Inspection·November 18, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure weights were obtained and the physician was notified of weight gains per Physicians Order. The facility also failed to monitor weights for discrepancies for one of three residents (R19) with daily weights in a sample of 28. Findings include:The facility's Weight policy, revised 5/18/25, documents the purpose of this policy is to monitor the residents' weights, and track weight changes as they occur.The facility's Documentation Guidelines policy, revised 3/14/17, documents, Not documented, not done, and document facts.R19's Physician Order, dated 2/27/25, documents to weigh R19 daily related to R19's diagnosis of congestive heart failure and to notify the physician if R19's weight gain is greater than three pounds (lbs.) in a day or five pounds in a week.R19's Weight Summary, dated 6/1/25 to 9/17/25, has no documentation of R19's daily weights being obtained for 28 out of the 59 days during the time span of 6/1/25 through 9/15/25. R19's Weight Summary also documents daily weight gain fluctuations varying from 13.6 lbs to 36.9 lbs (6/21/25 through 6/22/25-36.9 lbs; 6/23/25 through 6/24/25-35.5 lbs; 7/10/25 through 7/11/25-32.6 lbs; 7/18/25 through 7/23/25 16.1 lbs; 8/22/25 through 8/23/25 13.6 lbs). R19's current medical record has no documentation of R19's physician being notified of R19's weight gains of more than three pounds in a day and/or five pounds in a week.On 9/18/25 at 2:40 PM, V7 (Care Plan Coordinator) confirmed R19's daily weights were not obtained as ordered, the physician was not notified of R19's gains of more than three pounds in a day or five pounds in a week per R19's physicians order, nor were R19's weights monitored for discrepancies. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146098 If continuation sheet Page 2 of 5 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 11/18/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review the facility failed to initiate Enhanced Barrier Precautions for two residents (R66, R2) out of five residents reviewed in a total sample of 28. Residents Affected - Few Findings include: The facility's undated Enhanced Barrier Policy documents, Enhanced Barrier Precautions involve gown and glove use during high-contact resident care activities for residents at increased risk of MDRO (Multidrug-resistant organism) acquisition (e.g., residents with wounds or indwelling medical devices). 1. R2 was admitted on [DATE] with diagnoses of Encephalopathy, Lymphedema, Sepsis, Cellulitis Right lower Limb, Protein-Calorie Malnutrition and Failure to Thrive. R2's current Care Plan documents R2 has actual impairment to skin integrity of the (bilateral) legs related to lymphedema. R2's Hospital records documented on 8/24/25 R2 was admitted to the hospital from the facility with diagnoses of right lower leg cellulitis resulting in Sepsis (Life-threatening condition to an infection which can cause widespread inflammation, organ failure and/or blood clots.) R2 was treated with Intravenous Antibiotics, discharge back to the facility on 8/26/26 and continued oral antibiotics until 9/2/25. R2 Physician's Order dated 9/5/25 documents to cleanse pubis area with Normal Saline and pat dry, apply Hydrocolloid dressing every Monday, Wednesday and Friday and was last conducted on 9/17/25. R2's Progress Notes dated 9/10/25 documents R2 had a traumatic injury resulting in an acquired wound of the Pubis, documented measurements, continue with ordered dressing changes and on 9/17/25 R2 refused for the wound doctor to evaluate her continued wounds. Throughout the survey on 9/16/25 through 9/18/25, R2 did not have an Enhanced Barrier Precaution sign posted on her door or available Personal Protective Equipment (PPE) available for use. On 9/16/25 at 9:40 AM, V16 (Certified Nurse Aide/CNA) and V17 (CNA) were observed to transfer R2 from her bed to a reclining wheelchair via a mechanical lift. V16 and V17 did not don PPE during the mechanical lift. R2 had a Physician's Order for EBP initiated on 3/19/25 and discontinued on 7/1/25. The record lacked a current EBP order. The EBP log last updated 9/12/25 did not indicate R2 was on EBP. On 9/17/25 at 2:30 PM, V8 (Registered Nurse/Wound Nurse) confirmed R2 had a wound. On 9/18/25 at 1:00 PM, V2 (Director of Nursing/Infection Preventionist) stated residents with wounds should be placed in Enhanced Barrier Precautions and was unsure if R2 had an order for EBP or not. 2. R66's medical record documents R66 was admitted to the facility on [DATE] with the following (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146098 If continuation sheet Page 3 of 5 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 11/18/2025 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)

F 0880 diagnoses: Multiple Sclerosis, Gastrostomy, Heart Failure, and endocarditis. Level of Harm - Minimal harm or potential for actual harm R66's Physician's orders dated 8/5/25 documents, Enhanced Barrier Precautions. Residents Affected - Few On 9/17/25 at 11:41 AM V5 (Licensed Practical Nurse) performed hand hygiene and applied gloves. V5 assessed and gave water flush for R66's feeding tube. V5 confirmed R66 is on Enhanced Barrier Precautions (EBP). V5 then put gown on to finish R66's cares. On 9/17/25 at 12:40 PM V2 (Director of Nursing) provided R66's urine culture results dated 9/7/25. Culture results document, Vancomycin screen is positive. This is VRE (Vancomycin Resistant Enterococcus). On 9/17/25 at 12:45 PM V2 confirmed R66's culture results indicate VRE. V2 stated, I went ahead and placed R66 on contact isolation even though it is only two more days. On 09/18/2025 at 9:15 AM V2 stated a physician's order is placed in the EHR (Electronic Health Record) when a resident is placed on contact isolation. V2 confirmed there was not a physician's order in R66's chart for contact isolation at this time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146098 If continuation sheet Page 4 of 5 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 11/18/2025 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)

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to maintain an Infection Control log for June, July, August and September of 2025. This failure has the potential to affect all 69 residents residing in the facility.Findings include:The facility's Resident Roster dated 9/16/25 was provided by V1/Administrator and documents 69 residents reside in the facility at the time of the survey.The facility's undated Infection Control Protocol and Antibiotic Stewardship policy documents, The Infection Control Preventionist/Antibiotic Stewardship Leader will track all Facility Infections, monthly laboratory organism reporting . On 9/18/25, V2 Infection Preventionist and DON/Director of Nursing could not provide a complete list of residents currently on isolation precautions including Enhanced Barrier Precaution/EBP, Contact or Droplet isolation, or an Infection Control Log for June, July, August, or September 2025. On 9/16/25 at 2:45pm V2 stated she was the facility's Infection Preventionist and produced the certificate of completion of the Infection Prevention Program Training dated 2023.On 9/17/25 at approximately 3:00pm V2 stated, she did not have Infection Control and tracking Logs for the months of June, July, August, or September of this year. V2 stated she knew the monthly tracking logs should have been completed in accordance with the Infection Control and Prevention Protocol and Infection Preventionist's role. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146098 If continuation sheet Page 5 of 5