Aperion Care West Chicago

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure the call light system was working in resident rooms. This applies to 28 of 28 (R102, R6, R156, R103, R77, R47, R202, R4, R206, R13, R209, R171, R96, R108, R177, R52, R24, R25, R31, R44, R8, R19, R109, R183, R10, R90, R113, and R210) residents reviewed for call lights.On 1/27/2026 at 10:05 AM, R113 was in bed. R113 said he was extremely upset because his call light had not worked since yesterday. R113 said the facility reported they fixed the call system problem, but it frequently continued to malfunction, causing the call lights for his entire hall to stop working for extended periods of time. R113 pressed his call light, but it was not sending a call signal outside his door and to the nurses' station main panel. R113 said it was very upsetting because he had no way of getting assistance with his care needs and for emergency situations. R113's MDS (Minimum Data Set), dated 11/17/2025, said he was cognitively intact and required…

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 honor a resident's wishes to have food warmed in a microwave at their preferred time.This applies to 1 resident (R37) reviewed for accommodation of needs.On 01/27/2026 at 12:43 PM, R37 stated there use to be a microwave available for residents' use, but it was taken away. The only microwave available is at the nursing station and is not accessible to the residents. R37 stated if residents want any food reheated, they must request the facility staff do it for them, but the time for reheating food is limited. If he wants any food reheated after 9:30 PM, staff will not heat his food. On 01/28/2026 at 4:10 PM, V8 RN (Registered Nurse) stated residents are not allowed behind the nursing station to use the microwave. Staff will reheat food for residents, but only during the posted specified times (8:30 AM to 9:30 AM, and 8:45 PM to 9:15 PM). V8 stated it's to prevent the residents from interrupting staff while they are working and because the residents need to go to sleep at night. V8 stated if there isn't a cut…

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 identify abuse, investigate an incident of resident-to-resident abuse, implement interventions to prevent further recurrence, and report the incident. This applies to 2 of 2 residents (R131 and R200) reviewed for abuse in a sample of 38. The findings include: On 1/27/2026 at 10:37 AM, R131 was observed sitting in bed, holding his left shoulder and wincing in pain. R131 stated he was experiencing severe left shoulder pain that began on 1/18/2026 when he was physically attacked by R200. According to R131, R200 suddenly charged at him, grabbed him, and placed both arms around his upper torso, putting him in a headlock. On 1/28/2026 at 3:12 PM, V1 (Administrator/Abuse Coordinator) stated he had reviewed the facility's security camera footage from 1/18/2026 and confirmed he was made aware of the incident that night. V1 described the footage showed R200 approaching R131 from behind and placing both arms around his upper torso. V1 stated he did not report the incident to the Illinois Department of Public Health…

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 conduct a thorough investigation of physical abuse between 2 residents. This applies to 2 of 2 residents (R131 and R200) reviewed for abuse in a sample of 38. The findings include: On 1/27/2026 at 10:37 AM, R131 was observed sitting in bed, holding his left shoulder and wincing in pain. R131 stated he was experiencing severe left shoulder pain that began on 1/18/2026 when he was physically attacked by R200. According to R131, R200 suddenly charged at him, grabbed him, and placed both arms around his upper torso, putting him in a headlock. On 1/28/2026 at 3:12 PM, V1 (Administrator/Abuse Coordinator) stated he reviewed security camera footage from 1/18/2026 and confirmed awareness of the incident that night. V1 stated he did not report the incident to IDPH (Illinois Department of Public Health) at that time because he did not believe it met the definition of abuse, reasoning there was no serious injury, bodily harm, or psychosocial effects. V1 further acknowledged the incident was not reported to IDPH until…

