Pearl Of Rolling Meadows,the
Inspection Findings
F-Tag F0657
F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Based on observation, interview, and record review the facility failed to revise and update the comprehensive care plan for one resident identified with injury of unknown origin. This deficiency has the potential to affect 1 of 3 residents (Resident R1) reviewed for Injury of Unknown Origin in a sample of 3. Findings Include:Resident R1 admitted to facility on 11/6/2018. Diagnosis information includes senile degeneration of brain, Alzheimer's disease, primary generalized osteoarthritis, vascular dementia. On 11/25/2025 at 10:43AM, Resident R1
in the second-floor dining room, seated on the wheelchair with pillow on her back and no protective (geri) sleeves worn was observed.Review of Illinois Department of Public Health (IDPH) final report, date 8/25/2025, State Report indicate Resident R1's intervention include staff to place pillows on her sides when up on wheelchair, to provide additional support or cushion when leaning on hard surface. Will provide Gerisleeves to both arms. Review of comprehensive care plan report did not indicate the occurrence and revision/updated interventions of Resident R1's injury of unknown origin date of 8/20/2025.On 11/25/2025 at 10:21 AM V2 (Director of Nursing) and V3 (Restorative Nurse) both stated there was no plan of care revision/update for Resident R1 addressing pillows to be placed on the sides while sitting on the wheelchair and Resident R1 to wear bilateral protective (geri) sleeves. V2 stated care plan should have been updated after concluding her investigation of Resident R1's injury of unknown origin, date 8/25/2025 to reflect the new plan of care. V2 stated resident care plan is updated when there are changes, quarterly, and after investigation of injury of unknown origin.On 11/25/2025 at 10:55 AM V4 (Registered Nurse) stated she's aware of Resident R1's injury of unknown origin (bruising on the left cheek) but doesn't know the new interventions on her care plan. V4 said she reviews care plan at the start of her shift. Policy and ProcedureTitle: Comprehensive Care Plans, Reviewed 9/18/2025Policy Statement: To meet the resident's physical, psychosocial and functional needs, facility will develop and implement a comprehensive, person-centered care plan for each resident that includes measurable objectives and target goals.Procedure:10. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change.
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.