Aspyre of Bronzeville

Based on observation, interview, and record review the facility staff failed to provide care and services for a catheter bag for one resident. Observations of R1 revealed the attached urinary drainage leg bag was wrapped in a brief with the closure cap not in place for a resident at risk for urinary tract infections in a sample of 29.Findings include:R1 has diagnosis not limited to Gastro-Esophageal Reflux Disease, Gout, Osteoarthritis, Hypothyroidism, Pain in Left Upper Arm, Rheumatoid Arthritis, Chronic Viral Hepatitis, Hydronephrosis with Ureteropelvic Junction Obstruction, Chronic Kidney Disease, Calculus of Kidney, Major Depressive Disorder, Recurrent, Delusional Disorders, Hallucinations, Anxiety Disorder, Hypertensive Heart Disease with Heart Failure, Atherosclerotic Heart Disease of Native Coronary Artery, Hyperlipidemia, Artificial Openings of Urinary Tract Status, Presence of Urogenital Implants, Elevated [NAME] Blood Cell Count, Myocardial Infarction Type 2, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Systemic Lupus Erythematosus, Hemiplegia and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to (a) follow oxygen liter flow as ordered by physician, (b) provide humidification for oxygen use, (c) properly stored oxygen tubing when not in use and (d) develop care plan for oxygen use for 1 (R33) of 2 residents reviewed for respiratory care in a sample of 29. The findings include: R33's admission record showed admit date on 2/11/25 with diagnoses not limited to Acute on chronic systolic (congestive) heart failure, Hypertensive heart disease with heart failure, Chronic kidney disease stage 3, Chronic obstructive pulmonary disease, Nicotine dependence. MDS (Minimum Data Set, dated [DATE] showed R33's cognition was intact. On 9/2/25 at 11:20 AM Observed R33 up and about, ambulatory with steady gait, alert and oriented x 3, verbally responsive. Observed oxygen tubing and nasal cannula placed on the bed and not properly stored, oxygen concentrator was on at 3L/min, no humidification bottle on the oxygen concentrator. R33 said he has been…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility staff failed to reconcile and account for controlled medications accurately in 1 of 3 medication carts reviewed for medication labeling and storage.Findings Include:On 09/02/25 at 12:52PM the third floor A medication cart was reviewed with V7 (Registered Nurse). When checking the controlled substances with V7 said R100 has 25 Vimpat Oral Tablet 100 MG (Lacosamide) Twice a day for Seizure. The Controlled Drug Receipt/Record/Disposition Form document dated dispensed 08/30/25, Lacosamide Tab 100 MG take 1 tablet by mouth twice daily. Quantity dispensed, 30 amount left 26. R100's Lacosamide 100 MG medication punch card has a remaining count of 25 pills. V7 said I did not sign for the Lacosamide, 26 is documented on the sheet. It was given at 9am. R105 Phenobarbital 64.8 MG Twice a day for seizures should have 13 and there is 14 documented on the sheet. The Controlled Drug Receipt/Record/Disposition Form document dated dispensed 08/06/25, Phenobarbital Tab 64.8 MG Take 1 tablet by mouth twice daily. Quantity dispensed 30,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure a medication error rate was less than 5%, by making 9 errors out of 30 opportunities with an error rate of 30%.Findings Include:On 09/02/2025 at 09:37 AM V5 (Registered Nurse) entered R109's room and said to R109, come out and take your blood pressure. At 09:40 AM V5 placed the blood pressure cuff on R109's right arm while standing at the medication cart with a blood pressure reading of 81/54 pulse 100. V5 placed the blood pressure cuff on R109 left arm to recheck R109's blood pressure with a reading of 104/75 pulse 101. V5 said let me look to see if you have some blood pressure medications because your blood pressure is a little too low. I am not giving Amlodipine; I am going to hold it because the blood pressure is a little low. R109 gets three blood pressure medications that I am going to hold. I will revisit R109 blood pressure after lunch to see if he needs them. (The blood pressure medications). There are 7 pills in the medication cup. (Amlodipine Besylate 10 MG Daily, Hydrochlorothiazide 25 MG…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure medications were administered as ordered by the residents' Physicians orders resulting in significant medication errors for 2 (R92, R109) of 3 (R96) residents reviewed during medication administration.Findings Include:R109 has diagnosis not limited to Cerebrovascular Disease, Hypertensive Heart Disease with Heart Failure and Hyperlipidemia.0n [DATE] at 09:37 AM V5 (Registered Nurse) entered R109 room and said to R109, come out and take your blood pressure. At 09:40 AM V5 placed the blood pressure cuff on R109's right arm while standing at the medication cart with a blood pressure reading of 81/54 pulse 100. V5 placed the blood pressure cuff on R109 left arm and rechecked R109's blood pressure with a reading of 104/75 pulse 101. V5 said let me look to see if you have some blood pressure medications because your blood pressure is a little too low. I