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 pain assessment and management was provided for a resident's new onset of pain. This applies to 1of 1 resident (R131) reviewed for pain management in a sample of 38. The findings include: On 1/27/2026 at 10:37 AM, R131 was observed sitting in bed holding his left shoulder and wincing in pain. R131 reported his shoulder pain began ten days earlier on 1/18/2026 following a physical altercation with another resident. R131 described his left shoulder pain as severe, rating it 8-10/10, with 10 being the worst pain he has ever experienced. R131 stated his current pain medication was not relieving his left shoulder pain and he had been requesting an X-ray and transfer to the hospital to have the injury evaluated. Review of R131's N Adv - Long Term Care Evaluation documented a pain level of 8, categorizing it as severe, with indicators including vocal complaints of left anterior shoulder pain and facial expressions consistent with pain. The assessment identified this as a new issue and further documented 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 interview and record review, the facility failed to provide physical therapy that was ordered by the physician.This applies to 1 of 1 resident (R151) reviewed for rehab services in a sample of 38. Findings Include:R151's diagnosis list includes Parkinsonism, idiopathic progressive neuropathy, recurrent major depressive disorder, and drug-induced subacute dyskinesia.R151's current care plan includes limited range of motion in bilateral upper and lower extremities related to pain and limited mobility; interventions include to demonstrate exercises and have resident return-demonstrate the exercises.On 01/27/2026 at 11:02 AM, R151 stated for two years he's had numbness and tingling in both legs and his fingers. R151 stated his Neurologist wrote orders for him to have PT (Physical Therapy) that was never set up for him. R151 stated he provides his after-visit summary from his doctor's office visit to the floor nurse on duty and to V29, Scheduler.On 01/28/2026 at 2:59 PM, V8, RN (Registered Nurse), stated R151 had not recently received any physical therapy services.On 01/28/2026…

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 temperatures at a comfortable range for residents in bathrooms and showers. This applies to all 206 residents residing in the facility.The findings include:On December 16, 2025 at 10:30 AM, R3 said the water at the facility had been freezing for the last three weeks. R3 said he had a doctor's appointment earlier in the day and he had to take a freezing cold shower. R3 said a lot of residents had been complaining about the temperature and it was making the residents angry. R3 said it was the water everywhere in the building including the bathrooms and the showers. R3 said administration was not doing anything about it, based on what he could see. On December 16, 2025, the water was tested in the facility. At 11:12 AM, V3 (Maintenance Director) tested the hot water in a resident's bathroom sink, which showed it was 68 degrees. V3 said the hot water temperature should be between 102 to 110 degrees. V3 said he found out 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.

Based on interview and record review, the facility failed to report an abuse allegation. This applies to 1 of 3 (R1) residents reviewed for reporting abuse allegations. The findings include:On October 17, 2025, multiple requests were made for abuse allegations for October 2025 to V1 (Administrator) and V2 (DON/Director of Nursing), with none provided. On October 17, 2025 at 1:50 PM, R1 said she was in pain a lot and it hurt her when she was changed, especially when V3 (CNA/Certified Nurse Assistant) would change her. V3 said she told the staff she was in pain because she felt they pull and hurt her when they change her. R1 said when V3 changed her, she would lift her leg high up, and when she would say she was in pain, V3 would apologize. R1 said she told the nurse she did not want V3 to care for her anymore. The EHR (Electronic Health Record) shows R1 was admitted to the facility with diagnoses including hemiplegia and hemiparesis, major depressive disorder, seizures, persistent mood (affective) disorder, generalized osteoarthritis, contracture of the left hand and left ankle, 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 provide a comfortable, homelike environment for residents. This applies to 2 of 3 residents (R1 and R2) reviewed for inadequate cooling in the sample of 3. The findings include:Findings Include: R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], with multiple diagnoses including major depressive disorder, hypertension, type 2 diabetes mellitus, peripheral vascular disease, and asthma. R1's MDS (Minimum Data Set), dated August 8, 2025, showed R1 was cognitively intact. R2's EMR showed R2 was admitted to the facility on [DATE], with multiple diagnoses including type 2 diabetes mellitus, hypertension, and major depressive disorder. R2's MDS, dated [DATE], showed R2 was cognitively intact. On August 18, 2025, at 11:24 AM, R1 and R2 were in their room. V3 (Maintenance Director) obtained temperatures of R1 and R2's room. V3's thermometer showed the room temperature was 77.5 degrees Fahrenheit, the humidity…

