Continental Nursing & Rehab Center

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

review of records and interviews the facility failed to follow reporting procedures of injury of unknown origin or source for 1 out of 3 residents (Resident R8) total sample of 3 residents reviewed for right of every resident to be free from all forms of abuse. These failures are not in accordance with facility's abuse policy applicable to 1 resident (Resident R8) who sustained injuries of unknown origin or source. Finding includes: Resident R8 is [AGE] years old, initially admitted in the facility on 04/10/2018 medical diagnosis dated 07/13/2025, includes metabolic encephalopathy, displaced fracture of anterior wall of right acetabulum, wedge compression fracture of first lumbar vertebra. Resident R8 has impaired cognition unable to perform brief interview of mental status assessment (BIMS) dated 07/28/2025. V28 (Registered Nurse) nursing notes dated 07/08/2025, documents that Resident R8 was transferred to hospital due to weak, pale, difficult to arouse and minimal respond to call. Facility submitted initial transmittal report to State Agency dated 07/15/2025. On that report it documents that Resident R8 returned from the hospital to facility on 07/13/2025. The hospital records include an imaging (CT scan) fracture of the right acetabulum (near hip/pelvis) and compression fracture to vertebral bodies (support of the spine).

Facility submitted final report of investigation dated 07/21/2025, without definite conclusion as to how Resident R8 sustained those fractures. Per Minimum Data Set (MDS) assessment dated [DATE REDACTED], Resident R8 does not walk, uses wheelchair for locomotion and dependent for functional abilities including bed mobility. Resident R8 was care planned as substantial assist on bed mobility, dependent on transfers that needs mechanical (Hoyer) lift, non-weight bearing on right lower extremity and non-ambulatory. On 12/31/2025, at 10:23 AM, V6 (Assistant Director of Nursing) stated Resident R8 went to the hospital because he was difficult to arouse. At that time there was no concern with fall or trauma. Resident R8 went back to the facility on [DATE REDACTED], that was when facility knew about the fracture based on hospital records. V6 stated that Resident R8's fracture was reported on 07/15/2025, per facility's procedure on timely reporting of resident's injury is within 24-hours when facility knew about the fracture. V6 stated that it should have been reported on 07/14/2025. After checking the calendar, 07/14/2025 falls on Monday. V6 stated there was no determination on how exactly Resident R8 sustained fracture. Abuse Prevention Policy dated 01/2019: Injuries of unknown origin procedure on reporting requires facility as follows: Report shall be made immediately, but no later than two hours after allegation is made. If the event that cause the allegation involve abuse or resulted to serious injury, or not less than 24-hours if the event that cause the allegation do not involve abuse and did not result in serious bodily injury.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/02/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continental Nursing & Rehab Center

5336 North Western Avenue Chicago, IL 60625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

assess Resident R8 on 07/09/2025 when resident was not here, they do not do assessment when resident is not here. That may be an error. As to assessments dated 07/15/2025 and 07/23/2025 I have to ask V18 (Wound Coordinator) about this. Per facility's guidelines for prevention / treatment of pressure injuries dated 10/09/2023: If upon assessment an actual pressure injury is found appropriate treatment and intervention will be added on residents' care plan. Skin assessments will identify other risk factors including existing pressure injuries. Assessments will repeat at least weekly. The Braden Scale will be performed in addition to weekly skin assessments being completed as per policy and regulation. Ensure all assessments are timely and accurate.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/02/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continental Nursing & Rehab Center

5336 North Western Avenue Chicago, IL 60625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

neurological assessment initiated, ROM within the resident's baseline, PERRLA was noted, no C/O pain.