am not giving Amlodipine; I am going to hold it because the blood pressure is a little…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews, the facility [A] failed to follow their Abuse Prevention Program Policy and report an allegation of abuse within 2 hours of the incident to IDPH (Illinois Department of Public Health) and [B] failed to submit the final report to IDPH within five business days for two 2 (R1 and R2) of three [R3] residents reviewed for abuse. Findings include, R1's clinical record indicates the following in part: R1 is a seventy-four-year-old male with medical diagnosis of Parkinson's Disease, chronic obstructive pulmonary disease, dysphagia, seizures disorder, contracture of left knee, contracture of right knee, major depression disorder and schizophrenia. [NAME] Date Set [MDS] section [C] indicates R1 is cognitively impaired. R1's MDS section [GG] indicates he needs maximal assistance with ADL Care, and transfers. R1 is unable to ambulate. R2's clinical record indicates the following in part: R2 is a seventy-four-year-old male with medical diagnosis include but not limited to violent…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and records review, the facility failed to assist one resident (R1) of three reviewed in a sample of three with communication and access to services inside and outside the facility. This failure resulted in R1 not getting his social security card. Findings include: R1's current face sheet documents R1's medical conditions to include but not limited to: type 2 diabetes mellitus with diabetic chronic kidney disease, chronic kidney disease, stage 3 unspecified, acquired absence of right/left leg below knee, unspecified combined systolic (congestive) and diastolic (congestive) heart failure. MDS (Minimum Data Set) section C -Cognitive Function dated [DATE], documents R1's Brief Interview for Mental Status (BIMS) as 15/15 indicating R1 has intact cognitive function. On 05/17/2025, at 10:06 AM, R1 was observed laying in bed awake. R1 was alert, oriented to person, place, time, and situation. R1 stated he applied for his Social Security (SS) card about four weeks ago, but he has not yet received it.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to maintain hot water at comfortable level in one resident's hand sink for one of four residents (R1) in a total sample of 5. Findings include: On 4/12/2025, at 10:44 AM, V3 (Maintenance Director) stated, I received a complaint from a resident on the 3rd floor. I don't know his name; I will know him when I see him. He is in room (3rd floor room) I was in a room, maybe three weeks ago, one of the nursing staff told me the water in resident's sink was coming out cold. I spoke with the resident; he told me staff don't let water in the hand sink run before filling his wash basin. (R1) said he receives cold bed baths. I did test the water temperature of the water in the hand sink, I turned it on, it felt really cold. I left it running, put my cart away and went downstairs to the basement to get my thermometer. I tested it when I retuned; it only got up to 105 or 106 (degrees Fahrenheit). Surveyor requested facility's temperature log and asked how…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record reviews, the facility failed to ensure that there was no ice build-up in their walk-in freezer, separate the prep area from the sanitization area, and air-dry their blender container and pans prior to use. This has the potential to affect all 59 residents receiving nutritional needs from the kitchen. Findings include: Facility's list of residents on specialized diets document in part one resident that does not receive oral nutrition (nothing by mouth). On 7/30/2024 at 9:31 AM, V4 (Dietary Director) stated there were 60 residents in the building with one resident not receiving nutrition prepared in the kitchen. Surveyor conducted a brief kitchen tour with V4. Inside the walk-in freezer, there was ice build-up on the condenser and the surrounding areas. There was ice build-up on the food boxes, metal shelf, and floor under the condenser. There was ice build-up on the ceiling and on the metal shelves and food boxes underneath it. V4 stated V5 (Cook) left the door open earlier because [V5] was rearranging stuff in the walk-in freezer. On…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

2. R6's admission Record documents in part medical diagnoses of overactive bladder, neuromuscular dysfunction of bladder, benign prostatic hyperplasia with lower urinary tract symptoms, obstructive and reflux uropathy, disorder of male genital organs, retention of urine, and presence of urogenital implants. R6's Order Summary Report documents in part orders for an indwelling urinary catheter. It does not include orders for Enhanced Barrier Precautions. R6's comprehensive care plan documents in part that R6 has an indwelling urinary catheter related to diagnosis of obstructive uropathy and benign prostatic hyperplasia (initiated 3/11/2024). R6's care plan does not document in part Enhanced Barrier Precautions. On 7/30/2024 at 10:41 AM, surveyor observed an isolation bin outside R6's bedroom. There was no isolation sign