Inspection·May 31, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to adequately supervise a resident (R1) to prevent resident-to-resident physical abuse for five of five residents (R1-R5) reviewed for abuse in the sample of five. These failures resulted in R1 punching R2 in the left eye, causing a hematoma under R2's left eye and bruising surrounding R2's left eye, and R1 punching R5 in the right arm, causing R5 right arm pain for three days. Findings include: The facility's Abuse Prevention Program policy undated documents, Policy: The facility affirms the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion. This facility therefore prohibits mistreatment, neglect, or abuse of its residents, and has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect, or abuse of our residents. This will be done by: Establishing an environment that promotes resident sensitivity, resident security, and prevention of mistreatment and identifying occurrences and patterns of potential mistreatment. This facility is committed to protecting our residents from abuse by anyone including, but not limited to, facility staff, other residents, consultations, volunteers, staff from other agencies providing services to the individual, family members or legal guardians, friends, or any other individuals. Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting in physical harm, pain, or mental anguish. Physical abuse is the infliction of injury on a resident that occurs other than by accidental means and that requires medical attention. Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment. 1. R1's admission Record documents R1 was a [AGE] year-old admitted to the facility on [DATE] with the diagnoses of Drug-Induced Subacute Dyskinesia, Schizoaffective Disorder Bipolar Type, Psychotic Disorder with Delusions, Anxiety Disorder, and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct. R1's MDS (Minimum Data Set) assessment dated [DATE] documents R1 is severely cognitively impaired, displays physical symptoms directed towards other daily (e.g. (for example) hitting, kicking, pushing, scratching, grabbing, abusing others sexually), displays verbal behaviors directed towards others daily (e.g. threatening others, screaming at others, cursing at others) and wanders daily significantly intruding on the privacy or activities of others. (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: 146098 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 146098 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sharon Health Care Elms 3611 North Rochelle Peoria, IL 61604 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)