Lakewood Nrsg & Rehab Center

F 0684 Level of Harm - Immediate jeopardy to resident health or safety

is achieved on the following: -Ensuring orders and monitoring are in place for LVAD battery function and monitoring -LVAD company contact information posted -Ensure a minimum of 2 fully charged LVAD battery units are in place at all times -Care Plan includes LVAD management and battery monitoring - Emergency Care of LVAD Patient guide at nurse's station and bedside -Staff able to articulate and/or teach back steps to ensure device is functioning as intended, including but not limited to battery function and emergency care guide -QAPI will be completed upon acceptable Removal Plan

Residents Affected - Few

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

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

10/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakewood Nrsg & Rehab Center

14716 S Eastern Avenue Plainfield, IL 60544

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 0940

Develop, implement, and/or maintain an effective training program for all new and existing staff members.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to ensure a training plan was in place to educate licensed staff (including agency staff) on specialty care needs.This has the potential to affect all 113 residents in the facility.Based on interview and record review, the facility failed to ensure a training plan was in place to educate licensed staff (including agency staff) on specialty care needs. This has the potential to affect all 113 residents in the facility. Findings include: The Facility Data Sheet dated 10/14/25 showed the facility's total census was 113 residents. The Facility Assessment Tool (last updated 10/10/25) showed the purpose of the assessment is to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. It also showed that when the facility decides to accept residents with care needs it has not previously admitted , the Facility Assessment helps determine which areas require attention, such as training, education, and competencies necessary to provide the level and types of care needed for the resident population. The section of the Facility Assessment titled Resident Count - Special Treatment and Conditions showed the facility identified itself as capable of accepting and caring for residents with Left Ventricular Assist Devices (LVADs), noting two active residents in that category as of 10/10/25. Resident R1's face sheet showed Resident R1 was initially admitted to the facility on [DATE REDACTED] and discharged on 5/30/25. Resident R1's face sheet shows his most recent admission date as 8/11/25 with a diagnosis list that includes presence of heart assist device. Resident R4's face sheet shows an admission date of 7/17/25 with

a diagnosis list that includes presence of heart assist device. On 10/17/25 at 10:33 AM, V12 (Agency Licensed Practical Nurse/LPN) said she had cared for Resident R1 on 10/12/25. Per V12, she had never received any LVAD training or education from the facility. V12 stated there was another nurse, V17 (Registered Nurse/RN), who was working in the same area of the building when Resident R1 experienced a change in condition.

On 10/15/25 at 3:51 PM, V17 (RN) said he had not received any training about LVADs. On 10/15/25 at 4:14 PM, V2 (Director of Nursing/DON) said the only LVAD In-Service/Education completed was on 5/29/25-11 days after Resident R1's original admission date of 5/18/25. Per V2, Resident R1 should not have been accepted for admission

before staff received training. On 10/17/25 at 12:03 PM, V21 (Resident R1 and Resident R4's Physician) said that in general,

the facility should only accept residents with devices if the staff are trained and competent to care for those devices. V21 stated at minimum, nurses should know what these machines are, what they do, and why residents have them-that's Nursing 101. On 10/17/25 at 9:41 AM, V7 (Hospital Outpatient Nurse Practitioner with VAD Team) said that nurses caring for residents with LVADs should be trained according to facility protocol. Per V7, after the LVAD In-Service/Education done on 5/29/25, the facility should have reached out to her team or to the LVAD manufacturer to obtain additional training. The facility's LVAD Education sign-in sheet dated 5/29/25 lists 11 nurses who attended the training. Review of the facility's nurse roster shows a total of 23 nurses on staff (excluding agency staff), indicating that at least 12 nurses had not been trained prior to this survey. On 10/24/25 at 11:22 AM, V2 (DON) said the Special Treatments and Conditions section of the Facility Assessment refers to the acuity level the facility is able to care for. Per V2, the facility does not have a system in place to train agency staff. On 10/24/25 at 12:15 PM, V1 (Administrator) confirmed that the purpose of the Facility Assessment is, as stated on the first page, to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies, including training.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet