Park View Rehab Center

F 0558

Reasonably accommodate the needs and preferences of each resident.

Level of Harm - Minimal harm or potential for actual harm

Based on observations, interviews, and record reviews, the facility failed to provide hand splints for one resident (Resident R31) out of a total sample of 25 residents.Findings include:Resident R31's ‘admission Record' documents a primary diagnosis of rheumatoid arthritis.On 9/09/2025 at 12:40 PM, Resident R31 was sitting at the side of the bed. Resident R31 was oriented to person, place, date, and situation. Resident R31's left fingers were closed inward. Resident R31 stated both hands had weakness, but it is worse on the left. Resident R31 stated Resident R31 is able to spread left fingers open with right hand. Resident R31 stated the nurses and Certified Nurse Aides used to apply bilateral hand splints during the day, but not anymore. Resident R31 stated the facility did a deep clean close to a year ago, and Resident R31's hand splints disappeared. Resident R31 suspected staff must have thrown them out by mistake. Resident R31 informed staff, but they never replaced them. Resident R31's ‘Order Summary Report' documents Resident R31 may wear splint to bilateral upper extremities as tolerated and as needed for comfort (active since 10/10/2023).Resident R31's ‘Care Plan Report' documents Resident R31 has orthoses (brace/splint) related to rheumatoid arthritis (revised 4/14/2024). Intervention includes Educate on the importance of wearing splint/brace (revised 10/05/2023) and Monitor splint for cleanliness, need for refitting, repair or fit as needed (revised 10/05/2023).Resident R31's 2025 progress notes prior to the survey did not mention hand splints or braces. No mention of hand braces or splints under the ADL (Activities of Daily Living) tasks in the electronic medical records. On 9/10/2025 at 9:10 AM, V5 (Nurse) stated V5 works with Resident R31 on most days of the week. V5 stated V5 has been taking care of Resident R31 since resident has been residing on the first floor. V5 stated Resident R31 does not have any hand splints. V5 stated Resident R31 had them years ago, but none this year. On 9/10/2025 at 10:03 AM, V7 (Restorative Nurse) stated the facility did not reorder the hand splints/braces until date of the survey. On 9/10/2025 at 10:29 AM, V9 (Certified Nurse Aide-CNA) stated V9 takes care of Resident R31 for most days of the week, since Resident R31 moved to the first floor. V9 stated Resident R31 is not able to hold open the left fingers all the time. V9 stated left fingers are closing inward. V9 stated Resident R31 hasn't had hand splints/braces for more than a year. On 9/10/2025 at 10:38 AM, V10 (Psychiatric Rehabilitation Services Coordinator) stated V10 has worked with Resident R31 for less than half a year. When V10 does morning rounds, V10 hasn't seen Resident R31 with hand splints. On 9/10/2025 at 11:45 AM, V2 (Director of Nursing) stated when making rounds, V2 hasn't seen hand splints/braces on Resident R31.

Facility's ‘Splints/Braces/Devices' policy (11/17) documents: Resident with the following conditions, but not limited to, may be eligible for evaluation: (a) weak or absent muscle strength. Nursing/Restorative will document the application of the splint/brace/device on the appropriate facility ADL form.

Residents Affected - Few

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

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Park View Rehab Center

5888 North Ridge Chicago, IL 60660

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 0658

Ensure services provided by the nursing facility meet professional standards of quality.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to follow professional standards and administer medications in a timely manner for two (Resident R11 and Resident R31) out of a total sample of 10 residents reviewed for medication times.Findings include: 1.On 9/09/2025 at approximately 10:20 AM, V6 (Licensed Practical Nurse) prepared Resident R11's morning medications. These included Hydroxyzine Pamoate (given for restless leg syndrome), Lamotrigine (antianxiety), Levetiracetam (anticonvulsant), Metoprolol Succinate Extended Release (for high blood pressure), and Potassium Chloride (for low potassium). At 10:32 AM, V6 stated V6 will not administer the Metoprolol because Resident R11's blood pressure was low. Resident R11 took the other morning medications at 10:32 AM. Resident R11's ‘Medication Administration Record (MAR)' documents Resident R11's morning medications are to be given at 9:00 AM. Resident R11's ‘Medication Admin Audit Report' documents on 9/03/2025, Resident R11's morning medications were also administered late. Resident R11's received the 9:00 AM medications at 12:08 PM. On 9/04/2025, Resident R11 received the morning medications at 10:57 AM. On 9/08/2025, Resident R11 received the morning medications at 12:40 PM. 2.On 9/09/2025 at 12:44 PM, Resident R31 stated there were incidents a week to two weeks ago in which a new nurse gave Resident R31's evening medications late. Resident R31 stated nurses usually give Resident R31's evening medications an hour after dinner. Resident R31 stated during the mentioned incidents, it was almost 11:00 PM, and Resident R31 still hadn't received the evening medications. Resident R31's current MAR documents Resident R31 is to receive Haloperidol (for agitation) and Vitamin C (supplement) at 5:00 PM. Resident R31 is also to receive Donepezil Hydrochloride (for dementia) at 9:00 PM.Resident R31's ‘Medication Admin Audit Report' documents in August, Resident R31 had Naproxen (for pain) and Vitamin C scheduled at 5:00 PM. On 8/06/2025, Resident R31 received the medications at 7:03 PM. On 8/07/2025, Resident R31 received the medications at 6:25 PM. On 8/09/2025, Resident R31 received the medications around 8:28 PM. On 8/12/2025, Resident R31 was no longer receiving Naproxen in the evening; however, Resident R31 remained scheduled to receive Vitamin C at 5:00 PM. On

