's Face Sheet documents R5 was admitted to the facility on [DATE] with diagnoses including cerebral infarction, obstructive sleep apnea, hypertension, and depression. R5's MDS dated [DATE] documented R5 was cognitively intact, ambulated via wheelchair and walker, and required partial/moderate assistance with oral hygiene, toileting, bathing and dressing. R5's Care Plan dated 1/16/24 documents R5 requires assistance with mobility. On 2/2/24 at 6:18 AM, R5 stated sometimes call lights take a long time and usually take around 30 minutes to get a response. 3. R6's Face Sheet documents R6 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, anxiety, muscle weakness, hypothyroidism, hyperlipidemia, need for assistance with personal care, and other abnormalities of gait and mobility. R6's MDS dated [DATE] documented R6 was cognitively intact, ambulated via wheelchair, and required substantial assistance with rolling left to right and transfer. (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: 146052 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 146052 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alhambra Rehab & Healthcare 417 East Main Street, Box 310 Alhambra, IL 62001 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)