Claridge Healthcare Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

did not see the altercation happen because he was at lunch, but he heard the yelling. Resident R7 said the other guy (Resident R4) comes into our room all the time and eats jelly off my nightstand, usually he leaves on his own. An incident/occurrence report form dated 9/2/25 shows that Resident R4 returned to the facility on 9/2/25 at 4:00 PM, he was stable and had steri strips to his left temple, the local hospital had completed a CT/computed tomography scan of the spine and head which were negative for any bleed or fractures, Resident R4 did not require sutures to the laceration. Hospital documents show Resident R4 was diagnosed with a facial contusion. On 9/3/25 at 8:45 AM, Resident R4 was sitting in the dining area at a table, his left eye was dark purple and very bruised around

the eye socket. The sclera of his eye was red in color, and he had several steri strips to the outer temporal area of the left eye. Resident R4 said, I am okay. When this surveyor attempted to talk to him. He also said no when asked if his eye was hurting him. On 9/3/25 at 8:47 AM, V20 (CNA) said she was here the day prior when

the altercation happened. V20 said staff were in the dining room feeding residents and V5 came into the room saying someone needs to get him out of my room. V20 said she told another CNA to go see what was going on and the next thing she knows it had escalated, and they were fighting. V20 said Resident R4 goes in and out of the other resident rooms frequently but will usually come right out because he is confused about which room is his.On 9/3/25 at 11:07 AM, V1 (Administrator) said when a resident hits another resident it is abuse.The facility provided Abuse Prevention Program policy last revised on 7/30/12 shows that the facility will prevent abuse, neglect and theft by establishing a sensitive and secure environment and all residents have the right to be free from abuse. The policy describes physical abuse as hitting, slapping, pinching, kicking or controlling behaviors.

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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

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Claridge Healthcare Center

700 Jenkisson Lake Bluff, IL 60044

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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

possible for Resident R1 to have had that much cash on her possession. On 9/3/25 at 8:15 AM, V3 said she was alerted to Resident R1's missing money on 8/21/25 and they did do a room search and the money was not located.

V3 said Resident R1 is deaf and does read lips and if someone came into her room while she was asleep, she would not hear them. V3 confirmed that Resident R1 does not go out of the facility very often and that she is alert and oriented. V3 also confirmed when she interviewed Resident R1 on 8/21/25 that her account of what cash she had, and the events matched what Resident R1 reported to this surveyor. On 9/3/25 at 11:07 AM, V1 (Administrator) said

they encourage residents to not have that much cash on them. V1 said he is highly upset that Resident R1 had her cash taken from her and that they facility does not have cameras to identify who may have done it.The facility provided Abuse Prevention Program policy last revised on 7/30/2012 shows residents have the right to be free from misappropriation/theft and any missing money should be treated as theft until there are clear indications the property was mislaid or lost by means other than theft.

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

09/03/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Claridge Healthcare Center

700 Jenkisson Lake Bluff, IL 60044

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on interview and record review the facility failed to ensure the abuse coordinator was immediately notified of an allegation of misappropriation of resident property for 1 of 5 residents (Resident R1) reviewed for abuse reporting in the sample of 7. Findings Include:An Illinois Department of Public Health Investigation Report completed by V3 (Assistant Director of Nursing) on 8/21/25 shows that Resident R1 had reported that $300 was missing from her wallet.A Nursing Progress Note completed by V17 (Registered Nurse) on 8/20/25 at 10:30 PM for Resident R1 states, Resident reported to nursing assistant that she lost $300.00 between 1 PM and 5 PM. On 9/2/25 at 3:10 PM, V19 said Resident R1 did report to her that she had money missing from her wallet. V19 said she went and told her nurse (V17) that evening about the missing money. On 9/2/25 at 12:45 PM, V3 said she was not alerted to Resident R1's missing money until 8/21/25 and when an allegation is made staff should notify an administrator or V1(Administrator and abuse coordinator) immediately. On 9/2/25 at 3:02 PM, V17 said he was alerted by a CNA, V19 the evening of 8/20/25 that Resident R1 had money missing from her wallet but it was getting late in the evening, so he did not call anyone he just left a message to pass on in report to have social services see her the next day. V17 said he knows that you should call the abuse coordinator right away for any abuse allegations, but he thought they should wait to see if the money turns up. On 9/3/25 at 11:07 AM, V1 (Administrator) said staff are required to report to the abuse coordinator or a member of management who would then call the abuse coordinator immediately for any allegations of theft, misappropriation, abuse etc. V1 said waiting until the next day is not acceptable. The facility provided Abuse Prevention Program policy last revised 7/30/2012 shows that any allegations of abuse or mistreatment including misappropriation of property should be reported to a supervisor who should immediately report it to the administrator.

Event ID:

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If continuation sheet