Inspection·April 29, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident was free from physical abuse for one of three residents (R2) reviewed for abuse in a sample of six. Findings include: The facility's Abuse, Prevention and Prohibition Policy, dated 3/2025, documents Statement of intent: Each resident has the right to be free from abuse, corporal punishment, and involuntary seclusion. Residents must not be subjected to abuse by anyone, including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals. Resident to Resident Altercations: Resident to resident abuse includes the term willful. The word willful means that the individual's action was deliberate (not inadvertent or accidental), regardless of whether the individual intended to inflict injury or harm. An example of a deliberate (willful) action would be a cognitively impaired resident who strikes out a resident within his/her reach, as opposed to a resident with a neurological disease who has involuntary movements (example: muscle spasms, twitching, jerking, writhing movements) and his/her body movements impact resident who is nearby. Definitions: Abuse- means the willful infliction of injury, unreasonable confinement, intimidation, or punishment resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, or physical condition cause harm, pain, or mental anguish. It includes verbal abused, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled using technology. Physical Abuseincludes, but is not limited to, hitting, slapping, punching, biting, and kicking. R1 and R2's Final Five-Day Reported Incident to Illinois Department of Public health, dated 3/26/25, documents (R2) states (R1) was upset over having a towel, words were exchanged and then (R1) open handed struck (R2). A typed form dated 3/21/25 and signed by V14/Social Service Director, documents (R5) states she asked (R1) if he found towels, (R5) states (R1) cursed. (R2) then shouted at (R1) and (R1) hit (R2) on top of the head. R1's Face Sheet documents R1 is a [AGE] year-old-male admitted to the facility on [DATE] with the following but not limited to diagnoses: Schizoaffective Disorder, Bipolar Disorder, Major Depressive Disorder, and Dementia with Moderate Agitation. R1's MDS (Minimum Data Set) Assessment, dated 3/31/25, documents R1 is severely cognitively (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: 146097 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 146097 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Paso Rehabilitation and Health Care Center 850 East Second Street El Paso, IL 61738 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)