inside the bin or on R6's bedroom door. V26 was cleaning the room. V26 stated R6 was not on strict isolation but was on enhanced barrier precautions for urinary catheter. V26 did not know where the sign was located. On 7/30/24 at 10:56 AM, R6 stated having a urinary…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to follow its policy by not obtaining code status order from a prescriber for 1 (R45) resident reviewed for advance directives in a sample of 19. The findings include: R45's face sheet showed admission date on 2/26/2024 with diagnoses not limited to Chronic obstructive pulmonary disease, Hypertensive heart disease without heart failure, Type 2 diabetes mellitus, Major depressive disorder, Anxiety disorder, Cachexia, Calculus of kidney, Low back pain, Unspecified osteoarthritis, Hyperlipidemia, Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris, Unilateral inguinal hernia, Alcohol dependence, Other psychoactive substance dependence, Anemia, Subsequent non-st elevation (nstemi) myocardial infarction, Acute embolism and thrombosis of unspecified deep veins of right lower extremity, Unspecified right bundle-branch block, Chronic kidney disease, stage 4 (severe), Supraventricular tachycardia. On 7/31/24 at 12:46 PM V2 (Director of Nursing / DON) stated resident should have a code status, once…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and records reviews, the facility failed to follow fall care plan intervention for a resident with history of falls and failed to update care plan fall interventions after fall had occurred. These failures affected 1 (R204) of 4 residents reviewed for falls out of a sample of 19. Findings Include: R204 admitted to the facility on [DATE] with diagnosis not limited to Seizures, Epilepsy, Repeated Falls, Major Depressive Disorder, Unspecified Hearing Loss, Dementia, Bipolar Disorder with Psychotic Features, Schizophrenia, Psychotic Disturbance, Mood Disturbance, Drug Induced Subacute Dyskinesia, Legal Blindness, As Defined In USA, Parkinson's Disease, Restlessness and Agitation, Chronic Obstructive Pulmonary Disease. R204's MDS (Minimum Data Set) dated 06/14/24 documents BIMS (Brief Interview of Mental Status) score of 03/15 indicating severely impaired cognition. R204's Fall Risk Assessment completed on 02/12/24 identified R204 as being at high risk for falls. R204's care plan dated 02/12/24…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to follow its policy by not performing a nutritional evaluation on readmission for 1 (R45) resident with significant weight loss. This failure affected 1 (R45) of 2 residents reviewed for nutrition in a sample of 19. The findings include: R45's face sheet showed admission date on 2/26/2024 with diagnoses not limited to Chronic obstructive pulmonary disease, Hypertensive heart disease without heart failure, Type 2 diabetes mellitus, Major depressive disorder, Anxiety disorder, Cachexia, Calculus of kidney, Low back pain, Unspecified osteoarthritis, Hyperlipidemia, Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris, Unilateral inguinal hernia, Alcohol dependence, Other psychoactive substance dependence, Anemia, Subsequent non-st elevation (nstemi) myocardial infarction, Acute embolism and thrombosis of unspecified deep veins of right lower extremity, Unspecified right bundle-branch block, Chronic kidney…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record reviews, the facility failed to date and store nebulizer mask inside a plastic bag when not in use for 1 (R103) resident in a sample of 19. Findings Include: From 07/30/24 to 08/02/24, surveyor observed R103's nebulizer mask by the window, undated and not inside a plastic bag when not in use. On 07/30/24 at 11:10 AM, V6 (Registered Nurse/RN) stated the Nebulizer mask should be dated and kept in a plastic bag when not in use to prevent contamination which could potentially cause infection for R103. V6 stated the nebulizer was administered by previous shift, V6 then discarded the undated nebulizer mask and replaced with a new dated mask in a plastic bag. On 07/30/24 at 12:07 PM, V2 (Director of Nursing) V2 stated it is V2's expectation that nurses will date and keep nebulizer mask inside the plastic bag when not in use to prevent infection. V2 stated when the nebulizer mask/tubing is not dated, nurses will not know when the tubing was changed and that can increase the risk of infection for R103. R103's Physician Order Sheet (POS) shows…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to follow standards of professional practice by leaving medications at the bedside of one resident (R19), failed to date insulin for one resident (R25) and failed to store insulin inside the refrigerator for one resident (R49) in a sample of 19. Findings Include: 1. On [DATE] at 11:25 AM, 1 of 2 medication carts and 1 of 1 medication storage room inspected for medication storage and labeling. Surveyor observed R25's multi-dose vial of Humulin R Injection solution (Insulin Regular Human) inside the medication cart, opened and undated. V9 (Licensed Practical Nurse/LPN) stated the multi-dose vial of Humulin R Insulin is opened and should have been dated per the facility's policy. V9 also stated the potential problem of the opened, undated Humulin R insulin is that it may not be effective because nurses may not know when it was opened, and V9 stated nurses may be administering an expired Humulin R Insulin to R25. 2. Surveyor also observed R49's…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview, observation and record review, the facility failed to provide dental care services to one resident (R20) in a sample of 19 residents. Findings include: On 07/30/24 at 10:41 AM R20 stated I would like to get dentures. Someone here, I don't know her name, said that we would make an appointment with the dentist, but I haven't had an appointment yet. On 07/31/24 at 9:37AM, V16 (Registered Nurse) reviewed R20's electronic health record and stated R20 does not have an order to see a dentist. It looks like his care plan has an intervention to coordinate arrangements for dental care as needed. It is dated 1/28/2024. It looks like R20 should have seen a dentist. He did not go to the dentist. On 07/31/24 at 10:54 AM V17 (Minimum Data Set/Care Plan Coordinator) stated that R20 has a care plan for dental that states: dental appointments as needed. V17 stated It has been an intervention since 1/28/2024. We have to coordinate appointments and transportation. I would have to refer to social services regarding coordinating the dental appointment. We met in April about R20. I…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record reviews, the facility failed to follow physician's orders for nectar-thick liquids for one resident (R353) out of a total sample of 19 residents. Findings include: R353's admission Record documents in part: medical diagnosis of dysphagia, oropharyngeal phase. R353's 5/20/2024 Modified Barium Swallow Study documents in part: Moderate to severe oropharyngeal dysphagia [secondary to] decreased oral control/formation and propulsion, as well as decreased pharyngeal efficiency/motility resulting in moderate to severe diffuse hypopharyngeal residual after the swallow. It documents in part that R353 is at continued risk for aspiration. Recommendation is pureed diet with nectar thick liquids. R353's Order Summary Report (7/02/2024) and comprehensive care plan (4/09/2024) document in part nectar-thick liquid consistency. On 7/30/2024 at 12:08 PM, R353 sat in the dining room. V7 (Certified Nurse Aide-CNA) placed a seven-ounce cup of pink lemonade in front of R353. Lemonade was thin consistency and not nectar thick. At 12:11 PM, R353 took a drink of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to follow their Antibiotic Stewardship Program, [A] failed to develop a report for the number of residents on antibiotics that did not meet criteria for active infection, and [B] failed to keep an accurate report for surveillance tracking for 4 [R1, R6, R10, R17,] out of 5 residents reviewed for antibiotic stewardship in a sample of 19. Findings Include: On 7/31/24, surveyor and V3 [Infection Preventionist (IP)/Licensed Practical Nurse] reviewed the following facility antibiotic stewardship record-Infection Control Log dated 1/1/24 thru 7/23/24: R1 was admitted on [DATE], and his urine was collected for testing, no signs or symptoms documented on the log. On 1/26/24, R1's urine resulted in bacterial growth, the organism was not documented on the log. On 1/27/24, R1 was ordered Cipro 500mg twice daily for ten days. R1's antibiotic use was not observed on the facility's surveillance tracking log. R6 was admitted on [DATE], and his urine was collected for…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record reviews the facility failed to follow their Influenza and Pneumococcal Immunization policy and administer immunizations for 3 [R5, R11, R46] of 5 residents reviewed for immunizations in the sample of 19. Findings Include: On 7/31/24, surveyor and V3 [Infection Preventionist (IP)/Licensed Practical Nurse] reviewed the following facility immunization records dated 1/1/24 thru 7/28/24: R5 consented on 1/17/24 for pneumococcal and influenza vaccine on 1/17/24. V3 stated, R5 originally consented on 1/17/24 according to his electric clinical record under misc. documents both consents were effective dated on 1/17/24 and scanned into R5's chart on 1/17/24. I was not aware R5 consented on 1/17/24. I received his consents again on 5/15/24 for pneumococcal and influenza vaccines. R5 did not received the influenza vaccine, R5 did not receive the pneumococcal vaccine, it was documented he was not eligible. However, I know now that R5 has a diagnosis of type II diabetes, heart disease and chronic…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and record reviews, the facility failed to ensure that resident' call light is functioning for one (R22) out of a total sample of 59 residents reviewed for resident call system. Findings Include: On 07/30/24 at 11:15 AM, surveyor observed R22 lying in bed. Surveyor observed R22's call light not functioning. R22 stated R22's call light is not working since last storm 2 Mondays ago (7/15/24). R22 stated the staff are aware of the broken call light. R22 stated R22 cannot get out of bed independently, and R22 stated R22 must wait until staff come in to help R22 when staff feel like. R22 stated R22 is wet and sad that the call light is not working. R22 stated the staff come to check on R22 sometimes. On 07/30/24 at 11:25 AM, V13 (Registered Nurse/RN) and surveyor observed R22's call light not working. V13 stated the call light is broken, and V13 did not know that the call light is broken. V13 stated R22 will not be able to communicate with the staff for toileting care and any care as needed. V13 stated the potential problem is that R22 could develop…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to provide and acquire medications as ordered by the doctor to meet the needs of each resident. These failures could potentially affect 2 (R1 and R5) of 5 residents reviewed for improper nursing care. The findings include: R1's face sheet documented admission date on 4/5/2024 with diagnoses not limited to Chronic obstructive pulmonary disease, Transient cerebral ischemic attack, Suicidal ideations, Antiphospholipid syndrome, Coagulation defect, Hypertensive heart disease without heart failure, Hematuria, Hyperlipidemia, Calculus of kidney, Systemic lupus erythematosus, Unspecified urinary incontinence, Personal history of transient ischemic attack, and cerebral infarction without residual deficits, Major depressive disorder. R5's face sheet documented admission date on 2/1/2024 with diagnoses not limited to Type 2 diabetes mellitus with foot ulcer, Chronic obstructive pulmonary disease, Non-pressure chronic ulcer of other part of left lower leg with fat layer exposed, Major depressive disorder, Hypertensive heart…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to complete an elopement risk assessment, develop and implement an elopement care plan, and provide a secure physical environment to minimize the risk of unwitnessed elopement for a resident with a known history of successful elopement for one of three residents (R1) reviewed for supervision. These failures resulted in an incident of successful elopement that the facility staff were not aware of until the resident had already left the facility. R1 was located two days later at his mother's home. Findings include: R1's medical record (Face Sheet) documents R1 is a [AGE] year old re-admitted to the facility on 2.13.2024 with diagnoses including but not limited to: Major Depressive Disorder, Paranoid Schizophrenia, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Delusional Disorders, Bipolar Disorder, and Hallucinations. R1's MDS (Minimum Data Set of 2.20.2024) documents a BIMS score (Brief Interview for Mental Status) of 15 or cognitively…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review the facility failed to ensure a safe and orderly transfer for all 132 residents residing in the facility who were subjected to hazardous temperatures above 80F (Fahrenheit) on 8/23/23 requiring evacuation and transfer to different facilities. This failure affected all 132 residents residing in the facility. This failure also resulted in an unnecessary hospital transfer for R50 due to the receiving facility not being able to accommodate R50's physical needs. Findings include: R50 is [AGE] years old with diagnoses that include but are not limited to type 2 diabetes mellitus, schizoaffective disorder, heart failure, morbid obesity, myasthenia gravis, chronic kidney disease, chronic obstructive pulmonary disease, hypotension, schizophrenia, non-pressure chronic ulcer of buttock. R50 was observed being prepared for transport to the hospital by EMS (Emergency Medical Services) after returning from the receiving facility. R50 is listed on the list of Vulnerable…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based upon observation, interview, and record review the facility failed to ensure the menu was followed, failed to post alternate menu, failed to provide meal options, and failed to provide meals timely. This failure has the potential to affect 130 residents receiving meals from facility. Findings include: The 8/23/23 menu includes the following: Lunch; spaghetti noodles, Italian blend vegetables, strawberry blondie, garlic Texas toast, coffee/tea. Supper: chicken nuggets, crispy French fries seasoned corn, watermelon, milk, coffee/hot tea. On 8/23/23, residents were being evacuated from the facility due to hazardous temperatures in the building. On 8/23/23 at approximately 7:00pm, surveyor observed sandwiches, fruit and juice being served to residents however an alternate menu was not posted and/or offered at this time. On 8/23/23 at 7:05pm, V6 (Licensed Practical Nurse) affirmed dinner had not been served but they (staff) are bringing something for the residents now. On 8/23/23 at 7:15pm, R86 stated there was no dinner served, residents just got a sandwich. R86's (6/20/23) BIMS…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to provide resources in a safe, effective, and efficient manner, and failed to provide adequate supervision, direction and instruction during the evacuation and discharge of facility residents. These failures have the potential to affect all 132 residents residing in the facility. Findings include: The (8/23/23) census included 132 