this evening, Resident R31 received it at 9:34 PM. There were multiple evenings afterwards in which staff administered it late (8/13/2025, 8/15/2025 - 8/17/2025, 8/20/2025, 8/21/2025, 8/23/2025 - 8/25/2025).Resident R31's ‘Medication Admin Audit Report' also documents in August, Resident R31 had Donepezil Hydrochloride and Haloperidol scheduled at 9:00 PM. On 08/07/2025, Resident R31 received the medications at 10:22 PM. On 8/20/2025, Resident R31 received them at 11:14 PM. Resident R31's ‘Medication Admin Audit Report' documents on 8/26/2025, Resident R31's 5:00 PM medications were now Vitamin C and Haloperidol. On this evening, Resident R31 received them late at 8:01 PM. Resident R31 also received them late on 8/27/2025 - 8/29/2025, 9/02/2025 - 9/04/2025, and 9/06/2025 with the latest one being at 8:45 PM on 8/29/2025. On 9/10/2025 at 11:23 AM, V2 (Director of Nursing) stated V24 (outside Social Worker) spoke with facility staff at the end of August to report Resident R31 had complained about late or missing evening medications. V2 stated with some of the new nurses such as V13 and V25, it's possible medications were given late, since the residents were new to them. V2 stated all nurses were in-serviced on medication timeliness to make sure medications are administered within one hour before or one hour after the scheduled time. Facility's ‘Medication Administration Policy' (8/15) documents: Medications must be administered in accordance with a physician's order at his/her discretion, e.g., the right resident, right medication, right dosage, right route, and right time.

Residents Affected - Few

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

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

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Park View Rehab Center

5888 North Ridge Chicago, IL 60660

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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Metoprolol. V4 stated the nurses need to inform V4 when they are holding or not administering a medication because it is a complicated decision. V4 stated V4 will need to trend Resident R11's blood pressures, heart rates, and symptoms in the last three to four days prior to deciding whether to hold the Metoprolol Succinate ER or change it. When asked about Resident R107's Risperidone, V4 stated it ‘definitely' would not be good if the nurse increased the dosage and administered more than what was ordered. V4 stated Resident R107 would have increased sedation and systemic slowing.3.Resident R1's ‘Order Summary Report' documents Sucralfate Oral Suspension 1 GM (Gram)/10 ML (Sucralfate) Give 10 ml by mouth three times a day related to GASTROINTESTINAL HEMORRHAGE.Resident R1's ‘Care Plan Report' documents Resident R1 has gastritis and duodenitis (initiated 9/05/2025). Intervention initiated on 9/05/2025 documents in part to administer medications per physician orders. On 9/10/2025 at 12:03 PM, V13 (Nurse) prepared Resident R1's noon medications. One of the medications was Sucralfate 100 MG / ML (milliliter) oral suspension. V13 stated the order was for 1 gram / 10 ML of Sucralfate. V13 held a medication cup in the air and poured the medication into the medicine cup.

The medication when held in the air was at the 10 ML mark; however, when V13 placed the medicine cup

on top of the medication cart, the medicine cup read 15 ML. At 12:10 PM, V13 went into the room and told Resident R1 which medications V13 had prepared. V13 was asked to review Sucralfate medicine cup on a flat, stable surface. V13 took out 5 ML and administered 10 ML to Resident R1. 3.On 9/10/2025 at 12:19 PM, V13 prepared medications for Resident R110. V13 did not locate Resident R110's blister pack for Hydroxyzine in the medication cart or medication room. V13 stated V13 administered the last pill from the blister pack in the morning. V13 reordered it from pharmacy via the electronic medical record. V13 then went to Resident R110's room. V13 informed Resident R110 the Hydroxyzine was not in the medicine cup, but V13 had reordered it from pharmacy. V13 informed Resident R110 that pharmacy will deliver it in the evening and Resident R110 will get it during the evening dose. V13 checked 9 in the MAR, and stated V13 will let the oncoming nurse know the medication was not there, but it was reordered. V13 stated Resident R110's medication pass was complete and proceeded to prepare another resident's medications. V13 did not inform Resident R110's physician the medication was not available. 4.Resident R30's ‘Order Audit Report' documents: Simethicone Tablet 80 MG Give 2 tablet by mouth three times a day for bloating, give with meals.On 9/10/2025 at 12:32 PM, V13 prepared Resident R30's noon medications. Reading off the MAR on the computer, V13 stated Resident R30 was scheduled to get two Simethicone 80 mg chewable tablets. V13 stated it was a house stock medicine and pulled a bottle of Simethicone on the top right drawer of the medication cart. V13 stated there were two pills left in the bottle, which was exactly how many Resident R30 needed. The bottle read Simethicone 125 MG tablets. V13 was notified of the dosage difference. V13 stated V13 did not notice

the dosage difference. V13 searched the medication cart, medication room, and facility stock on the other floors. At 1:12 PM, V13 stated the facility did not have Simethicone 80 MG in the building. V13 stated V13 did administer two pills from the same bottle during morning administration. V13 stated V13did not know the dosage was different. On 9/10/2025 at 11:37 AM, V2 (Director of Nursing) stated the nurses are to administer medications based on the doctors' orders. V2 stated residents' rights with medications include

the right patient, right medication, right dosage, right route, and right time. V2 stated nurses have one hour

before and one hour after the scheduled time to administer the medications. V2 stated the nurses should reorder medications when they are running low so that there is ample medications and no issues with administration. V2 stated the pharmacy can deliver medications when needed as long as the nurses reorder them. V2 also stated if a nurse holds or does not administer a medication, the nurse is supposed to inform the physician. Facility's ‘Medication Administration Policy' (8/15) documents: Medications must be administered in accordance with a physician's order at his/her discretion, e.g., the right resident, right medication, right dosage, right route, and right time.

Event ID:

Facility ID:

If continuation sheet