Avantara Park Ridge

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow their policy to provide professional care and services in an environment free from misappropriation of property from one (R2) of three residents reviewed for misappropriation of property. This failure resulted to R2 missing her money in the sum of $50.00. Findings include: On 5/30/2025 at 1:37 PM, V4 (CNA) said that occasionally R2 is assigned to (V4). V4 said that R2 mentioned to her once that R2 told her that, someone stole something from her purse, it looks like $50.00 dollars. V4 said that V4 could not imagine how that could be possible because R2 always carry her purse even when V4 is giving R2 a shower. V4 said that she did not report to anyone that R2 told her that someone stole her money because V4 did not think that can be possible. V4 said that should have reported it to the administrator. On 5/30/2025 at 3:38 PM, V8 (Assistant Director of Nursing) said that V4 notified the management today that R2 complained to her that R2 lost her…

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 within one hour of their scheduled administration time for 3 of 6 residents ( R11, R12, and R13) reviewed for medication administration in the sample of 14. The findings include: On 1/12/25 at 11:15 AM, V4 RN (Registered Nurse) was passing morning medications to residents. V4 said she was late with medications because this was her first day working in the facility because she is agency. V4 said there were 6 residents left to receive their scheduled morning medications. R11's face sheet showed she was admitted to the facility on [DATE] with diagnoses to include nonrheumatic aortic valve stenosis, multiple myeloma, pantocytopenia, hyperlipidemia, generalized anxiety disorder, essential hypertension, cerebral infarction, centrilobular emphysema, chronic obstructive pulmonary disease, chronic respiratory failure with hypoxia, spinal stenosis, and urinary tract infection. R11's January 2025 eMAR showed an…

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 remove expired medications for three (R1, R90, R121) residents from first floor medication carts and house stock medication refrigerator, failed to ensure multi-dose vials and eye drop medications for four (R28, R29, R80, R138) residents were dated upon opening and, failed to remove medications for one (R205) expired resident from the medication cart. These failures have the potential to affect all 66 residents receiving medication from the 1st floor medication carts and Medication room. Findings include: On 04/17/24 at 09:30 AM The following medications were observed for storage and labeling Sunshine Medication Cart one with V7 Licensed Practical Nurse. R121 - Tramadol 50mg tablets expired 3/38/24 verified with V7 Licensed Practical Nurse. Physician order: Tramadol 50mg 1 tab every 8 hours as need for pain. Brimonidine Tartrate 0.2% eye drops for R80 open and not labeled verified with Licensed Practical Nurse. Physician order: Brimonidine Tartrate ophthalmic solution 0.2% (Brimonidine tartrate instill 1 drop…

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 reviews the facility failed to follow their policy and procedures for activities of daily living by not ensuring a resident received assistance with feeding and personal hygiene as required, and by not ensuring residents who require incontinence care were changed in a timely manner. This failure applies to three of four residents (R93, R121, and R135) reviewed for ADL (Activities of Daily Living) care. Findings include: 1. R93 is a [AGE] year-old female with a diagnoses history of Partial Paralysis Due to Stroke who was admitted to the facility 08/27/2020. On 04/15/24 at 11:33 AM Observed R93 lying in her bed with a towel on her chest. Observed food residue and particles left on R93's mouth and towel on her chest. R93 nodded yes when asked if she fed herself. R93's current Care Plan Initiated: 09/03/2020 documents she has an ADL (Activities of Daily Living) Self Care Performance Deficit and Impaired Mobility related to diagnoses and past medical history of Morbid…

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 and Interview and Record Review the facility failed to have a five percent (5 %) or lower medication error rate. There were eight (8) medications error out of 31 opportunities, resulting in a 25. 81% medication error rate. These failures affected four (R46, R105, R136, R203) residents observed for medications not administered as ordered. Our findings include: On 04/16/24 at 04:29 PM V6 RN (Registered Nurse) was observed administering medications. When passing medications to R136, V6 omitted Diclofenac Sodium External Gel 1 % Apply to 4GM (grams) to affected area topically four times a day for pain. Administered medications were reconciled against the current (April 2024) Medication Records (MAR). Physician Order: Diclofenac Sodium External Gel 1 % Apply to 4GM TO AFFECTED AREA topically four times a day for PAIN-Scheduled to be given at 5:00 PM. On 04/16/24 at 05:00 PM For R203, V6 held (did not administer) medication Senna-Plus Tablet 8.6-50 milligrams Give 1 tablet via G-Tube two times a day times, scheduled for 5:00 PM. Administered medications were…

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.