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 provide visitation rights to 2 residents, both sisters, who reside at the facility.This applies to 2 of 6 residents (R1 and R2) reviewed for right to receive visitors in the sample of 6.The findings include: The EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE]. R1's diagnoses included but not limited to generalized anxiety, recurrent depressive disorder, schizophrenia, and suicidal ideation. The EMR also showed R1 has a twin sister (R2), who also resides in the facility. R1 resides on the third floor, a secured unit, and R2 resides on the first floor.R1's MDS (Minimum Data Set), dated January 7, 2025, shows R1 is cognitively intact. The assessment also showed R1 had not exhibited behavior issues.R1's current care plan, dated February 23, 2018, showed R1 was at risk for depression. R1's care plan shows multiple interventions, including, encourage participation in activities of choice and interest, 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 interview and record review, the facility failed to protect the resident's right to be free from physical abuse. This applies to 2 of 3 residents (R1 and R3) reviewed for resident-to-resident physical abuse. The findings include: The facility's 4/29/2025 Facility Reported Incident showed On 4/16/2025 resident [R2] had an altercation with her roommate [R1]. Staff immediately separated . On 5/01/2025 at 11:30 AM, R2 was in bed. R2 was confused and unable to be interviewed. R2's EMR (Electronic Medical Record) showed she had multiple diagnoses including paranoid schizophrenia, dementia with anxiety, and major depressive disorder. R2's MDS dated [DATE] showed R2 was cognitively impaired. R2's MDS also said she had symptoms of being short-tempered and easily annoyed nearly every day. R2's care plan initiated on 3/06/2018 documented, I have a hx (history) of becoming physically and verbally aggressive with my peers and staff due to my medications/treatment noncompliance, poor coping skills, and diagnosis 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 interview and record review, the facility failed to notify the facility Abuse Coordinator and the State Agency of an allegation of physical abuse. This applies to 2 of 4 residents (R2 and R3) reviewed for physical abuse in a sample of 4. The findings include: R3 is a [AGE] year-old-female admitted on [DATE], having cognition intact as per the MDS (Minimum Data Set), dated 4/7/25. On 4/22/25 at 12:30 PM, R3 stated, (R4) hit me on my head and face. But I don't remember the day exactly. It happened in my room, and nobody saw it. R2 is a [AGE] year-old female admitted on [DATE], with cognition intact, as per the MDS, dated [DATE]. On 4/22/25 at 11:40 AM, R2 stated, One of the residents (R4) hit me on my head four times last week. I had a headache after that for two days. The incident happened in front of the nurse's station and (V7, Certified Nursing Assistant/CNA) and (V8, CNA) witnessed the incident. I reported the incident directly to (V9, Psychiatric Rehabilitation Services Coordinator/PRSC) and (V10,…

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 of interview and record review, the facility failed to ensure the the pharmacy was completing monthly MRR (Medication Regimen Review) for residents residing in the facility. The facility failed to provide documentation that showed residents identified as having irregularities on their monthly MRR were addressed by the physician. This applies to 4 of 5 residents (R54, R64, R70, R122) reviewed for monthly MRR (Medication Regimen Review) in the sample of 35. The findings include: 1. R54's EMR (Electronic Medical Record) showed R54 was admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disorder, dysphasia, unspecified mental disorder due to a physiological condition, altered mental status, schizoaffective disorder, schizophrenia, anxiety, and major depressive disorder. R54's MDS (Minimum Data Set), dated October 16, 2024, showed R54 had severe cognitive impairment. R54's Psych notes and Pharmacy notes were reviewed. R54's MRR (Medication Regimen Review) for February…

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 resident's dignity was maintained while in the dining room during meal service. This applies to 1 of 2 (R70) residents reviewed for dignity in the sample of 35. R70's EMR (Electronic Medical Record) showed R70 was [AGE] years old and had been admitted to the facility on [DATE]. R70 was admitted with multiple diagnoses including schizoaffective disorder, bipolar disorder, other abnormalities of gait and mobility, generalized anxiety disorder, abnormal posture, and chronic peripheral venous insufficiency. R70's MDS (Minimum Data Set). dated October 21, 2024, showed R70 was cognitively intact, and required assistance with ADL's (Activities of Daily Living) including substantial assistance with bathing and supervision/touching assistance with dressing. R70's care plan. dated April 24, 2024, showed R70 needed supervision/touching assistance with both upper and lower body dressing. R70's care plan did not address any concern regarding…

