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Complaint Investigation

Carlton At The Lake, The

November 21, 2025 · Chicago, IL · 725 West Montrose Avenue
Citations 2
CMS Rating 2/5
Beds 244
Provider ID 145679
Healthcare Facility
Carlton At The Lake, The
Chicago, IL  ·  View full profile →
Inspection Summary

CARLTON AT THE LAKE, THE in CHICAGO, IL — inspection on November 21, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0607
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Potential for More Than Minimal Harm

related to abuse prohibition, neglect, exploitation, misappropriation of property such as: Appropriate interventions to deal with aggressive and/or catastrophic reactions of residents.

Abuse identification and recognizing signs of abuse.

How staff should report their knowledge related to allegation without fear of reprisal.

How to recognize signs of burnout, frustration and stress that may lead to abuse; and to what constitutes abuse, neglect, exploitation, and misappropriation of resident property.

Understanding of behavior that increase risk of abuse.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/21/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Carlton at the Lake, The

725 West Montrose Avenue Chicago, IL 60613

SUMMARY STATEMENT OF DEFICIENCIES

Based on interviews and record reviews, the facility failed to follow their ‘Abuse and Neglect' policy and report an allegation of abuse to the Illinois Department of Public Health (IDPH) for one (R1) out of three residents reviewed for abuse.

Findings include: R1's admission Record documents in part diagnosis of anxiety disorder.During interviews with R1 on 11/14/2025 at approximately 9:39 AM and 11:00 AM, R1 stated facility hired security to antagonize and intimidate R1. R1 stated V9 (Security) curls [V9's] lips and mean mugs R1. R1 stated V9 puts hand on the gun in front of R1 to intimidate R1. R1 stated [R1] had to call police a few days ago (11/11/2025) because V9 threatened R1 and held gun. R1 stated a receptionist (later identified as V7) and V12 (Human Resources) were present for the incident. On 11/14/2025 at 10:16 AM, V2 (Assistant Administrator / Abuse Coordinator) stated being aware that R1 called police because R1 alleged that V9 was threatening R1. V2 stated did not report the incident to Illinois Department of Public Health and there is no open reportable related to it. On 11/14/2025 at 11:10 AM, V9 (Security) stated R1 was recording staff without consent. V9 stated when staff reminded R1 of facility policy, R1 got mad and called the police. V9 stated R1 told the 911 dispatchers that V9 pointed the gun to R1. V9 denied pointing a gun to R1 or intimidating R1. V9 stated reporting the incident to V2. On 11/14/2025 at 1:36 PM, V7 (Receptionist) stated R1 called the police and informed the 911 dispatcher that security was threatening R1 with a gun. On 11/18/2025 at 9:47 AM, V12 (Human Resources) stated R1 was recording staff without consent.

Staff reminded R1 that R1 cannot record, but R1 got more upset. V12 stated R1 kept pointing to the no gun sign at the front desk and saying facility wasn't allowed to have security. V12 stated R1 then called police.Facility's Abuse and Neglect policy (last revised 6/26/2025) documents in part: All allegations of abuse will be reported to IDPH immediately not exceeding 2 hours after the initial allegation is received.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in CHICAGO, IL, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CARLTON AT THE LAKE, THE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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