Physician group was called and an order to transfer the resident to the nearest hospital VIA 911 for CT-Scan was obtained and carried out. The writer spoke with the nurse practitioner and the director of nursing was made aware of the incident. Resident R9's Progress Note (dated 10/05/2025) documents, The resident was brought back into the facility by 2 paramedics on a stretcher, the resident was transferred to bed and was made comfortable. A/Ox3, vital signs were BP-124/84, P-80, R-16,02-95%RA. No complaints of pain or discomfort. Director of nursing and State Guardian office made aware. Guidelines for Mechanical Lift Transfer/Usage Policy (dated 07/08/2024) states in part: Many residents who require a two-person transferwill need to be transferred using a mechanical lift. The type of transfer must be the safest method based on

the resident's assessed ability to safely assist in their own transfer. Two staff members are required when a mechanical lift is used. Position the lift around the resident's bed/chair/surface. Base legs are usually more stable in full open position. The mechanical lift legs open and close to accommodate wheelchairs.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/02/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continental Nursing & Rehab Center

5336 North Western Avenue Chicago, IL 60625

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0813

Have a policy regarding use and storage of foods brought to residents by family and other visitors.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to record the daily refrigerator temperature log on a personal refrigerator for one (Resident R1) in a total sample of 3 residents reviewed. Findings include: On 12/30/2025 at 11:14 AM, Surveyor observed Resident R1 laying down in his bed while watching television, there were no signs of discomfort or pain. Resident R1 is alert and oriented to person, place and time.

Surveyor observed Resident R1's personal refrigerator temperature set to 40 degrees Fahrenheit. Surveyor observed

the daily refrigerator temperature log was did not have a temperature or initial documented for several dates

on the month of December. Surveyor observed the refrigerator was attached to the wall outlet. Surveyor observed the refrigerator was clean, organized, and there were no odors at this time. On 12/30/2025 at 11:15 AM, Resident R1 stated in the past a complaint was filed about the refrigerator not being attached to the wall outlet, causing the food to get spoiled. Resident R1 stated the staff always says the temperature is at 39 degrees Fahrenheit, but it is never recorded. Resident R1 stated housekeeping should come every day to check the temperature in the refrigerator to prevent the food getting spoiled. On 12/30/2025 at 11:41 AM, V10 (Registered Nurse) stated housekeeping is responsible for ensuring that the refrigerator temperature is approximately 39-40 degrees Fahrenheit. V10 stated there is a log attached to the refrigerator, and it is expected to be recorded every day. Surveyor asked V10 what can potentially happen to the food inside the refrigerator if the temperature log is not being recorded per facility policy. V10 stated the temperature should be checked and documented daily. On 12/30/2025 at 2:05 PM, V21 (Housekeeping Director) stated housekeeping staff is responsible for making sure the refrigerator is clean, sanitized, organized, and temperature is documented every day. V21 stated the refrigerator should be at approximately 35-40 degrees Fahrenheit. Surveyor asked V21 what can potentially happen to the food inside the refrigerator if

the temperature log is not being recorded per facility policy. V21 stated the food can get contaminated if the temperature is not at the expected temperature range. V21 stated the temperature should be recorded daily to avoid exposure to residents getting sick for eating potential spoiled food. On 12/31/2025 at 10:15 AM, surveyor observed Resident R1's refrigerator temperature thermostat, it was at 39 degrees Fahrenheit. Survey observed inside Resident R1's refrigerator, it was clean and organized and there were no odors noted. There was no refrigerator temperature recorded on the daily refrigerator temperature log. On 12/31/2025 at 10:19 AM, V25 (Housekeeping) stated she is responsible for making sure residents' personal refrigerator is kept clean.

V25 stated she makes sure to monitor the temperature, and document it on the refrigerator temperature logs every day. V25 stated the temperature should be set to approximately 39- 40 degrees Fahrenheit.

Surveyor asked V25 what can potentially happen to the food if the temperature is not being recorded daily.

V25 stated the food will get contaminated causing the resident to get sick. Policy titled Unit (Resident Room) Refrigerators with no review date documents in part It is the policy of the facility to assure that perishable food requiring refrigeration is stored at the proper temperature. Each refrigerator will be provided with a thermometer to ensure that the refrigerator is maintained between 35 degrees and 40 degrees Fahrenheit. Refrigerator temps will be checked and documented daily. Policy titled Food Brought into the Facility by Friends/Family/Others (Outside Sources)For Residents Policy with review date 11/28/2016 documents in part Facility staff will monitor resident rooms, resident personal refrigerators, unit pantries as well as facility refrigerators and freezers for food and beverage disposal needs for safety.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet