Aliya Of Palos Park
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
bumped herself on the dresser, V12 checked and no bruising was present, she did not inform the nurse because nothing happened to her, Resident R3 had no marks. V2 said, she told V12 that if anything happens with a resident, she was to let the nurse know right away. V2 said, V12 was suspended pending investigation, and
it had to happen during her shift. V2 said, Resident R3 is 1 person assist. V2 said, the nightstand was right next to
the bed and it was moved right away.On 11/24/25 at 12:27 pm V16 (Resident R3's Physician) said the facility staff made him aware of the incident and Resident R3 is in hospice but he still ordered for Resident R3 to be sent out due to hitting her head. V16 said, the CNA needed to report this incident to the nurse. V16 said, Resident R3 ended up with clavicle fracture however at [AGE] years old she is small and weights only around 98 pounds and she has fragile bones. V16 said, not sure how the incident could have been avoided as the resident jerked during care and how the CNA (V12) could have known the resident would jerk during care. V16 said, he was not in
the room when the incident happened, and this is what the CNA has reported. V16 said, not sure if the jerking is avoidable, we want to say all fractures are avoidable but that is not always the case. V16 said, if Resident R3 jerked and the diagnosis of Osteoarthritis will contribute to the fracture, his bones (V16) are stronger than hers and if that would have been him, no fracture would happen. V16 said, due to Resident R3's age and being
in hospice, we are not focusing on osteoporosis, she has no padding on her body and will break her bones more easily.Resident R3's 10/28/25 Incident Report documents in part: Upon morning rounds CNA informed nurse that resident had some discoloration to her left side of her head and her left shoulder. Upon assessment nurse noted the discoloration in those areas, the patient denied having any pain and states she is unsure of what happened. The patient is confused at baseline. (Incident happened around 3:30 am and nurse on duty was not made aware until around 7:30 am)Resident R3's (10/28/2025 at 7:40 pm) Nursing Note: Resident R3 returned to the facility from Hospital around 7:30 with dx of clavicle fracture and scalp bruise. The patient's vitals within her baseline, and no signs nor symptoms of pain nor distress.Facility's Certified Nurse Aide job description documents in part: 19. Observe and report any physical or emotional changes observed in the residents including any complaints or grievances made by the resident. 24. Report all hazardous conditions and equipment to the nurse immediately.
Event ID:
Facility ID:
If continuation sheet
ALIYA OF PALOS PARK in PALOS PARK, 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 PALOS PARK, 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 ALIYA OF PALOS PARK or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.