Pearl Of Evanston,the
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility's policy on Incontinence care review date 3/9/25 indicated: General: Incontinence care is provided to keep residents as dry, comfortable and odor free as possible. It also helps in preventing skin breakdown.
Guideline: 4. Removed soiled clothing and linen. Doff gloves and perform hand washing. 5. Clean peri area with appropriate cleanse and dry. Doff gloves and perform hand hygiene7. Apply barrier cream if appropriate.10. Dispose of soiled clothes and linen in appropriate areas. Remove gloves.11. Wash hands.
Facility unable to provide policy on checking for incontinence care every 2 hours. Facility's policy on Medication storage in the facility November 2021 indicated: Procedures: B. Only licensed nurses, pharmacy personnel and those lawful authorized to administer medications permitted to access medications.
Medication rooms, carts and medication supplies are locked when not attended by the persons with authorized access. Facility's policy on Physician orders review date 3/20/25 indicated: Policy: 1. Licensed Professional nurses/registered nurses will follow orders from physicians. 2. All completed orders are entered in the HER.Facility's policy on Specialty mattress review date 5/24/25 indicated: Procedure: 1. As per manufacturer guidelines, no more than 1 piece of linen will be placed between the mattress and the resident. Facility's policy on Enhanced barrier precautions (EBP) review date 10/2024 indicated: General: EBP is an approach of targeted gown and gloves use during high contact resident care activities. Examples of high contact resident care activities: *Providing hygiene*Changing briefs or assisting with toileting
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
08/29/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pearl of Evanston,the
820 Foster Street Evanston, IL 60201
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-Tag F0688
F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
the Nurse designated to oversee the Restorative nursing process for inclusion into the appropriate facility restorative nursing program when it has been identified by the interdisciplinary team that the resident is in need or may benefit from such programs. 2. The facility restorative nursing program will include but not limited to the following programs: a. Hygiene- bathing, dressing, grooming and oral careb. Mobility- transfer and ambulation, including walking, prosthetic and or splintc. Elimination- toileting, bowel, and bladderd.
Dining- eating, including meals and snackse. Communication- including speech language, other functional communication systems.4. The above program will be documented on the facility designated restorative care forms/tools in the resident's electronic medical record. 5. Based on clinical evaluation and ongoing consideration residents may be placed in one or more of the above listed programs at one time.6. The designated nurse will be responsible for the following: a. Obtaining orders for the resident's restorative programb. Documentation monthly (at a minimum) and c. Initiation and updating restorative care plans7.
Once in an appropriate restorative nursing program, the designated nurse will continue to monitor the resident's progress8. The designated nurse will evaluate the restorative documentation monthly to determine if there are any changes needed to the existing program and make a monthly progress note, in
the resident's electronic medical record related to this evaluation.
Event ID:
Facility ID:
If continuation sheet
PEARL OF EVANSTON,THE in EVANSTON, 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 EVANSTON, 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 EVANSTON,THE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.