residents. On 8/23/23, the Chicago temperature was 98 degrees Fahrenheit with heat index 116 degrees Fahrenheit per National Weather Service. The Emergency closure order documents, in part, effective date 8/23/23. Community Care Center, located at 4314 S. Wabash Avenue, Chicago, IL is a public nuisance that is dangerous, hazardous and endangers the public health due to the violations as stated in the attached Property Condition Report: Department of Building Property Condition Report, Building Code Violations that Constitute an Actual and Imminent Danger, and Lift Safety: Cooling system at the facility is inoperable, Location Entire Premises. On 8/23/23 at 6:24 pm, surveyor observed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based upon observation, interview and record review the facility failed to document AC (Air Conditioner) concerns on a maintenance log/worksheet, failed to repair malfunctioning AC, failed to ensure that the AC remained operable, and failed to maintain facility air temperature below 80F (Fahrenheit). These failures affected 132 residents residing in the facility. Findings include: The (8/23/23) census includes 132 residents. The (8/23/23) daily air temperature log includes but not limited to the following hazardous temperatures: 81.2F in room [ROOM NUMBER], 86.0F in room [ROOM NUMBER], 86.1F at the (2nd floor) Nurse's station and 86.2F in room [ROOM NUMBER]. On 8/23/23 at 6:46pm, the (2nd floor) temperature was uncomfortably hot. V8 (Social Service Director) stated the facility air conditioner has been out since Monday 8/21/23 (2 days prior). On 8/23/23 at 7:07pm, R79 stated it has been hot for about a month now, they (staff) provided fans. R79's (6/6/23) BIMS (Brief Interview Mental Status) determined a score…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to employ sufficient staff with the appropriate competencies and skill set to carry out the functions of the food and nutrition service. The failure has the potential to affect all residents receiving oral nutrition residing in the facility. Findings: On 8/09/2023 at 10:45am V3 (Dietary Manager) stated, she (V3) was not sure when Food Handlers Certificate of Completion expires, how often it (food handlers certification) needs to be renewed and if new hires are required to have a Food Handlers Certificate. During this survey, the facility was unable to provide Food Handlers Training Certificate of Completion for V23, V33, V34, V35 and V36. Certificate of Completion provided did not have an expiration date and documented training was completed 5 years ago. Illinois requires all food workers and food employees to earn an Illinois food handlers card within 30 days of starting work. If you work with unpackaged food, food equipment, food utensils or food-contact surfaces, you need a food handlers card under the Illinois Food…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to discard food items from the walk-in cooler by the use by date. This failure has the potential to affect all resident receiving oral nutrition from the kitchen. Findings: On 8/07/2023 at 9:10am surveyor observed in the walk-in cooler, 2 large steel pans of lunch meat (diced ham, sliced ham and turkey) dated 8/03/2023 and a pan of pureed mixed fruit dated 8/2/2023. V3 (Dietary Manager) stated, the dated items should be kept for 3 days from the date it was cut or prepared and then disposed of. Undated policy states, titled Storage of Food and Supplies states, in part, food and supply storage areas shall be maintained in a clean, safe, and sanitary manner and all pack, all packaging and containers should be labeled with the name of the food and expiration date.

Based on observation, interview and record review, the facility failed to thoroughly clean the dryer lint screen to provide a safe environment for the residents. This failure has the potential to affect all 128 residents residing at the facility. Findings include: On 8/08/23 at 2:00 pm, surveyor observed three dryers inside the laundry room. Dryer #1 and Dryer #2 were both in use. Surveyor requested V20 (Laundry Aide) to stop dryer #2 and open the lint compartment. The lint compartment floor was clean however the lint screen was fully covered with lint. On 8/08/23 at 2:05 pm, surveyor requested V20 to stop Dryer #1 and open the lint compartment. The lint compartment floor had loose lint on the floor. On 8/08/23 at 2:15 pm, V20 stated, Every three hours we clean the lint screens, I have not cleaned the lint compartment today. V20 stated the dryer can catch on fire if the lint screen is not cleaned out regularly. On 8/09/23 at 12:50 pm V7 (Maintenance Director) stated, the lint screens are checked and cleaned every shift by the laundry aides. V7 stated, the purpose for cleaning the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to ensure a homelike environment for eight residents (R10, R23, R25, R32, R39, R51, R68, R91) in the sample of 59 residents. Findings include: On 08/07/23 at 10:42 am, surveyor observed R23, R39 and R51's room window frame detached; broken and hanging from the windowsill with the window handles missing. R51 stated, R51 likes to have the window open in R51's room