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 honor R196's decision to observe a vegan diet. This applies to 1 of 1 residents (R196) reviewed for self determination in the sample 35. The findings include: MDS (Minimum Data Set), dated September 5, 2024, shows R196's cognition was intact. POS (Physician Order Sheet), printed December 4, 2024, shows R196's diagnoses included major depressive disorder, suicidal ideation, and personal history of suicidal behavior. The POS shows R196's diet order, ordered November 28, 2023, shows General diet, Regular texture, Regular consistency. The POS shows, Allergies: Dairy Products. On December 4, 2024 at 10:10 PM with V1 (Administrator) present, R196 stated she was upset she was made to drink milk because she had no other protein sources in the diet served to her by the facility. R196 stated she chose to be vegan over 20 years prior, and was vegan when she was admitted to the facility a year ago. R196 stated in March of 2024, she spoke with V6 (Corporate Dietitian) via teleconference with V1 (Administrator) present 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to implement their policy regarding care and management of implanted central venous catheter to prevent infection. This applies to 1 of 1 (R26) reviewed for central venous catheter in the sample of 35. The findings include: The EMR (Electronic Medical Record) shows that R26, a [AGE] year-old with diagnoses that includes type 2 diabetes mellitus, foot ulcer, osteomyelitis, PVD (peripheral vascular disease), PD (Parkinson's Disease), and Schizophrenia. The MDS (Minimum Data Set) dated November 26,2024 showed that R26's cognition was intact with BIMS (Brief Interview for Mental Status) score of 15/15. The assessment also showed that R26 was identified with no behavior. The POS (Physician Order Sheet) shows a physician order dated December 2,2024 for R26 to have antibiotic medication of Vancomycin HCl Intravenous Solution 2000 MG/400ML (Vancomycin HCl) to be administered intravenously via the implanted central venous catheter. The Vancomycin 2…

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 ensure a resident assessment was documented upon return to the facility after dialysis. This applies to 1 of 1 (R109) residents reviewed for dialysis services in the sample of 35. R109's EMR (Electronic Medical Record) showed R109 was [AGE] years old and admitted to the facility on [DATE]. R109 had multiple diagnoses including end stage renal disease with dependence on hemodialysis, chronic obstructive pulmonary disease, unspecified asthma, schizophrenia, unspecified, history of falling, and essential hypertension. R109's care plan, dated November 5, 2024, showed R109 receives hemodialysis at the local dialysis center on Monday, Wednesday, and Friday. R109's care plan for dialysis was initiated on November 26, 2019, upon his admission to the facility. Review of R109's progress notes from November 1, 2024, through December 4, 2024, showed there was no documentation of a resident assessment upon return from dialysis. On December 4, 2024, at 1:30 PM,V2…

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 ensure medications were obtained from the pharmacy in a timely manner to prevent residents from missing medication doses as ordered by the physician. This applies to 1 of 1 resident (R412) reviewed for pharmacy services in the sample of 35. The findings include: The EMR (Electronic Medical Record) showed R412 was admitted to the facility on [DATE], with multiple diagnoses including major depressive disorder, polycystic ovarian syndrome, Lyme disease, insomnia, and anxiety disorder. On December 2, 2024, at 10:18 AM, R412 said she was admitted to the facility on [DATE]. R412 continued to say she had not received her pregabalin since she was admitted to the facility. On December 3, 2024, at 12:25 PM, V9 (LPN/Licensed Practical Nurse) said the facility did not have R412's pregabalin, and V9 did not administer R412's pregabalin morning dose. V9 said medications are usually delivered within 24 hours of a resident being admitted , but R412's pregabalin was…

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 prepare and follow a vegan and dairy free diet for a resident who adhered to a vegan diet and who was allergic to dairy. This applied 1 of 1 (R196) reviewed for vegan diet menus in the sample of 35. The findings include: POS (Physician Order Sheet), printed December 4, 2024, shows R196's diagnoses included major depressive disorder, suicidal ideations, and personal history of suicidal behavior. The POS shows R196's diet order, ordered 11/28/23, shows General diet, Regular texture, Regular consistency. The POS shows, Allergies: Dairy Products. On December 4, 2024 at 10:10 PM with V1 (Administrator) present, R196 stated she was upset she was made to drink milk because she had no other protein sources in the diet served to her by the facility. R196 stated she chose to be vegan over 20 years prior, and was vegan when she was admitted to the facility a year ago. R196 stated in March of 2024, she spoke with V6 (Corporate Dietitian) via teleconference with V1 (Administrator) present in V1's office. R196 stated they…

