Health inspection·April 24, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to perform a PASARR (Pre-admission Screening and Resident Review) rescreen after the emergence of a newly diagnosed severe mental illness for two of three residents (R4, R27) reviewed for PASARR screening, in the sample of 24. Findings include: The (undated) facility policy, Resident Assessment- Coordination with PASARR (Pre-admission Screening and Resident Review) Program directs staff, This facility coordinates assessments with the preadmission screening and resident review (PASARR) program under Medicaid to ensure that individuals with a mental disorder, intellectual disability or a related condition receives care and services in the most integrated setting appropriate to their needs. Any resident who exhibits a newly evident or possible serious mental disorder, intellectual disability or a related condition will be referred promptly to the state mental health or intellectual disability authority for a level II resident review. 1. R4's (facility) Face Sheet documents that R4 was admitted to the facility on [DATE] with the following diagnosis: Bipolar Disorder (11/14/23). R4's Notice of PASARR, dated 7/21/20 documents, No Level II required- No Serious Mental Illness. On 4/22/25 at 10:00 A.M., V1/Administrator verified that R4 had not had a PASARR rescreen upon the emergence of a newly diagnosed severe mental illness. 2. R27's current Face Sheet documents the following diagnosis: Insomnia, Delusional Disorder, Post-Traumatic Stress Disorder, Dementia, unspecified severity, with other Behavioral Disturbance, General Anxiety. R27's PASRR, Preadmission Screening and Resident Review, dated 8/28/23, documents that R27 does not show that she has a serious mental illness or an intellectual/developmental disability (IDD). You do not need more screening unless you have or may have a serious mental illness or an IDD and are experiencing a significant change in treatment needs. On 4/22/25 at 2:00pm, V1, Administrator, verified that R27 did not have a PASRR screening completed after R27 was diagnosed with a mental illness. 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 7 Event ID: 146063 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 146063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Walnut 308 South Second Street Walnut, IL 61376 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)