Pearl Of Elgin, The
Inspection Findings
F-Tag F0551
F 0551
Give the resident's representative the ability to exercise the resident's rights.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the
interview and record review, the facility failed to inform a resident's Power of Attorney (POA) before facilitating the completion of guardianship paperwork by another family member.This applies to 1 of 6 residents (Resident R1) reviewed for the right exercised by the representative.Findings include:On 08/28/2025, approximately at 11:45 AM, V10 (Resident R1's POA) said the facility facilitated the completion of Resident R1's guardianship for another family member without her knowledge or consent. The Power of Attorney for Healthcare Statutory Form dated 02/19/2025, signed by Resident R1, listed V10 as his healthcare agent (Power of Attorney-POA). Under the facility contact information in Resident R1's profile, V10 is entered as the POA, responsible party for Healthcare Care, Surrogate Decision Maker, and Emergency Contact # 1.The facility provided a completed and signed evaluation report form for Resident R1's guardianship, dated 8/12/2025, that was requested by
a non-POA family member without the consent of V10, and the report was given to the non-POA family member.Resident R1's EMR (Electronic Medical Record) showed that Resident R1 is an [AGE] year-old male who was admitted to the facility on [DATE REDACTED] for therapies, medical oversight, and assistance with activities of daily living. The SLUMS (St. Louis University Mental Status Examination), a comprehensive cognitive assessment dated [DATE REDACTED], showed that Resident R1 was cognitively impaired. Resident R1's care plan, dated 06/27/2025, showed that Resident R1's judgment was impaired. On 08/28/2025 at 11:30 AM, V2 (Social Services Director) stated that Resident R1's non-POA family member provided her with a legal letterhead guardianship form on 08/05/2025 for
the physician to complete the health information portion. V2 said she thought the Attorney would have been dealing with it and did not realize she needed to go through V10's (POA) authorization. V2 said she had given the form to V1(Administrator) to facilitate further. V2 said Resident R1 never expressed to her about a change of guardianship, and she should have honored the wishes of Resident R1 and notified V10 for the consent.On 08/28/2025 at 3:00 PM, V1 (Administrator) stated that V2 provided the form to him, and he facilitated its completion by V3 (Resident R1's Physician). V1 stated the completed form was provided to the non-POA family member on 08/13/2025. V1 also said Resident R1 did not express any desire to him for a change of guardianship, and he should have honored the wishes of V10 (POA), Resident R1's previously designated POA.The facility's policy, titled Notification of Change of Condition, Discharge, and Transfer, dated 06/06/2025, states in part that The resident representative shall be notified of a change in resident rights under federal or state law or regulations .
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:
PEARL OF ELGIN, THE in ELGIN, IL inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 ELGIN, 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 PEARL OF ELGIN, THE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.