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 eliminate a known dairy allergen from a resident's diet at the facility. This applies to 1 of 2 residents (R196) reviewed for food allergies in the sample of 35. The findings include: POS (Physician Order Sheet), printed December 4, 2024, shows R196's diagnoses included major depressive disorder, suicidal ideations, and personal history of suicidal behavior. The POS shows R196's diet order, ordered November 11, 2023, shows General diet, Regular texture, Regular consistency. The POS shows, Allergies: Dairy Products. R196's Care plan documents, I am allergic to dairy (Date initiated March 7, 2024). Ensure allergy is noted on MAR (Medication Administration Record), TAR (Treatment Administration Record), tray care and [NAME]. Notify nurse of allergic reaction symptoms, such as shortness of breath, rash, itching, swelling and redness. On December 2, 2024 at 11:30 AM, R196 had (lactose free) milk sitting on the dresser in room, and stated she…

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 timely report an incident of sexual abuse as per facility guidance shown in their policy and procedure for sexual abuse. This applies to 1 of 6 residents (R1) reviewed for sexual abuse in the sample of 10. The findings include: Facility Initial Reported Incident, dated July 11, 2024 at 10:49 AM, included as follows: Staff reported an interaction between R1 and R2 in the 3rd floor dining room on July 9, 2024 at approximately 7:00 PM. Staff intervened and separated both residents .Both residents stated that the interaction was consensual. Facility will conduct a thorough investigation . R1's EMR (Electronic Medical Records) included nursing progress notes, dated July 9, 2024 at 6:45 PM, included R1's behavior noted at that shift was socially inappropriate with R1 being sexually inappropriate with co-peer R2 in the dining room. On July 11, 2024 at 11:00 AM, R5 stated she was in the dining room and saw R1 and R2 in the corner, Doing something they should…

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 promptly conduct a thorough investigation of an incident of sexual abuse. This applies to 1 of 6 residents (R1) reviewed for sexual abuse in the sample of 10. The findings include: Facility census, dated July 9, 2024, showed R1-R6 reside on the secure behavioral unit of the facility. Facility provided information R3 and R4 are unable to provide sexual consent. Facility Initial Reported Incident, dated July 11, 2024 at 10:49 AM, included as follows: Staff reported an interaction between R1 and R2 in the 3rd floor dining room on July 9, 2024 at approximately 7:00 PM. Staff intervened and separated both residents .Both residents stated that the interaction was consensual. Facility will conduct a thorough investigation . R1's EMR (Electronic Medical Records) included nursing progress notes, dated July 9, 2024 at 6:45 PM, included R1's behavior noted at that shift was socially inappropriate, with R1 being sexually inappropriate with co-peer R2 in the dining room. On July 11, 2024 at 11:00 AM, R5 stated she was in the dining…

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 update and revise a care plan after a resident's change in cognitive status and inability to consent to sexual activity. This applies to 1 of 6 residents (R1) reviewed for sexual abuse in the sample of 10. The findings include: R1's EMR (Electronic Medical Records) showed R1 was a [AGE] year-old female admitted to the facility on [DATE], with diagnoses including unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, Schizoaffective disorder, depressive type, need for assistance with personal care, mood disturbance, and anxiety, mixed obsessional thoughts and acts, and difficulty in walking, not elsewhere classified, other lack of coordination. R1's quarterly MDS (Minimum Data Set), dated June 25, 2024, showed R1 was severely impaired in cognition. R1's care plan, initiated April 23, 2024, included R1 is able to exercise the right to engage in a sexual/intimate relationship and has received…

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 ensure residents' rights to be free from acts of physical abuse by their peers. This included 10 of 10 residents (R1, R2, R3, R4, R5, R6, R7, R8, R9, R10) reviewed for abuse. The findings included: On June 18, 2024 at 9:10 AM, V1 (Administrator) was asked to provide a list of physical altercations. V1 provided a list of Abuse Reportables. The list provided did not include the incident with R1 and R2. V1 was asked to provide any information he had on an incident that occurred on April 23, 2024. V1 said he has a list in his office of incidents he did not report because he said the direction he was given was if the incident did not cause emotional distress or physical injury, the incident did not need to be reported to IDPH (Illinois Department of Public Health). V1 later stated this directive came from corporate. At 1:42 PM, record review showed 10 residents had been involved in physical altercations with a peer and incidents were not reported to 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to report allegations of abuse to the IDPH (Illinois Department of Public Health) Regional Office within two hours of the notification of the allegation of abuse. This applies to 10 of 10 residents (R1, R2, R3, R4, R5, R6, R7, R8, R9, R10) reviewed for allegations of abuse. The findings included: On June 17, 2024 at 10:25 AM, V1 (Administrator) said he was given the directive that if an allegation of abuse did not cause emotional distress or physical injury, then the allegation did not need to be reported to IDPH. V1 said this directive came from the facility's corporation. On June 17, 2024 at 3:00 PM, V4 (PRSD/(Psychiatric Rehabilitation Service Director), said, When we have a physical altercation between two residents, we follow the chain of command and we first notify (V1, Administrator), and if he is not available, then the DON (Director of Nursing), if can't reach her, then the staff contact PRSD. We also involve corporate. After an incident happens,…