for fresh air. Surveyor observed R51's bottom closet drawer detached from R51's closet; broken (hanging from R51's closet). R51 stated, R51 cannot store R51's items in R51's closet dresser drawer because R51's dresser is broken. On 08/07/23 at 10:48 am, surveyor observed R32's mattress ripped and torn near the bottom two thirds of R32's mattress with yellow foam exposed. R32 stated, My (R32) mattress has been like . On 08/07/23 at 10:51 am, surveyor observed R25's closet door detached and hanging from R25's dresser. R25 stated, I (R25) do not put anything in there (referring to R25's closet door) because its broken. On 08/09/23 at 11:40 am, surveyor…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to implement fall prevention interventions for 4 (R26, R84, R96, R103) residents reviewed for fall prevention in the sample of 59 residents. Findings include: On 08/07/23 at 10:21 AM, there was a star next to R84's identifier by R84's door. R84 was lying on bed. There was a floor mat on R84's left side of the bed and another floor mat was folded leaning on R84's head of the bed. This observation was pointed out to V5 (Licensed Practice Nurse). V5 stated, staff might have changed him (R84) this morning and forget to put the floor mat down. On 08/07/23 at 10:46 AM, there was a star next to R96's identifier by R96's door. R96 was lying on bed. R96's call device string was on the floor. There was a folded floor mat on the side of R96's wall. These observations were pointed out to V6 (CNA). V6 stated the string is too short for him (R96) to reach it. It should not be like that. V6 also stated I (V6) don't know what happened to the floor mat. At this time, V12 (Restorative Aide) came into R96's room. V12 stated the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observations, interviews, and records review, the facility failed to ensure staff did not pre pour medications, failed to keep medications in original packaging, failed to monitor vaccine refrigerator twice a day, failed to ensure staff did not keep food item inside the medication room, failed to ensure unopened insulin vial was kept in the refrigerator, failed to ensure medication refrigerator temperature kept at appropriate temperature, failed to ensure insulin was labeled with open and discard dates, and failed to ensure medication carts were free of loose pills. These failures affected 5 (R24, R75, R85, R88, R131) residents reviewed for medication storage and labeling and have the potential to affect the 3rd floor Team B residents, all the resident in 1st and 2nd floors. Findings include: On 08/08/2023 at 10:56am, during the medication Storage and labeling task with V15 (Licensed Practice Nurse) of the 3rd floor medication cart labeled Team A, there were 3 med cups in the first drawer. V15 stated, the first med cup has 4 Tylenol 325mg tabs, the 2nd med cup has R131's…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review the facility failed to ensure a resident's indwelling catheter drainage bag was covered for dignity. This failure affected 1 (R103) resident reviewed for dignity in the total sample of 59 residents. Findings include: On 08/07/23 at 10:56 AM, R103's indwelling catheter drainage bag was not in privacy bag and was placed on the left side of R103's bed, towards the door. This observation was pointed out to V6 (Certified Nursing Assistant). V6 stated that it was not covered for privacy. On 08/09/2023 at 12:05pm, V2 (Director of Nursing) stated, indwelling catheter drainage bag should be in a privacy bag for dignity. R103's diagnoses include but not limited to paranoid schizophrenia, myalgia and muscle spasm. R103's (05/23/2023) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 15. Indicating R103's mental status as cognitively intact. Section H. Bladder and Bowel. H0100. Appliances. A. Indwelling catheter. H0300. Urinary Continence. 9. Not rated, resident had…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation and interview the facility failed to ensure the call light was within reach for 2 residents (R87, R91) out of 59 residents reviewed for call lights. Findings include: R91's diagnosis includes, but are not limited to, schizoaffective disorder, bipolar type, type 2 diabetes mellitus with diabetic chronic kidney disease, cyst of kidney, acquired, asthma, hypothyroidism, hypertensive heart disease with heart failure, heart failure, unspecified, morbid (severe) obesity due to excess calories, myasthenia gravis without (acute) exacerbation, unspecified osteoarthritis, unspecified site, hyperlipidemia, unspecified, benign prostatic hyperplasia with lower urinary tract symptoms, history of falling, nonrheumatic aortic (valve) stenosis, chronic kidney disease, stage 3 unspecified, chronic obstructive pulmonary disease, unspecified, non-pressure chronic ulcer of buttock with unspecified severity, cognitive communication deficit, muscle weakness (generalized), schizophrenia, unspecified, and hypotension, unspecified. R91 has a Brief Interview for Mental Status (BIMS) dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to list the code status for one resident (R40) on the electronic medical record. This failure has