Pearl Of Rolling Meadows,the
Inspection Findings
F-Tag F0628
F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Based on interview and record review the facility failed to notify the local emergency room hospital of a resident's transfer for 1 of 1 resident (Resident R1) reviewed for admission, transfer and discharge. Findings include:On 8/12/2025 at 11:30am V4(Nurse) said that Resident R1 had an unwitnessed fall and was found on the bedroom floor with a pillow under his head, V4 said that Resident R1 is alert and oriented times one and unable to say what happened Resident R1 was assisted to the bed and the nurse practitioner gave orders to send to the local emergency room for an evaluation. V4 said that she gave report to the oncoming nurse of the incident, prepared documents, while Resident R1 was waiting for the ambulance to arrive, V4 said she did not notify the local emergency room hospital of Resident R1 transfer because she did not know when the ambulance would arrive, V6(Nurse) expressed understanding. On 8/12/2025 at 1:00pm V6(Nurse) said that he received report from
the ongoing nurse of Resident R1 fall and that Resident R1 is alert but confused and would not be able to say what happened to him. V6 said when the ambulance arrived, he gave documents to the ambulance, and he did not notify
the local emergency room of Resident R1 arrival for an evaluation of a fall that is for the ambulance driver to do we don't do that here. On 8/12/2025 at 1:10pm V2 (Director of Nursing-DON) said I expect all nurses to notify
the receiving facility of a transfer even if they can advocate for themselves or not, Resident R1 is confused and cannot speak for himself the local emergency room hospital should have been notified.On 8/12/2025 at 1:15pm V1(Administrator) said I expect all nurses to give a full report to the receiving facility of any resident transferring. An admission Record dated 8/12/2025 indicates Resident R1 has a diagnosis of Delirium due to know physiological condition, cognitive functions and abnormalities of the gait and mobility, a care plan dated 8/12/2025 for impaired cognitive function/dementia or impaired thought processes. Facility Policy:Transfer or Discharge, Emergency revised 2/28/2025Policy Statement:Emergency transfers or discharges may be necessary to protect the health and /or well -being of the resident. Procedure:4. Should it become necessary to make an emergency transfer or discharge to a hospital or other related institution, our facility will implement the following procedures. b. notifies the receiving facility that the transfer is being made.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
PEARL OF ROLLING MEADOWS,THE in ROLLING MEADOWS, 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 ROLLING MEADOWS, 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 PEARL OF ROLLING MEADOWS,THE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.