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 provide sufficient staff to care for residents. This has the potential to affect all 206 residents residing in the facility. The findings include: The Facility Data Sheet, dated January 31, 2024, shows the facility census as 206 residents. On January 31, 2024 at 4:15 PM, V2 (DON-Director of Nursing) said the facility does not have a staffing coordinator, and she does the staff scheduling with V7 (ADON-Assistant Director of Nursing). V2 (DON) continued to say nurses and CNAs (Certified Nursing Assistants) work day shift from 7:00 AM to 3:00 PM, evening shift from 3:00 PM to 11:00 PM, and night shift from 11:00 PM to 7:00 AM. V2 said [NAME] (Behavioral Aides) help out on the resident units but cannot provide hands-on care to residents such as incontinence care or feeding. [NAME] are able to help answer resident call lights, pass meal trays, and take residents for smoking breaks. V2 continued to say staffing for the facility's census during January 2024…

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 ensure a resident with a healed pressure ulcer on the coccyx area received care to prevent the development of another pressure ulcer. This applies to 1 of 3 residents (R2) reviewed for pressure ulcers in the sample of 51. The findings include: The EMR (Electronic Medical Record) shows R2 was admitted to the facility on [DATE]. The EMR continues to show R2 was transferred to the local hospital on December 20, 2023 due to abnormal lab values and did not return to the facility. R2 had multiple diagnoses including Type 2 diabetes, dementia, COPD (Chronic Obstructive Pulmonary Disease), hypertension, depression, bilateral above the knee amputations, anemia, and high cholesterol. R2's MDS (Minimum Data Set), dated December 4, 2023, shows R2 had severe cognitive impairment, required supervision with eating oral hygiene, substantial/maximal assistance with dressing and personal hygiene, and was dependent on facility staff for toilet hygiene, showering, 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.

Based on observation, interview, and record review, the facility failed to submerge a food processor container for 60 seconds to ensure sanitation. This applies to 6 of 6 (R99, R36, R81, R120, R51, R192) residents reviewed for puree diets in the sample of 35. The findings include: Facility provided Diet Type Report, dated 1/8/24, shows R99, R36, R81, R120, R51, and R192 receive a puree diet. On 1/8/24 at 10:16 AM, V22 (Cook) started to puree food for lunch. V22 started with barbecue pork. At 10:18 AM, V22 brought the food processor container to the three compartment sink and washed and rinsed the container. After rinsing the container, V22 put the food processor container under a stream of running water with pre-diluted sanitizer and removed it within ten seconds. V22 did not fully submerge the container for a minimum of 60 seconds. Facility provided Safety Data Sheet for the sanitizer used in the kitchen shows the sanitizer uses quaternary ammonium compounds (quat) to sanitize. Facility Dishwashing Instructions form, no date, states, . 4. Soak in sanitizer. Collect and soak all…

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 COVID 19 positive residents remained isolated in their rooms, and failed to ensure doors were kept closed on COVID 19 positive residents for 5 of 35 residents (R175, R1, R151, 154, and R60) reviewed for infection control in the sample of 35. The findings include: 1. R175's Rapid (COVID) Testing Results form, dated 1/4/24, showed R175 tested positive for COVID-19. The form showed R175 had symptoms of COVID including a cough. R175's (physician) Order Summary Report, dated 1/4/24, showed, Strict Isolation-Droplet and Contact for COVID-19. On 1/8/24 at 9:03 AM, R175 was seated on a chair in one of the hallways on the second floor. R175 wore no face mask. V13, Behavioral Aide, walked down the hall, past R175. V13 said nothing to R175. When this surveyor asked V13 about R175's COVID status, V13 stated, (R175) is COVID positive. V13 then continued down the hallway. V13 made no attempt to direct R175 back into his room. On 1/8/24 at 9:32 AM, R175 remained seated in the hallway of the second floor with no mask…

