Ryze On The Avenue

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 ensure staff monitor a resident's blood glucose per physician's order and failed to ensure staff document the result of the blood glucose accordingly. These failures affected 1 (Resident R67) resident reviewed for professional standard of care in the total sample of 66 residents.Findings include:On 08/25/2025 at 8:57am, V22 (Licensed Practice Nurse) opened Resident R67's electronic health record, the 7:30am glucose check was red and read as blood glucose before meals and before bedtime. V22 stated the facility serves breakfast on the first floor between 8:00am to 8:30am. On 08/25/2025 at 8:59am, V30 (Certified Nursing Assistant) was assisting Resident R67 with feeding. Resident R67's food tray was almost empty except for the cookie. V30 stated she (Resident R67) still wants her cookie. On 08/25/2025 at 9:00am, V22 took Resident R67's blood sugar; the glucometer announced the result as 309. On 08/25/2025 at 9:01am, V22 stated he was supposed to take her blood sugar before breakfast. Review of Resident R67's (08/2025) MAR (Medication Administration Record documented, in part Blood glucose via Accuchecks before meal and at HS (hour of sleep) for diabetes. 08/25, 730(7:30am), 144. 1100 (11:00am), 131. Signed by V22 (Licensed Practice Nurse).On 08/26/2025 at 9:54am with V2 (Director of Nursing), V30 stated that she was present when V22 took her (Resident R67)'s blood sugar on 08/25/2025 at around 9am and the result was at 300 or something.On 08/26/2025 at 11:41am, V2 (Director of Nursing) stated the expectation is to get the blood sugar before breakfast. At this time, this surveyor presented V2 the 1st floor mealtimes. V2 stated staff is expected to get the blood sugar between 7:00am and 7:15am to prevent from getting a false reading. I also expected the nurse (V22) to document the accurate result, if it is 200 then document 200. Documenting the correct result will determine the resident's endocrine system is working or an adjustment to her diabetes medications need to be done. On 08/27/2025 at 10:04am, V50 (Nurse Practitioner) stated blood glucose monitoring is usually ordered to make sure the resident's diabetes is well controlled. The staff are expected to document the correct result so when the physician reviews the results, the physician will be able to determine whether the medication is working appropriately or needs to be adjusted. The expectation is to follow the physician's order to get the blood sugar; it is usually before meals and before bedtime.Resident R67's (Active Order as of: 08/25/2025) Order Summary Report documented, in part Diagnoses: (include but not limited to) hypertension, chronic pain, and Type 2 Diabetes Mellitus. Order Summary: Blood Glucose via Accuchecks before meals and at bedtime for Diabetes. Order date: 07/30/2025.Resident R67's (08/2025) MAR (Medication Administration Record documented, in part Blood glucose via Accuchecks before meal and at HS (hour of sleep) for diabetes. 08/25, 730(7:30am), 144. 1100 (11:00am), 131. Signed by V22 (Licensed Practice Nurse). The (undated) Mealtimes 1st Floor Dining Area documented in part Breakfast: 7:15am.The (01/01/2025) Blood Glucose Monitoring documented, in part Policy: It is the policy of this facility to perform blood glucose monitoring to a diabetic residents as per physician's order. Policy Explanation and Compliance Guidelines: 1. The facility will perform blood glucose monitoring per physician's orders.

Procedure: 21. Document the procedure.

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

08/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ryze on the Avenue

3400 South Indiana Chicago, IL 60616

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)

Federal health inspectors cited RYZE ON THE AVENUE in CHICAGO, IL for a deficiency under regulatory tag F-F0686 during a complaint investigation conducted on 2025-08-27.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Scope/Severity Level G: isolated, actual harm that is not immediate jeopardy.

Actual harm to residents was documented as a result of this deficiency.

This was one of 2 deficiencies cited during this inspection of RYZE ON THE AVENUE.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-09-12.