Health inspection·May 24, 2023

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 residents were free from mental and physical abuse by staff. This failure affects two (R1, R10) of 10 residents reviewed for abuse from a total sample list of 10. Findings include: 1.) A facility reported incident dated 5/1/23 documents that a witnessed altercation occurred between V3 Certified Nursing Assistant (CNA) and R1, in the dining room. R1's undated diagnosis sheet documents the following diagnoses: Neurocognitive Disorder with Lewy Body Dementia, Diabetes Mellitus Type II, Anxiety, Weakness, Dementia with Behavioral Disturbances, Benign Prostatic Hypertrophy, Gastroesophageal Reflux Disease and Osteoarthritis. R1's Minimum Data Set, dated [DATE] documents R1 as severely cognitively impaired. On 5/24/23 at 2:21PM, V14 CNA stated that she was at the facility the night of the altercation. During supper I had gone down the hall to give something to a resident as I was walking back to the dining room, halfway down the hall, I heard yelling and swearing. I ran to the dining room and saw R1 holding V3's hands away from him in a defensive position. (V3 CNA) was yelling at him and he was yelling at her to get away from him and once she got his arms off of her, I told her to take a break. She wouldn't leave at this point; she kept yelling at him. No one was in danger; I couldn't figure out why she just wouldn't leave. Finally, she kicked his wheelchair and said, 'I'm going to hit someone,' and left. I went to the nurse and reported it to her and then went to V1 Administrator and reported what had happened. On 5/24/23 at 3:33PM, V16 Dietary Aid stated, I was in the kitchen that night and I watched the whole thing through the window. R1 likes to help people and he was trying to push R2's wheelchair. (R2) is new to the facility and blind and told him not to do that and he just put his hands up like ok, I'm done. V3 CNA came over yelling at R1. She hit his hands down and yelled at him. After V14 CNA came over to help, V3 CNA kicked R2's wheelchair and walked away saying, Oh My God, I just want to punch him! I told V14 CNA that I saw the whole thing and she sent me to (V1 Administrator). On 5/24/23 at 3:11PM, V3 CNA stated, I have been upset with myself. I can't remember what happened. I can't recall taking any dementia training. I don't feel like I have enough training in abuse or dementia. (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: 146113 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 146113 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenup Rehab and Nursing 300 North Marietta Street Greenup, IL 62428 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)