the potential to affect one resident (R40) in a sample of 59 residents. Findings include: R40's admission Record documents, in part, diagnoses of diabetes, hypertension, gastro esophageal reflux, pacemaker, dilated cardiomyopathy, atrial fibrillation, sick sinus syndrome, and congestive heart failure. R40 's Minimum Data Set (MDS), dated [DATE], documents in part, Brief Interview of Mental Status (BIMS) score of 14 which indicates that R40 is cognitively intact. R40's Order Summary Report (POS) with active orders as of 8/9/23, documents that no physician's order for advance directives (full code or DNR {Do Not Resuscitate} status) for R40. R40's admission Record Form for Advance Directive section was blank. R40's Care plan dated 5/3/23 documents in part, Goal: Advance Directive information will be assessed and discussed and honored at each time point.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review the facility failed to provide two residents (R64, R138) Medicare end of coverage notice. This failure has the potential to affect all 59 residents in the sample. Findings include: On 08/08/23 at 12:15 pm, surveyor was provided beneficiary protection notification review forms for R64 and R138 without a signed Medicare end of coverage notice was provided to R64 and R138's or R64 and R138's representatives. On 08/07/23 at 12:25 pm, V14 (Social Service Director) was interviewed regarding Medicare end of coverage notice to residents. V14 stated, V14 is responsible for providing the residents with a Medicare end of coverage notice at the facility. V14 stated, V14 does not know why V14 did not issue R64 and R138 a Medicare end of coverage notice. V14 stated, V14 should have issued R64, and R138 a Medicare end of coverage notice within 72 hours of R64 and R138's Medicare Part A last day of covered services. V14 stated, I (V14) going to be up front and let you know I did not do it. I (V14) had just started this position in November of 22 and was still…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure the piston syringe was changed daily for 1 (R84) resident reviewed for tube feeding in the total sample of 59 residents. Findings include: On 08/07/23 at 10:21 AM, R84's piston syringe was in bag was labeled with R84's name, room number, bed number, and was dated 8/6/23. This observation was pointed out to V5 (Licensed Practice Nurse). V5 checked the piston syringe and stated, the nurse who worked here last night did not change the syringe. The piston syringe should be changed daily. On 08/09/2023 at 11:56am, V2 (Director of Nursing) stated, My (V2) night shift nurse is responsible for changing the piston syringe. If they come in on the 6th of the month, the date on the piston syringe should be on the 7th of the month. The importance of changing the piston syringe daily is to prevent infection. R84's diagnoses include but not limited to hemiplegia and hemiparesis, dysphagia, aphasia, gastrostomy status, and seizure. R84's (05/25/2023) Minimum Data Set documented, in part Section C. Cognitive Patterns.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, and record review, the facility failed to ensure incoming and outgoing nurses reconciled the controlled medications during shift change and failed to ensure administration of controlled medication was documented. These failures affected 3 residents (R47, R61 and R76) reviewed for pharmacy services and records in a total sample of 59 residents. Findings include: On 08/08/2023 at 11:07 am, during the controlled medication count of R76's Lorazepam 1mg, noted 18 tablets left in R76's Medication Dispensing Card (BINGO Card). R76's Controlled Drug Receipt/Record/Disposition Form's last entry was on 08/07 at 5pm and amount left was 19. V15 (Licensed Practice Nurse) stated, I (V15) did not sign it yet. I (V15) am supposed to sign it after I (V15) gave the medication at 9am. On 08/08/2023 at 11:27am, the 08/2023 Controlled Substances Check form for 3rd floor's Team B's medication cart had missing signatures. This observation was pointed out to V16 (Licensed Practice Nurse). V16 stated,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review the facility failed to ensure one resident (R28) mattress was the correct size for R28's bed frame. This has the potential to affect one (R28) of 59 residents in the sample reviewed for home-like environment. Findings include: R28's admission Record documents, in part, diagnoses of diabetes, hypertensive heart disease, thyroid disorder, schizophrenia, bipolar, cerebrovascular disease, intracranial injury and hemiplegia affecting left dominant side. R28's Minimum Data Set (MDS), dated [DATE], documents in part, Brief Interview of Mental Status (BIMS) score of 14 which indicates that R28 is cognitively intact. R28's Functional Status dated, 7/17/23, documents in part, A. Bed Mobility-how resident moves to and from lying position, turns side to side, and positions body while in bed .Self-performance indicates 1 (Supervision). Support indicates 1 (Set-up) help only. On 8/7/23 at 11:00 am surveyor observed R28 lying in bed on a full-size mattress with a twin size bed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.