Bria Of Elmwood Park

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

identified concern will be addressed immediately. (This immediate action was initiated on [DATE REDACTED] daily for 4 weeks then weekly times 8 weeks, then monthly x 3) J. To ensure compliance, the results of the audit will be reviewed daily during the meeting which is attended by the clinical leadership which includes but is not limited to the: DON, ADON, MDS, IP, Restorative, and the Administrator/Designee. (This immediate action was initiated on [DATE REDACTED] daily for 4 weeks then weekly times 8 weeks, then monthly x 3) K. Any identified concern will be addressed immediately and will also be discussed during the weekly Adhoc QAPI. The facility will reinforce the following process.L. All results of the audits and unit rounds will be reported to the QAPI committee. An Ad-hoc QAPI meeting will be held weekly to review results of the audits and rounds to determine if additional interventions are necessary to ensure compliance. (This immediate action was initiated on [DATE REDACTED], daily times 4 weeks then weekly times 8 weeks, then monthly x 3) M. The Administrator, DON and Designee will monitor completion of this plan of removal. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: Completion Date: [DATE REDACTED]

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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

12/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Bria of Elmwood Park

7733 West Grand Avenue Elmwood Park, IL 60707

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 0757 Level of Harm - Actual harm Residents Affected - Few

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

potassium, after treatment, I would have checked it the next day because potassium responds pretty quickly; or at least within a week or so. Potassium less than 2.5 would have been appropriate for hospitalization so they could administer IV. A value of 3.0 is reasonable to give oral potassium supplement and then recheck. I would have expected the NP to call me or send the patient to the hospital. When the NP ordered the supplement, I would have told her to recheck it the same day, a few hours after or at least the next day early morning. I did do a talk with the NP's after this happened and discussed what are critical labs and when to repeat. It also depends on the facility capabilities for labs, I don't know what the facility capabilities are some can give IV and some can't. If we need to recheck labs then that can play a role in the management as well. I have not been aware of this issue for any other residents. I don't remember if the NP called me about this resident in particular. I would have definitely remembered a potassium of 2.0. I know

she has called me before. One of the problems is sending text messaging and then the other thing I advised is if it's a critical lab they need to call me or they can also call telehealth after hours. I recommended educating nursing to understand what is meaning of critical lab values. If we had been following her, we would have seen the potassium trending up and intervened. The main concern with a potassium of 8.4 is the risk of arrhythmia (irregular or abnormal heart rhythm).Record review showed that Resident R1 was found unresponsive in the facility on [DATE REDACTED], four days after the facility obtained the critically abnormal potassium result.Resident R1's death certificate lists date of death as [DATE REDACTED] and includes cause of death as cardiopulmonary arrest with other comorbidities. Per the American Academy of Family Physicians: Treatment of Hyperkalemia: GENERAL PRINCIPLES: The goals of acute treatment are to prevent potentially life-threatening cardiac conduction and neuromuscular disturbances, shift potassium into cells, eliminate excess potassium, and resolve the underlying disturbance .Indications for prompt intervention are symptoms of hyperkalemia, changes on ECG, severe hyperkalemia (greater than 6.5 mEq per L), rapid-onset hyperkalemia, or underlying heart disease, cirrhosis, or kidney disease.24,30,33-35 Potassium should be monitored often because patients are at risk of redeveloping hyperkalemia until the underlying disorder is corrected and excess potassium is eliminated.Facility Policy, Critical Medications Requiring Laboratory Monitoring [DATE REDACTED], reads: Purpose:To ensure resident safety by identifying medications that require ongoing laboratory monitoring, early detection of adverse effects, and timely clinical intervention to prevent deterioration, medication errors, and unplanned hospitalization.Definition: Critical MedicationA critical medication is any medication that:Has a narrow therapeutic rangeCan cause serious harm if levels are too high or too lowRequires scheduled or symptom-triggered lab monitoringHas a high risk for hospitalization if not monitored appropriatelyGeneral Monitoring Expectations (All Critical Medications)Baseline labs obtained prior to initiation (or verified on admission).Routine lab monitoring per Medical Provider order.PRN / symptom-triggered labs when change in condition occurs.Critical values reported immediately to provider.Nursing assessment documented with lab review.Care plan updated to reflect medication risk and monitoring needs.High-Risk Medications & Required Lab Monitoring but not limited to: 1. Potassium (KCl oral)2. Warfarin (Coumadin)3. Digoxin4. Vancomycin

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

12/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Bria of Elmwood Park

7733 West Grand Avenue Elmwood Park, IL 60707

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 0773 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

labs and to escalate to medical director if md/np did not answer the call. This was completed on [DATE REDACTED].3.

All newly employed nurses will have orientation including change in condition policy review and the expected appropriate documentation in- service is ongoing.4. On [DATE REDACTED], DON had 1:1 in-service with ADON to ensure accurate monitoring of critical labs and potassium.5. The facility identified that all residents can be affected by the deficient practice, and none were identified as of [DATE REDACTED].6. A QA tool was developed

on [DATE REDACTED] to identify 5 residents, 3 times a week, for 4 weeks regarding timely notification to md for any abnormal labs and to escalate to medical director if md/p did not answer the call and was completed on [DATE REDACTED].7. A QA tool was developed on [DATE REDACTED] to identify 5 residents, 3 times a week, for 4 weeks regarding potassium order per MD order and was completed on [DATE REDACTED].8, On [DATE REDACTED], the Medical Director was made aware and in agreement with the abatement and on [DATE REDACTED], an in-service was conducted with her Nurse practitioner regarding critical labs.

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If continuation sheet