Inspection·February 25, 2026

F 0690 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. 1:55PM documents reached out to (local hospital) urology et (and) was referred to (local hospital), was reported that they will call back in approx. 2 wks (weeks) for f/u (follow up).R1's Progress Note dated 10/30/25 at 1:35PM documents This nurse called and spoke with (V14-Family Member) about concerns he has.This nurse explained that Urology appointment is on 11/17/25 at 10:30AM at (name of clinic), he asked about the resident catheter, that he says it hurts, explained that it was placed when resident was in hospital and we cannot remove it without a doctor order and he needs to be seen for follow up with urologist on that regard.R1's Progress Note dated 10/30/25 at 3:34pm documents T/C (telephone call) to Urologist to determine if resident appointment could be moved up per family request. They state they do not have anything sooner than what is scheduled. This nurse asked if they had a wait list he could be put on in case of a cancellation, and she states they do and she put his information in the computer and would contact facility if change.R1's Progress Note dated 10/30/25 at 8:40pm, documents Message sent to NP (V11 Nurse Practitioner) updating on family concerns about urinary pain, catheter is patent and intact, draining amber urine without difficulty. Resident does pull on the catheter tubing at times so may have gotten germs from hand onto the catheter. Has urology appointment set up. Informed him of family concerns and requested to do a UA (urinalysis).R1's Progress Note dated 10/31/2025 at 2:40pm documents T/C (telephone call) received from NP (V11 Nurse Practitioner) he was asking about resident catheter and was place in hospital and has follow up with urology. NP states that is fine, just wanted to make sure if he didn't need it to try and remove. NP states if family continues to question, explain hospital said to see urology and it cannot be removed until that time. Explained that family had been educated on this.There is no documentation in R1's Progress Notes or R1's Physician Order History that an order to obtain a urinalysis was received.R1's Progress Note dated 11/2/2025 at 3:11pm documents Res (Resident) c/o (complaint of) not being able to urinate. Did assess abd (abdomen) and distention felt. Urine has much sedimentation in it. Did replace f/c (foley catheter) with # 16 French and a 10cc bulb. Good urine return noted. Upon later evaluation -Res states he feels better and abd distention is gone.R1's Progress Note dated 11/20/25 at 4:22pm documents Called Urology office .spoke with (staff member), informed her that we have not yet received office notes or orders from res (resident) visit earlier this week, and provider agreed to remove foley and allow res (resident) to void on his own. She is going to re fax office notes and orders at this time. Res has been up for meals and is currently in room visiting with family .R1's Progress Note dated 11/21/25 at 5:33pm documents Per urology's request, catheter was removed today without complication. explained procedure to patient, ensured privacy, and performed hand hygiene. catheter balloon fully deflated and catheter withdrawn smoothly. Tip intact. patient tolerated procedure well with no signs of discomfort or bleeding. Perineal area cleansed and patient instructed to increase oral fluids and staff notified to encourage him as well. will continue to monitor urinary output and signs of urinary retention.R1's Progress Note dated 11/23/25 at 1:27pm documents 11/23/2025 [Recorded as Late Entry on 11/24/2025 10:30 PM] Res up in wc (wheelchair) with mech assist for transfers. Res alert, and able to make needs known. Res is tolerating Foley cath removal and has been able to urinate this shift on his own and without cath in place. Fluids encouraged and taken well, res will take fluids despite having thickened liquids. Res appears calmer and less agitated since catheter removal and cont (continue) to void yellow urine without distress. Will cont to monitor.R1's Progress Note dated 12/4/25 at 12:22 AM recorded as a late entry on 12/5/25 at 12:23am documents This nurse was called to residents room as resident had change in behavior. Per wife resident did not speak or feed self at dinner but allowed wife to feed them. Resident prompted to say name and resident slurred response. Able to make eye contact for a short period and then resident eyes would roll back. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146088 If continuation sheet Page 2 of 4 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 146088 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Helia Healthcare of Benton 1310 Mark Franklin Louis Street Benton, IL 62812 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)

