Landmark Of Hyde Park Rehabilitation And Nursing C

F 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to ensure resident's care needs were being met by permitting one employee (V15) to sleep on duty. This failure has the potential to affect 16 residents on the unit V15 was assigned.Findings include:On 9.17.2025 2:57 PM, V2 (DON-Director of Nursing) said V15 (Former CNA-Certified Nursing Assistant) was terminated after she was caught sleeping while on duty for

the second time. She was caught sleeping around 5:59 AM in the laundry room by laundry staff. That is an unauthorized area. V15 told a staff member you need to give (V15) 10-15 minutes. At 5:59 AM, (V15) should have been doing final rounds. Staff (laundry) found her in unauthorized area.On 9.18.2025 at 10:00 AM V2 (DON) said, V15 (Former CNA-Certified Nursing Assistant) should not have been sleeping while on duty, she should have been attending to her job duties, attending to the residents. It's very important we stay awake while working, something may happen to the residents. It's against the facility policy as well as union rules.On 9.18.205 at 10:33 AM V4 (Director of Housekeeping) said, when my staff came in that morning, she found a CNA sleeping at the folding table, with a blanket over her. (V15) told my staff they needed to give her 10 more minutes and then she'll be up. V17, Laundry Aide found V15 and reported it to me. V17 took a picture of V15, CNA and sent it to me. I reported the incident to V2.On 9.18.2025 at 1:36 PM via telephone, V17 (Laundry Aide) said, I want to say it was two weeks ago, around 5:42 AM. I came into the laundry room and saw a CNA sleeping. V15 had a blanket wrapped around her, her head down on

the folding table. She scared me, I was expecting to see washers and dryers, not someone sleeping. V15 said to me, just give me five or ten minutes more, then put head back down. I went upstairs to clock in, when I came back down, she was gone. I took a picture of V15. I informed my supervisor (V4- Director of Housekeeping).The facility's CNA Assignment Sheet, dated 9.3.2025, documents V15 was working 11:00 PM-7:00 AM and assigned to the 2nd floor. Midnight census report dated 9.3.2025 documents a total of 16 residents in rooms V15 was assigned to.V15's Employee Disciplinary Action Form signed 9.9.2025 documents: On 9.3.2025 (V15) was reportedly sleeping while on duty in the basement laundry room.

Sleeping while on duty is a violation of Category One offense #4 per union working agreement. Due to violation of the listed offense, (V15) is terminated from her position as CNA of (Facility).

Residents Affected - Some

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Parkshore Estates Nursing & Rehab

6125 South Kenwood Chicago, IL 60637

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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the nurses would know to administer the BIPAP if the order is in the MAR (medication administration record) or the TAR (treatment administration record), or sometimes by reviewing Resident R2's physician order set.

V14 stated that the administration of the BIPAP would need to be documented in the MAR, TAR, or the resident's progress notes. V14 stated that if it is a standard order, it would be documented in the MAR. V14 stated that if it is not documented then it is not done. Facility document not dated documents in part physician orders (following physician orders). It is the policy of the facility to follow the orders of the physician. The facility will have orders to provide essential care to the resident, consistent with the resident's mental and physical status upon admission. Facility provided document not dated documents in part resident rights. You have the right to safety and good care. Your facility must provide services to keep your physical and mental health, and sense of satisfaction.

Event ID:

Facility ID:

If continuation sheet