Health inspection·September 3, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provided showers to dependent residents. This failure affects four of four residents (R1, R2, R4, and R5) reviewed for showers and hygiene care on the sample list of five. Residents Affected - Some Findings Include: 1. R1's Comprehensive Assessment, dated 8/12/24, documents R1 is severely cognitively impaired with one sided lower limb impairment, and requires moderate assistance from staff with showers. R1's Care Plan (current) documents R1 requires assistance by staff with bathing. The Facility Resident Shower Schedule documents R1 is to receive showers on Monday and Thursday on day shift. R1's Point of Care (POC) Bathing Record for August and September 2024 documents R1 has only received two showers in the month of August and none in the month of September. This same record documents R1's last shower/bed bath was on 8/7/24. On 8/30/24 at 10:45am, R2 stated R2's showers are supposed to be on Monday and Thursday, during the day. R2 stated R2 has been receiving showers twice a week now that R2 complained about not receiving showers to the Ombudsman, V1, Administrator, and V2, Director of Nursing (DON). R2 stated he had only been receiving showers on Mondays. R2 stated R2 ended up with a yeast infection under abdominal folds. R2 stated showers not being given is due to staffing most likely, as staff are assigned to rooms, and if it is not their assigned room, staff won't assist other staff. 2. R2's Comprehensive Assessment, dated 7/17/24, documents R2 is cognitively intact and requires moderate assistance from staff for showers. R2's Care Plan (current) documents R2 requires participation of one staff (two staff if R2 feeling weak) with bathing. The Facility Resident Shower Schedule documents R2 is to receive showers on Monday and Thursday on day shift. R2's POC Bathing Record for August 2024 documents R2 received two showers in the month of August (8/1/24 and 8/26/24). (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: 146162 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 146162 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Moweaqua Rehab & Hcc 525 South Macon Street Moweaqua, IL 62550 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)