Encore Village
Inspection Findings
F-Tag F0578
F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to follow its advance directive/life sustaining policy by not having power of attorney implemented for a resident. This applies to 1 of 3 (Resident R1) residents reviewed for advance directives in a sample of 3.The findings include: Resident R1 was an [AGE] year-old male admitted on [DATE REDACTED] having moderate cognitive impairment as per the Minimum Data Set (MDS) dated [DATE REDACTED] and with
an admitting diagnosis including heart failure, atrial fibrillation, urinary retention, urinary tract infection (UTI), history of falling, and Benign Prostatic Hyperplasia. On 10/10/25 at 11:25 AM, V9 (Nurse Practitioner) stated, The daughter was making decision on Resident R1. One-time Resident R1 came back from the hospital, signing out Against Medical Advice (AMA) on Uber. The daughter said she was tired of him and asked why the facility couldn't call my fiance, who has the power of attorney. On 10/14/25 at 1:46 PM, V7 (Social Service) stated, I am not sure who was the power of attorney for Resident R1. I will ask the administrator about the Resident R1's POA.On 10/10/25 at 1:12PM, V6 (Resident R1's son-in-law) stated, I am Resident R1's power of attorney, and the facility didn't let me know about Resident R1's condition until the day Resident R1 passed away. I am not worried that they called V5 to notify Resident R1 of
the change in condition. They always contact V5; nobody informed me about Resident R1's decline or about his multiple falls.On 10/14/25 at 2:00 PM, V1 (Administrator) stated, We never got any power of attorney (POA) paperwork. V5 is the primary contact, so we were contacting V5. It was a mistake that staff were documenting V6 as Resident R1's POA. On 10/14/25 at 11:00 AM, V1 added, The social service has the sole responsibility to have the advance directive in place for our residents.Resident R1's medical record did not reveal any paperwork designated in writing that V5 nor V6 as Resident R1's Power of Attorney. A review of the facility provided advance directive/life sustaining treatment policy revised on 11/24 document: The Social Service Director and or designee will assess. Care plan and implement Advance Directives within 30 days after admission.DefinitionFor the purpose of this policy resident representative means a person appointed as a decisional representative that is either designated in writing by a resident to be his or her power of attorney or the resident's healthcare surrogate or guardian.
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:
ENCORE VILLAGE in SCHAUMBURG, 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 SCHAUMBURG, 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 ENCORE VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.