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Complaint Investigation

Bria Of Westmont

Inspection Date: August 27, 2025
Total Violations 1
Facility ID 145405
Location WESTMONT, IL
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Inspection Findings

F-Tag F0677

Quality of Life and Care Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

pm, 5 minutes before the State Surveyor came in, and changed her brief and put her on the toilet and left her there. Resident R3 said that this happens everyday, and it makes her mad. Resident R3's 7/2/25 Care Plan showed a focus on ADL deficits related to generalized weakness and immobility secondary to MS, and paraplegia.

The interventions included staff meet Resident R3's needs throughout the day, toileting every two hours and as needed. Resident R3's care plan showed a focus for bowel and bladder with a goal to keep clean and dry and odor free. On 08/26/25 at 1:55 PM, V4 CNA (Certified Nurse's Assistant) said that she was informed by Resident R3 that

she needed to be changed at 12:30pm and she told her she would have to wait until she finished passing

the trays. V4 said that Resident R3 asks everyday to be changed at that time and Resident R3 has had her lunch tray and has been outside so it is now time for the other residents to be provided care. V4 said that the trays have to be served timely. V4 said that she did not return to Resident R3 to provide incontinence care for her until around 1:10 pm - 1:20 pm and said that that was not timely for incontinence care and that not providing incontinence care could cause skin breakdowns. V4 said that she was the only staff to provide care for Resident R3, but she could have asked the nurse to assist or another staff, but she didn't. V4 said that when she did return to provide incontinence care between 40 to 50 minutes later, she asked another staff to assist. V4 said that she did not ask that staff earlier to assist because that staff was feeding residents. On 08/26/25 at 5:38 PM, V1 (Administrator) said that incontinence care should be provided every two hours and as needed. V1 said that if a resident informs the staff that they need incontinence care it should be provided then. V1 said that 40 to 50 minutes to wait for staff to provide incontinence care is not appropriate. V1 said that a 40-to-50-minute delay in providing incontinence care could cause skin breakdowns, infections and it is a dignity issue for the residents. On 08/26/25 at 4:42 PM, V2 DON (Director of Nursing) said that residents should be provided incontinence care as soon as they inform the staff that they need it. V2 said that 40 to 50 minutes is not acceptable to have to wait for incontinence care because it increases the risk of skin breakdowns and increases the risk for infections. V2 said that the residents call her and tell her that they have been waiting over for the staff to provide incontinence care for them. V2 said that it is unacceptable for Resident R3 to be incontinent of urine and have not been changed from 11am until 1:20 pm. V2 said that her expectations are that if staff are passing lunch trays and someone asks for assistance the staff is to ask the nurse to pass

the trays or assist the resident. V2 said that if the nurse is busy the staff are to call her to assist. V2 said she is aware that Resident R1 had to wait 40 to 45 minutes to be provided incontinence care and that was unacceptable.

The 6/30/25 Resident Council meeting notes showed under Nursing/CNA, residents would like staff to be quicker in responding to their needs. At times CNA's will say I'm not your CNA. The facility's ADL (Activities of Daily Living) policy (6/2025) showed that it is a program performing and assisting the residents with elimination to prevent disability and maintaining maximal functioning. The policy shows under Elimination, assistance is to be given as required. The policy did not show when staff should provide ADL assistance for

the residents.The facility's Incontinence Care policy (10/2024) showed that incontinence care is provided to keep the resident as dry, comfortable, and odor free as possible. It also helps in preventing skin breakdown.

The policy did not show when staff should provide incontinence care for the residents.The facility's Toileting Residents policy (6/2025) showed that staff should be providing residents with assistance with toileting safely and on a routine basis in a timely manner.

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📋 Inspection Summary

BRIA OF WESTMONT in WESTMONT, IL inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 WESTMONT, 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 BRIA OF WESTMONT or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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