Health inspection·August 30, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On August 29, 2024`at 4:52 PM, V1 was asked about where grievance resolution would be documented. V1 stated the resolution would be under the Immediate Action Taken section on the concern form, and was unsure why R1's August 11, 2024, concern form regarding call lights did not have a resolution documented. R1 returned with the form at 5:15 PM that included an undated, documentation on R1's August 11, 2024, concern form regarding call lights, Immediate Action Taken. R1's concern regarding call lights dated August 11, 2024, now had undated documentation showed Ongoing education regarding call light response was conducted for all nursing staff in section 1000 (R1's nursing unit). V1 provided in service documentation dated August 12, 13, and 14, 2024. V1 stated what else can be done? regarding extended wait times for call light response. On August 29, 2024, at 2:42 PM, R1 stated she continues to have concerns with her call light not being answered timely especially on the night shift and weekends. R1 stated she hears the staff talking in the hallway while her call light is on but is unsure why staff don't come into her room. R1 stated she has waited so long, at least 30 minutes that she has urinated on herself because she couldn't hold it any longer waiting for her call light to be answered. R1 demonstrated she was able to activate her call light. R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], with multiple diagnoses including nondisplaced condylar fracture of the humerus, chronic kidney disease, history of falls, osteoporosis, malignant neoplasm of the esophagus, and cognitive communication deficit. R1's MDS (Minimum Data Set) dated August 9, 2024, showed R1 had moderate cognitive impairment, and required assistance with ADLs including dependent on staff for transfer, bathing, toileting and lower body dressing, partial assistance with personal hygiene, and set up assistance with eating. On August 29, 2024, at 2:35 PM, R2 stated she has a concern regarding her call light being answered promptly especially on the night shift and weekend shifts. R2 stated she is unsure of the exact date, but she has waited for an hour for her call light to be answered during the night shift. R2's EMR showed R2 was admitted to the facility on [DATE], with multiple diagnoses including acute cystitis without hematuria, cellulitis of left upper limb, chronic pancreatitis, difficulty walking and vascular dementia. R2's MDS dated [DATE], showed R2 was cognitively intact, and required assistance with ADLs including dependent on staff for toileting, transfer and lower body dressing, partial assistance with oral and personal hygiene and upper body dressing, substantial assistance with bathing and bed mobility and set up assistance with eating. On August 29, 2024, at 2:47 PM, R4 stated she had concerns with her call light not being answered promptly, especially when she had a migraine headache and was waiting for her call light to be answered to ask for her medication. R4 stated she has waited for what seemed like 30 minutes but did not recall a specific date of when that occurred. R4 stated and her husband who was at her bedside agreed, since she first arrived at the facility, she has had a problem with her call light being responded to timely. R4's EMR showed R4 had admitted to the facility on [DATE], with multiple diagnoses including enterocolitis due to clostridium difficile infection, generalized weakness, protein calorie malnutrition, anxiety disorder, and migraine, unspecified. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146194 If continuation sheet Page 2 of 3 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 146194 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive of Fox Valley 4020 E New York Street Aurora, IL 60504 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete R4's MDS dated [DATE], showed R4 was cognitively intact, and required assistance with ADLs including partial assistance with toileting, bathing, lower body dressing, bed mobility and transfer, and set up assistance with personal hygiene and independent with eating. The Facility's policy titled Grievances dated April 2023, showed Purpose .and respond with prompt efforts to resolve while keeping the resident and/or resident representative appropriately apprised of progress toward resolution .Resident Council and filing a Grievance .All grievances identified during the Resident Council meeting will be submitted immediately to the Grievance Official for investigation and resolution .As necessary, the Grievance Official and facility leadership will take immediate action to prevent further potential continuations of any additional or like resident concerns while a grievance is being investigated .and .QAPI .Our facility will track and analyze the grievance process and findings for trends, performance gaps, and opportunities for individual education, system and systemic improvement. The facility will incorporate the Grievance process into the Quality Assurance and Performance Improvement program. Event ID: Facility ID: 146194 If continuation sheet Page 3 of 3