Franciscan Village
FRANCISCAN VILLAGE in LEMONT, IL — inspection on August 21, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
R52’s active care plan shows she is at risk/active for falls. R52 has altered safety awareness. R52 overestimates her abilities related to previous CVA (cerebrovascular accident), history of falls, decrease balance/mobility/ADL skills.
Decrease cognitive function and decrease thought process due to dementia.
This same care plan shows multiple interventions including two staff assistance with use of gait belt for transfers.
- Face sheet shows that R43 is 97 years-old with multiple medical diagnoses including vascular dementia,
poly-osteoarthritis, generalized muscle weakness, history of fall, history of fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing.
On August 19, 2025, at 1:25 PM, V20 and V21 (Both CNA) transferred R43 from reclining wheelchair to bed via mechanical lift. R43 was positioned in the middle lower half of the sling with the lower part of her buttocks and lower extremities off the sling and not supported. R43 was screaming that her back was hurting. V21 stated the sling was sliding while she was in the reclining chair. V20 placed her arms under R43’s legs during transfer, while R43 was screaming all throughout that her back was hurting.
- Face sheet shows R10 is R100 years-old who has multiple medical diagnoses including spinal stenosis,
generalized muscle weakness, lack of coordination, and unspecified dementia.
On August 20, 2025, around 12:20 PM, V23 and V29 (Both CAN) transferred R10 from bed to wheelchair using a gait belt. R10 appeared afraid and hesitant to transfer. R10's knees were bent/folded and was not fully standing.
There was no non-skid wheelchair pad on her wheelchair seat.
R10 Morse Fall Scale dated 8/13/25 shows, R10 is a high risk for fall.
Facility's fall log from February to August 2025 shows that R10 has had multiple fall incidents.
R10's Fall Care Plan shows: R10 is at risk/actual falls related to diagnoses of orthostatic hypotension, history of falls, incontinence, muscle weakness, joint stiffness, and dementia.
This same care plan shows interventions which include ensuring non-skid mat on the wheelchair seat.
On August 20, 2025, at 3:36 PM, V2 (Director of Nursing/DON) stated that staff must follow all fall prevention interventions especially for residents who are identified as high-risk for fall.
Ensure that staff use assistive device as recommended to prevent fall incidents.
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