F 0690 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. Spastic movements (short jerky motions) of body. Wife present. Sent to ER (name of hospital) for eval via EMS (Emergency Medical Services).R1's History and Physical Report from the local hospital dated 12/5/25 under History of Present Illness documents He presented to ER 9Emergency Room) with complaints of altered mental status from a local rehab facility. Family notes he has been in the facility for the last 2 months after a hip fracture. He went to facility for rehab. Family notes that he has been slowly deteriorating over the last 2 weeks. Speech declining, unable to feed self. ER workup significant for urine positive for UTI (Urinary Tract Infection), WBC (White Blood Cell) normal at 9.6, sodium elevated 157, lactic acid 2.8. He was given IV (intravenous) hydration and IV Rocephin. admitted to the floor for continued monitoring and management. Under Assessment and Plan diagnoses of altered mental status, UTI, and hypernatremia are documented.On 2/18/26 at 10:22am, V14 (family member) stated R1's catheter was not changed for over 4 weeks. V14 stated he was told they had to have urologist order to take it out, R1 only had the catheter for surgery and had no prior urinary issues. V14 stated he questioned administration several times about whether R1 could be dehydrated or have a UTI (Urinary Tract Infection). V14 stated he reported R1 was having urinary pain, and he was told they would request a Urinalysis but one was never done. V14 stated he requested to speak to the physician on more than one occasion but was never given the opportunity.On 2/18/26 at 2:11pm, V3 (Licensed Practical Nurse/LPN) stated R1's family was really concerned about him and his condition. V3 stated R1's family really tried to stay on top of his care. V3 stated she believes somewhere along the way the ball was dropped on scheduling R1's follow-up appointments. V3 stated R1 was admitted with a catheter and there was some confusion as to why it was still in place. V3 stated they called to get clarification, and it was left in place because R1 had some retention at the hospital, and they were waiting for R1 to follow up with urology for removal. V3 stated R1's catheter was really irritating for him; he would mess with it often. V3 stated R1's family did complain of it hurting him, but not to her. V3 stated if someone has a urinary retention and sediment with a catheter which resulted in it having to be changed, she would report symptoms to the physician. V3 stated even if symptoms were alleviated with catheter change. On 2/19/26 at 12:04pm, V4 (Licensed Practical Nurse/LPN) stated R1 did have a catheter that was put in at the hospital for surgery, but it was left in because he had urinary retention after surgery. V4 stated R1 had a referral for urology, and they were awaiting on that appointment to remove it. V4 stated R1 messed with it constantly, she was not sure if it was bothering him or if it was his anxiety. V4 stated she did change R1's catheter on or around November 2nd due to having retention and sediment in his drainage bag. V4 stated the new catheter was draining properly. V4 stated R1 had a standing order to change the catheter, so she did not have to contact the physician to let him know the symptoms that led to it being changed or that she changed it.On 2/23/26 at 1:35pm, V2 (Assistant Administrator) stated she covers the duties of Social Services Director when the facility does not have one. V2 stated if she was not provided with discharge instructions and follow-up appointments, she would reach out to the facility or hospital the resident came from and find out and make the appointments immediately. V2 stated she may not do it that day depending on when they admitted , but the next business day that she could. V2 confirmed that R1's urology appointment was not addressed until 10/15/25 and should have been addressed sooner.On 2/23/26 at 3:20pm, V1(Administrator) stated that she would expect a physician to be notified if a resident had urinary retention and abdominal distention, even if they had a standing order and symptoms were alleviated with catheterization.On 2/24/26 at 10:32am, V12 (Physician) stated he did R1's initial comprehensive evaluation in the facility. V12 stated R1's care was transferred to another provider shortly after. V12 stated there could be a few reasons why R1's catheter was not included in his initial (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146088 If continuation sheet Page 3 of 4 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 146088 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Helia Healthcare of Benton 1310 Mark Franklin Louis Street Benton, IL 62812 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)

F 0690 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation. FORM CMS-2567 (02/99) Previous Versions Obsolete assessment, he stated it could have been that he was not informed of it, or that he had more pertinent issues to address. V12 stated he does not recall knowing that R1 had a catheter, but he had a brief interaction and that was months ago. V12 stated it is very common for residents to come from the hospital with no previous history of urinary issues with a catheter. V12 stated sometimes he doubts if the hospital even tries to trial removal or just passes it off to the facility with a referral to urology. V12 stated getting a resident with a fracture like R1's to a urology appointment can be challenging. V12 stated he is pretty aggressive at safely removing a catheter and returning back to normal function with his own patients, even if they have a urology consultation. V12 stated he could not stress enough doing it safely, but with someone with no previous issues, it can typically be done successfully in house. V12 stated if he received a report of pain with a urinary catheter, he would order a urinalysis.On 2/24/26 at 11:33pm, V1 (Administrator) stated she did not see any lab results scanned into R1's file, but she requested R1's lab records from the hospital.On 2/24/26 at 11:48am, V1 forwarded R1's hospital lab results, there were no labs obtained at the facility prior to R1's hospitalization on 12/4/26.The facility Policy titled, Catheter Care, Urinary with a revision date of July 2017 documents under the section, Complications it states in section b. If the resident indicates that his or her bladder is full or that he or she needs to void (Urinate), notify the physician or supervisor. Under section e. Observe for other signs and symptoms of urinary tract infection or urinary retention. Event ID: Facility ID: 146088 If continuation sheet Page 4 of 4