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 who requires extensive assist was provided ADL (activities of daily) care. This applies to 1 of 35 residents (R74) reviewed for ADL's in the sample of 35. The findings include: R74's care plan, date initiated 4/19/23, shows, Focus: I have an ADL (activities daily of living) self-care performance deficit r/t (related to) epilepsy, dementia, major depression, intellectual disabilities, chronic ischemic heart disease, scoliosis. Interventions: Dressing: Extensive assistance, one person assist. R74's care plan, date initiated 4/27/23, shows, Focus: I require extensive x 1 assistance with grooming r/t dementia intellectual disabilities. On 1/8/24 at 10:35 AM, R74 was wandering around the unit. He was wearing blue pants, a blue shirt, and white socks. He did not have any shoes on. The sole of his socks were black from walking around the unit. His shirt had a brown dry crusted substance on the back by his buttock. At 12:45 PM, there was something wet on the floor in R74's room. R74 had stepped 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.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure a resident's blood glucose value was monitored for a resident with a diagnosis of diabetes, and failed to ensure a resident's sutures were removed who sustained a laceration to his eyebrow/forehead. This applies to 2 of 35 residents (R53 and R108) reviewed for quality of care in the sample of 35. The findings include: 1. R53's face sheet shows she is a [AGE] year old female with diagnosis including type 2 diabetes, bipolar, glaucoma, and generalized anxiety. R53's Medication Administration Record (M.A.R) for December 2023 and January 2024 shows an order, dated 12/21/23, to check blood sugar before meals for the next 30 days related to type 2 diabetes. The M.A.R shows no documentation of R53's blood sugar for 18 out of 19 days. R53's M.A.R. shows orders for Trulicity (antidiabetic) injection 0.75 mg(milligrams)/05 ml (milliter ). R53's Physician Progress note, dated 12/21/23, documents, (R53's) Power Of Attorney (POA) contacted my…

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 had hearing aids that were in working order to maintain a resident's hearing for 1 of 35 residents (R127) reviewed for hearing and vision services in the sample of 35. The findings include: R127's resident assessment, dated 10/17/23, showed R127 was hearing impaired and required hearing aids. A physician progress note for R127, dated 9/12/22, showed, Audiologist referral due to HOH (hard of hearing) . A Transportation Request Form, dated 10/12/22, showed R127 was sent out for an appointment with an audiologist. On 1/8/24 at 9:05 AM, this surveyor attempted to interview R127 in her room. R127 wore eyeglasses, but no hearing aids were noted in R127's ears. After this surveyor repeated the same question three different times to R127, R127 stated, I can't hear well. I need hearing aids that work. They got me some 1-2 years ago but they didn't help me at all so I stopped wearing them. I couldn't hear any better with them in. I don't even know where they are anymore. R127 stated she had reported…

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 supervise a resident in the shower (R16), and the facility failed to ensure a resident was transferred in a safe manner (R126). These failures apply to 2 of 35 (R16, R126) residents reviewed for safety and supervision in the sample of 35. The findings include: 1. R16's Fall Risk Assessment, dated 8/24/23, showed R16 was at high risk for falls due to her history of falls, a balance problem with walking, instability when making turns, and use of psychotropic medications. R16's Fall-Initial Occurrence Note, dated 12/10/23, showed, Resident had an un-witnessed fall. At 5:35 AM, Resident asked to go take her shower when I suddenly heard screaming inside (the shower) that she fell so I came and found her on the floor lying on her back .Resident stated that when she is about to go inside the shower she fell on her back . The note showed R16 sustained no injuries from the fall. R16's current care plan showed R16 required assistance with walking…

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 resident's pain was managed who has a history of chronic pain. This applies to 1 of 35 residents (R196) reviewed for pain management in the sample of 35. The findings include: R196's face sheet shows she is a [AGE] year old female with diagnoses including anxiety, Raynaud's syndrome, polyneuropathy, muscle spasm, scoliosis, and schizoaffective disorder. R196's Minimum Data Set assessment, dated 12/19/23, shows she has pain frequently, pain frequently limits her day to day activities, and is receiving scheduled and as needed pain medication. R196's Physician Order Sheets (POS) dated through January 2024, shows orders on 10/3/23 for pain clinic consult for chronic back pain, and a second order on 11/22/23 for pain consult for chronic back pain per patient request for scoliosis, polyneuropathy, and osteoarthritis. The POS shows orders for Acetaminophen with Codeine 300-30 mg (milligrams) every four hours as needed for scoliosis, 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.

