Health inspection·September 11, 2025

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 observation, interview, and record review the facility failed to assist a resident with incontinence care in a timely manner to promote dignity for 1 of 10 residents (R1) reviewed for dignity in a sample of 10. Findings include:R1's admission Record documents an admission date of 2/15/22 with diagnoses including in part: paranoid schizophrenia, post traumatic seizures, insomnia, anxiety disorder, essential tremor, and personal history of traumatic brain injury.R1's Minimum Data Set (MDS) dated [DATE] documents R1 is rarely/never understood. The same MDS documents R1 is dependent with toileting hygiene, the ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement. R1's current Care Plan documents R1 is at risk for impaired skin integrity related to impaired cognition and R1 is known to refuse incontinence care at times. On 9/11/25 at 8:15 AM, R1 was sitting on the couch in the dining room watching the television. On 9/11/25 at 8:43 AM, R1 was sitting on the couch in the dining room watching the television. On 9/11/25 starting at 9:15 AM, R1 was under constant observation by surveyor that lasted until 11:51 AM. On 9/11/25 at 9:15 AM, R1 was sitting on the couch in the dining room with his legs crossed, and his pants were visibly wet in the front left groin area. On 9/11/25 at 9:28 AM, R1 uncrossed his legs and there was a large wet circle on the front of R1's pants. On 9/11/25 at 9:33 AM, V5 (Certified Nursing Assistant/CNA) was walking a resident through the dining room and walked in front of R1 while he was sitting on the couch watching TV. V5 said, Good morning to R1 then R1 responded with a smile and a wave. R1's pants were still visibly wet. On 9/11/25 at 10:28 AM, R1 was still sitting on the couch watching the television with visibly soiled pants. V6 (Activities Assistant) went to R1 with a cart of snacks and drinks and offered R1 a snack and drink. R1 was pointing at the cart and V6 was trying to figure out what he was pointing at. V6 finally figured out he was pointing at the ice that snacks were sitting in. On 9/11/25 at 10:49 AM, V8 (CNA) walked by R1 while he was sitting on the couch, R1 still had visibly soiled pants. V8 did not look at R1. On 9/11/25 at 10:50 AM, V2 (Director of Nursing/DON) walked by R1 while he was sitting on the couch, still had visibly soiled pants. V2 did not look at R1. On 9/11/25 at 10:56 AM, V7 (CNA Supervisor) walked by R1 and didn't look at R1. R1 was still visibly wet. On 9/11/25 at 10:59 AM, V9 (CNA) walked by R1 and didn't look at him. R1 was still visibly wet. On 9/11/25 at 11:00 AM, V8 (CNA) walked by R1 to the resident sitting 2 down from him and took his vital signs. R1 was still visibly wet. On 9/11/25 at 11:03 AM, R1 stood up with visibly wet pants and walked to the door to the back patio area for smoke break. R1 sat down on a bench in the smoking area. On 9/11/25 at 11:05 AM, V10 (Housekeeping) lit R1's cigarette and sat outside with R1 and other residents while they smoked. R1 still had visibly wet pants. On 9/11/25 at 11:16 AM, V10 walked R1 back into the building after he finished smoking. R1's pants were still visibly wet. On 9/11/25 at 11:17 AM, R1 was sitting on the couch and still had visibly wet pants. V7 walked R1 to the scale in the dining room and weighed him. V7 then asked R1 if he wanted to take a shower. R1 did not (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: 146092 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 146092 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Integrity Hc of Herrin 1900 North Park Avenue Herrin, IL 62948 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)