Inspection·May 25, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on observation, interview and record review the facility failed to prevent abuse facilitated through social media for three of three residents (R1, R2, R3) reviewed for abuse. Residents Affected - Few Findings include: Facility Policy/Abuse Prohibition and Reporting dated/revised 11/28/19 documents: The facility actively prohibits resident abuse including neglect, corporal punishment, involuntary seclusion, misappropriation of property, injuries of unknown source, exploitation and use of physical or chemical restraints. Mental abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation. Mental abuse also includes, but is not limited to, abuse that is facilitated or caused by nursing home staff taking or using photographs or recordings in any manner that would demean or humiliate a resident(s). Facility Policy/Social Media Policy dated 10/20/21 documents: Examples of information that should not be disclosed on social media include: Photographs. Incident Investigation timeline indicates on 5/17/23 at 11AM, an email was sent to the facility's Marketing Director regarding a social media post of three current facility residents. Timeline indicates the Marketing Director immediately notified V1, Administrator and V2, DON (Director of Nursing) of the email. Email dated 5/17/23 at 10:05 AM indicates videos were seen on a social media site of V4, Resident Aide taking videos of himself arguing with residents, making fun of their appearance and winding up as if to punch them. The email had the videos attached to the email. On 5/25/23 at 12:45 AM, social media video's posted by V4 showed pictures of R1 and R2 sitting at a table in a facility dining room and another video of V4 wearing a facility designated name tag and shirt with the caption Bro, I'm high as F**K, arguing with theses Niggers. Another video shows V4 pretending to punch R3 in the face but does not actually make contact. R3 does not appear to be aware of V4's actions. Signed Statement (undated) indicates V4 stated he posted the videos as a joke and only believes it would be considered abuse if he actually struck (R3). V4 stated that he was only Joking that he was (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: 146091 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 146091 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manor Court of Peru 3230 Becker Drive Peru, IL 61354 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)