FACILITY Based on observations and interview, the facility failed to safely maintain proper freezer and food temperatures, failed to follow facility policy and department regulations for safe food temperatures to prevent food-born illness. This failure has the potential to affect all 134 residents who reside at the facility. Findings include: On 12/12/22 at 10:54 AM, observed temperature log on freezer labeled ice cream freezer for December 2022 that showed from 12/1-12/8, the logged AM and PM temperatures were all above 0 degrees Fahrenheit, and the AM temperature logged on 12/13/2022 showed 10 degrees F. Temperature log also showed acceptable freezer temps as below 0 degrees F. Also observed a Temperature Requirements For Potentially Hazardous Foods that showed for Hot Food Holding, temperature of 135 degrees F and freezing temperatures of 0 degrees F. At 10:56 AM, V6 opened ice cream freezer door and said the internal freezer temperature read 18 degrees F. Surveyor began checking food items within freezer and noted 2 opened boxes of ice cream cups that were soft to touch and not…

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 pharmacy medication labeling policy by not noting and implementing open date labels. This applies to 8 of 54 (R6, R27, R40, R51, R54, R68, R266, and R318) residents' medications in four of five medication carts during the medication storage and labeling task. Findings Include: On [DATE] at 03:00 PM Surveyor conducted inspection of medication cart (1-9) on Friendship unit. Surveyor observed opened and undated or dated inappropriately medications for: R54 - Ventolin HFA Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate) - open date 03/28 (no year) R27 - ProAir HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate) - no open date R51 - Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT - no open date On [DATE] at 03:50 PM Surveyor conducted inspection of medication cart on Love Pod unit. Surveyor observed opened and undated or dated with expired date medications for: R40 - Breo Ellipta Inhalation…

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 properly dispose of debris and loose medications in the medication cart, failed to ensure that medications are stored with proper label, and failed to remove expired medications from the medication cart. This failure has the potential to affect all 132 residents currently receiving medications from the facility. Findings include: On 03/02/21 at 10:45AM, review of the 1 medication cart and 1 medication room with V18 (RN) and noted 1 box of glycerin suppository with an expiration date of 10/2020,1 ophthalmic solution for R116 with an expiration date of 2/5/2021, 10 loose pills of different colors and sizes, 1 half pill and 1 lancet. V18 was unable to identify the pills and not sure if the lancet was used or not. On 3/2/2021 at 11:00AM, checked one medication cart in the Hope section of the facility with V19 (RN) and noted one open insulin bottle with an open date but no discard date, 1 bottle of fleet Enema with an expiration date of January 2021 and 3 loose pills of various shapes and colors. There was also a…

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, interview, and record review, the facility failed to properly monitor the dishwashing machine to ensure correct functioning, failed to follow their policy to maintain the cleanliness and sanitation of the kitchen and food service equipment, and failed to follow their policy and procedures on dented cans. This failure applies to 132 residents currently in the facility. Findings include: On 03/01/21 11:27 AM Observed multiple 6 pound cans with dents at the lip area, ranging in size from a small finger width to multiple finger width, in the dry storage area stocked with non dented cans. V14 (Dietary Manager) stated cans are considered dented if the top of the can is raised and bacteria can be observed growing inside the can. V14 stated dented cans are kept in her office and returned to the vendor. Six pound can of tropical fruit with dented lip area, sitting on the sink in the kitchen , with 2 other 6 pound cans of tropical salad for preparation to be served for the dinner meal. V15 (Dietary Aide/Dishwasher) stated he does not use temperature testing strips to…

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 maintain a medication error rate below 5% by failing to administer medications on time as ordered. There were 26 opportunities with 3 errors resulting in a 11.5% error rate. This applied to one ( R54) resident observed during the medication pass. Findings include: On 3/2/21 at 11:08AM, V11 administered Tinazidine HCl 4 mg tablet, two capsules of Gabapentin 100 mg and Amitiza (Lubiprostone) 24 microgram(mcg) to R54. R54's MAR indicated that Tinazidine and Gabapentin were to be administered at 9:00am, 1:00PM and 5:00PM, while Amitiza was to be administered at 9:00AM and 5:00PM. R54's Physician Order reads: Tinazidine HCl 4 mg. Give 1 tablet by mouth three times a day related to muscle spasm. Lubiprostone capsule 24 mcg. Give 1 capsule two times a day for constipation. Gabapentin Capsule 100 mg. Give 2 capsules by mouth three times a day for pain. Facility's Medication Pass times were the following: 6:00AM, 9:00AM, 1:00PM, 5:00PM, and 9:00PM. 3/3/21 at 2:02PM, V2 (Director of Nursing) said that she expects…

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 a physician order for resident to be on NPO (Nothing by Mouth) status by continuing to provide a resident with an oral food diet. This failure affected one resident (R117) reviewed for therapeutic diets. Findings include: R117 is a [AGE] year old female who was originally admitted to the facility on [DATE], with past medical history including, but not limited to cerebral infarction due to unspecified occlusion or stenosis of right middle artery, Hemiparesis and Hemiplegia following cerebral infarction affecting left dominant side, dysphagia, gastrostomy status, etc. R117 was sent to the hospital on 2/23/2021 and was readmitted to the facility on [DATE], a health status note dated 2/26/2021 at 19:52 reads; Hospital called to clarify previous diet order. Patient is to remain NPO until further evaluation by speech, continue tube feeding as ordered. Nurse's admission summary dated [DATE] @21:40 reads; resident is on NPO, peg tube in…

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.