Based on interview and record review, the facility failed to order a medication after a resident was hospitalized for 1 of 35 residents (R138) reviewed for pharmacy services in the sample of 35. The findings include: A facility assessment done on 12/15/23 showed R138 was cognitively intact. R138's admission Record showed R138 was diagnosed with COVID-19 on 1/5/24. R138's Order Summary Report showed Paxlovid (medication to treat COVID-19) was ordered to be given twice a day for 5 days starting on 1/6/24 and ending on 1/11/24. R138's Progress Notes indicated on 1/6/24, R138 was hospitalized and returned to the facility on 1/7/24. R138's hospital discharge paperwork, dated 1/7/24, showed Paxlovid was to be continued at the nursing home. R138's Order Summary Report showed Paxlovid was not ordered when R138 returned from the hospital. On 1/9/24 at 11:27 AM, V3 (Assistant Director of Nursing) said R138's Paxlovid was not ordered on R138's return from the hospital because R138 had refused the medication. On 1/9/24 at 12:01 PM, R138 said he never refused Paxlovid. R138 said, Why would I do…

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 administer medications at ordered times and in ordered dosage. There were 26 opportunities with 6 errors resulting in a 23.08% error rate. This applies to 2 of 3 residents (R73 & R185) observed in the medication pass. The findings include: 1. On 1/8/24 at 11:15 AM, V7, Registered Nurse (RN), was giving R73 medications. V7 gave R73 2 gabapentin (pain) capsules, 1 Ativan (anti-anxiety) tablet and 12 units of NovoLog insulin. R73 has a Novolog insulin pen. V7, RN, did not prime the needle prior to giving the 12 units. (The resident only received 10 units). R73's January Medication Administration Record (MAR) shows, Novolog flexpen, subcutaneous solution pen injector 100 unit/ml (milliters) (insulin aspart), inject per sliding scale . The same MAR shows, Gabapentin capsule, 300 mg (milligram), give 2 capsules by mouth three times per day . The medication is scheduled for 9:00 AM, 1:00 PM and 5:00 PM. V7 gave the medication 45 minutes early. 2. On 1/8/24 at 11:20 AM, V7 was giving R185 his medications. V7 gave him…

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 received the prescribed dose of insulin. This applies to 1 of 3 residents (R73) reviewed for medication administration in the sample of 35. The findings include: On 1/8/24 at 11:15 AM, V7, Registered Nurse (RN), gave R73 her medications. R73's blood sugar was 295. V7 had an insulin pen. V7 was to gave R73 12 units of insulin. She applied the needle to the insulin pen and then turned the dial to 12 units. She did not prime the needle prior to turning the dial to 12 units. (The resident only received 10 units). R73's Medications Administration Record (MAR) shows, Novolog flexpen, subcutaneous solution pen injector 100 unit/ml (milliters) (insulin aspart), inject per sliding scale: if 150-200 = 6 units, 201-250 = 9 units, 251-300 = 12 units, 301-350 = 15 units, 351-400 = 18 units, 401+ call MD, subcutaneously before meals . The facility provided a insulin aspart, recombinant medication guidelines on 1/10/24. The guidelines show, To use the Flexpen or Flex Touch Pen: Prime the pen by removing…

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 keep a resident free from abuse from another resident. This applies to 1 resident out 4 (R2) reviewed for resident to resident abuse. Findings include: The facility Resident Abuse Investigation Report, dated 7/30/2023, documented a disagreement between R1 and R2 on 7/30/2023 in the third floor lounge. According to the report, [R1] and [R2] were sitting at a table in the third floor lounge on 7/30/23. They got into an argument regarding [R2] talking in his sleep. A verbal altercation broke out and [R2] stated [R1] lost himself and hit him. [R1] denied hitting [R2]. Peer resident who was in the room notified nursing staff that residents were arguing. Nursing staff immediately separated both residents and ensured safety. R2 was interviewed on 8/8/2023 at 12:34PM, and stated he was beat up by R1, and the local police were called. According to R2, he was sitting at a table in the third floor lounge on 7/30/2023 when R2 and R1 got into an argument and R1 started to hit him. R2 stated that nursing staff intervened and stopped 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.