Inspection·September 29, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide timely Activities of Daily Living (ADL) assistance to residents who were dependent on staff for incontinence care. This applies to 3 of 3 residents (R1, R7 and R9) reviewed for incontinence care in a sample of 10. The findings include: 1. Face sheet, dated 9/25/25, showed R1's diagnoses included multiple sclerosis, obesity, congestive heart failure, and neuromuscular dysfunction of his bladder. MDS, dated [DATE], shows R1 was cognitively intact, was completely dependent on staff for toileting and personal hygiene, and was always incontinent of bowel and bladder. Review of R1's care plan showed R1 was totally dependent on staff for toileting and was able to tell staff when he needed to be changed after incontinence episodes. The care plan approaches included providing assistance for toileting after each incontinence episode. The care plan showed R1 was dependent on staff for transfers using a mechanical lift. On 9/24/25 1:10 PM, R1 stated the prior week he asked to be toileted at approximately 10:30-11:00 AM and waited until the next shift. R1 stated the last time his brief was changed was 8:00 AM when he got up from bed. On 9/24/25 at 2:25 PM, R1 asked V4 (Certified Nursing Assistant/CNA) to change his soiled incontinence brief. R1 sat in his room and waited for staff to arrive. On 9/24/25 at 2:55 PM, V4 was entering information into the computer system in the hallway. On 9/24/25 at 3:10 PM R1 was still waiting in his room for his incontinence brief to be changed. At 3:25 PM, R1 decided to leave his room and go downstairs. R1 had not had his soiled incontinence brief changed. R1 returned to his room soon after. On 9/24/25 at 3:28 PM, V6 (CNA) and V7 (CNA) both stated they were not aware R1 needed his incontinence brief changed and stated they got no report from V4 prior to V4 leaving her shift for the day. V2 (Director of Nursing) stated a staff member called in and the current facility staff needed to split the rooms to cover the floor. On 9/24/25 at 3:37 PM, V6 stated he was going to change R1's incontinence brief and then put R1 back in his wheelchair for dinner. V6 and V7 walked into R1's room and began to initiate changing R1's incontinence brief. At 4:00 PM, R1's incontinence brief was examined and appeared extremely full of urine and had a large amount of bowel movement in the brief. V6 and V7 both stated R1's incontinence brief was extremely full of urine and bowel movement. On 9/25/25 at 10:28 AM, V2 (Director of Nursing) stated nursing staff were expected to check incontinent residents' briefs every two hours even if residents were able to verbalize if they were wet or could change themselves. V2 stated on the morning of 9/24/25, V2 saw R1 and knew his incontinence brief needed changing by the smell of urine from R1. V2 stated she texted all the managers on duty on 9/24/25 to alert staff that R1 needed his incontinence brief change because he smelled of urine. On 9/25/25, V4 (CNA) stated she got R1 up out of bed and performed incontinence care for R1 at approximately 8:00 AM to 8:30 AM. V4 stated R1 becomes impatient when he needs to wait to have his soiled incontinence brief changed. V4 stated she overheard R1 tell V11 (Restorative) that he did not want a shower or incontinence care until the next shift. V4 stated R1 did not ask V4 for incontinence care during her Residents Affected - Few (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 4 Event ID: 146065 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 146065 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Abbington Vlge Nrsg & Rhb Ctr 31 West Central Roselle, IL 60172 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)