Pearl Of Hillside,the

F 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview and record review, the facility failed to check and provide incontinence care at least every two hours for one resident who was identified as dependent on staff for toileting. This affected one of three residents (Resident R3) reviewed for incontinence care. This failure resulted in Resident R3 being saturated with a urine filled adult brief for over four hours. Findings Include:Resident R3 was diagnosed with Hemiplegia and Hemiparesis following other Nontraumatic Intracranial Hemorrhage affecting left dominant side. Resident R3's care plan dated 3/28/24 documents: provide incontinence care after each incontinent episode.

Section C (cognitive patterns) dated 6/20/25 documents a score of twelve which indicated moderate cognitive impairment. Section GG (functional abilities) documents dependent with toileting hygiene. Section H (bladder and bowel) documents: urinary continence always incontinent.On 9/23/25 at 12:53pm, Resident R3 said,

he needed changed. V3 (unit supervisor), checked Resident R3's adult brief. Resident R3's entire brief was saturated with urine. V3 asked, Resident R3 when was he changed last. Resident R3 replied at 7:30am or 8:00am. V3 said, residents should be provided incontinence care every two hours and as needed. V5 (certified nursing assistant/cna) said,

she was Resident R3's assigned cna. V5 said, she last provided care for Resident R3 at 9:00am. Resident R3 was observed with a brief full of yellow urine, with a large yellow irregular ring on his bed pad and a smaller irregular shaped ring on his fitted sheet. V5 said, Resident R3's bed pad is wet with urine. Resident R3's sheet has a dried urine stain. V5 said, residents should be changed every two hours. V5 said, Resident R3 is a heavy wetter.Urinary Continence and Incontinence-Assessment and Management dated 2/13/25 documents: Staff will ensure that incontinence care needs are met.

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

09/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pearl of Hillside,the

4600 North Frontage Road Hillside, IL 60162

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

statement dated 9/5/25 documents: time of event 7:30am. Type of event: fall. Walking down hall seen Resident R1 up went to get the nurse. Resident R1 was on the floor when nurse came back. Lying on his back. On 9/25/25 at 12:06pm, V2 said, the day shift CNA for Resident R1's unit was in another resident's room. On 9/25/25 at 12:42pm, V2 said, Resident R1's did not have a fall care plan implemented upon admission. V2 said, when a resident does not have a fall care plan staff follows the facilities fall focus system. Fall focus system no date documents: (6 pearls)- personal needs: staff will assess and anticipate resident's personal and activity for daily living (ADL) needs such as toileting, incontinent care during rounds. Staff will attend to needs as they are identified.Hospital paperwork dated documents: CT scan of the head showed multiple rounded areas of hemorrhage in left cerebral hemisphere representing intraparenchymal contusion with hemorrhagic conversion. It also shows extensive edema involving left parieto-occipital region and left temporal region with associated internal hemorrhage. MRI of the brain shows subacute infarct with hemorrhage and associated surrounding edema involving left basal ganglia, temporal lobe and parietal occipital lobes.Fall Prevention and Management dated 10/29/21 documents: The facility is committed to its duty of care to residents and patients in reducing risk, the number and consequences of falls including those resulting in harm and ensuring that a safe patient environment is maintained.

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

09/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Pearl of Hillside,the

4600 North Frontage Road Hillside, IL 60162

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 0925

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview and record review, the facility failed to implement an effective pest management program. This affected two of four (Resident R5, Resident R6) residents reviewed for pest. This has the potential to affect all 154-resident having their meals prepared in the kitchen. This failure resulted in gnats being observed in Resident R5, and Resident R5 rooms and observed in flying in the kitchen dish area.Findings Include:On 9.23.25 there were currently 154 residents residing in the facility that utilize the kitchen to have their meals prepared. On 9/23/25 at 12:15pm, Resident R5's room was observed with two trash cans with lids near his entry way.

Multiple gnats were observed flying around the two trash cans when surveyor entered Resident R5's room. More than ten gnats were crawling on the outside of Resident R5's white trash can. Resident R5 was observed in bed asleep with a few gnats on his bed sheet resting above Resident R5's head.On 9/23/25 at 12:18pm, Resident R6 was observed resting in bed. Resident R6 was assessed to be alert and orient to person place and time. Three gnats were observed flying around Resident R6's bed and bedside table. Resident R6 said, she has been having a problem with gnats. Resident R6 said, it's nasty to have gnats flying around.On 9/23/25 at 12:19pm, V4 (maintenance director) said, there are gnat in Resident R5's entry way surrounding the trash cans and in Resident R5's trash can. Resident R5's white trash can was observed full with trash. V4 said, the gnats are in the trash due to the certified nursing assistance (CNA) not emptying Resident R5's trash. On 9/23/25 at 12:48pm, Resident R5 was observed awoke in bed and eating lunch. Resident R5 said, he has had a problem with gnats. On 9/23/25 at 12:51pm, V3 (unit manager) said, she saw one gnat around Resident R5's bed. V3 said, Resident R5 cannot swat the gnats away. On 9/23/25 at 1:06pm, during the tour of the kitchen, three to four gnats and one large mosquito were observed flying in the corner near the handwashing sink. V6 (dietary manager) identified the insect flying around as gnats and a mosquito. V6 said, this is the dish washing area.

V6 said, she has not seen any gnats prior to today.Service Inspection Report dated 9/24/25 documents: Main Kitchen Area: Comments: Fruit flies were present during the time of service. Kitchen floor needs to be regrouped to prevent fruit flies from breeding.On 9/23/25 at 3:43pm, Resident R5 was observed with a partially open bag of restaurant food on his bedside table with seven or more gnats crawling around top, inside and on the outside of his food bag. Three gnats were resting on Resident R5's wall near his bedside table. V4 said, there are gnats in and around Resident R5's food bag. V4 said, there are gnats on the wall. Pest control Policy dated 3/22/21 documents: Provide a healthy environment for residents. Mosquitoes-they not only bite patient and cause allergic reaction at times but also carry disease like [NAME] Nile virus. Often, elderly patient is more susceptible to this infection when compared to younger population and have more difficulty recovering.

Keep trach cans lined and empty them regularly.

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet