Grove Of Lagrange Park, The

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

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

medications. V19 stated she has asked the staff about Resident R3 using the walker and they said we have a walker for Resident R3 and she could use the walker. V19 stated when Resident R3 began walking different she asked the facility what can they give Resident R3 to assist her with walking. V19 stated Resident R3's is also hard of hearing and does need assistance with walking or needs a better walker. On October 15, 2025 at 3:42 PM, V18 (Certified Nursing Assistant) stated Resident R3 is confused, would sometimes sit in a chair outside her room and would stand on her own a lot.October 15, 2025 at 4:02 PM, V10 (Restorative Nurse/Licensed Practical Nurse) stated Resident R3 needs help with walking, has an unsteady gait, is a fall risk, needs supervision and cueing, and will get up unassisted from a chair. V9 (Restorative Nurse/Licensed Practical Nurse) stated on 09/21/2025 Resident R3 stood up, turned around, began walking lost her balance and fell. Neither V9 or V10 were aware of Resident R3 using a walker or why it was part of her care plan.On October 20, 2025 at 12:25 PM, V8 (Assistant Director of Nursing) stated Resident R3 did not have a walker when she fell on [DATE REDACTED] and she has never seen Resident R3 with a walker.On October 20, 2025 at 11:07 AM, V12 (Medical Director/Physician) stated if patients are high risk and have multiple falls we use bed alarm all the time unless the resident frequently removes it. V12 stated if

the resident has a change in condition and refuses to use bed alarm or frequently removes it this will be noted in their records. V12 states most residents have gait instability, history of falls, memory loss, coordination problems, and are taking certain medications that put them at risk for falls and those residents may need bed alarms. V12 stated an assessment by physical and occupational therapy determines if residents are safe to use a walker as well as day to day assessments from the nurses. V12 stated Resident R3's mental status does not allow her to remember to use the walker, and we put the walker next to the residents and always remind them to use it. V12 stated whenever the staff notices Resident R3 is out of her room

they come right away with the walker and remind her to use her walker and our staff are always available to help residents change positions. V12 stated there should be an attempt to have Resident R3 use a walker and no reason why this can't be done.The facility's Fall Occurrence Policy received 10/15/2025 states in part: It is

the policy of the facility to ensure that interventions are put in place. Those identified as high risk for falls will be provided fall interventions.

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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

10/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Grove of Lagrange Park, The

701 North Lagrange Road LA Grange Park, IL 60526

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

needed to be changed. 4. Resident R6 is an [AGE] year-old female who was admitted to facility on December 12,

1. 2021. Resident R6's face sheet includes the following diagnoses: atrial fibrillation, anxiety, overactive bladder,

anemia, hypothyroidism, hypertension, and congestive heart failure. Resident R6's current care plan dated February 10, 2024, shows a risk for skin impairment with a need for staff assistance for incontinence care. On October 14, 2025 at 12:10 PM, Resident R6 was in bed with a meal tray next to her and a foul odor was present in her room. V3 (Certified Nursing Assistant) provided care and discovered that Resident R6's adult brief was saturated with urine and feces. V3 said Resident R6 had not been checked or changed prior to meals and that this was her first round of the day. V3 said she believed Resident R6 was last changed around 5:00 AM by the overnight CNA. On October 15, 2025 at 1:11 PM, V6 (Certified Nursing Assistant) stated she was not present during the incident with Resident R1 but confirmed that facility protocol requires residents to be checked and changed every two hours and before and after meals.On October 15, 2025 at 2:15 PM, V2 (Director of Nursing) stated that CNAs are expected to check and change residents at least every two hours and before and after meals. V2 said all CNAs receive orientation, competence, and computer training upon hire.The facility's General Care Policy (dated June 30, 2025) states: The facility will provide care to meet each resident's physical and psychosocial needs.The facility's Incontinence and Perineal Care Policy (dated June 30, 2025) states: Do rounds at least every two hours to check for incontinence during shift Provide perineal care to ensure cleanliness, comfort, and infection prevention.

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