Health inspection·April 3, 2025

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to follow its policy and ensure that residents had physician orders for medications stored at the bedside and were assessed for self-administration of medications. This affected two of three residents (R1, R7) reviewed for self-administration of medications Residents Affected - Few Findings include: On 3/29/25 at 10:16 AM, R7 was observed to have a bottle of refresh eye drops on bedside table. R7 stated that the nurses have been administering this medication to him twice a day since his admission to this facility. R7 stated that he is not able to self-administer this medication. R7 stated that he is waiting for the nurse to administer eye drops. On 3/29/25 at 3:00 PM, R1 was observed to have a container of oral antidiarrheal medication on bedside table. R1 stated that R1 has diarrhea intermittently due to medical condition and has asked the nurse to have medication ordered. R1 stated that when R1 asks for this medication, the nurse informs R1 that the facility does not have any antidiarrheal medication. R1 stated that R1's family member brought in this medication so R1 can self-administer when needed. On 3/29/25 at 11:05 AM, V2 DON (director of nursing) stated that before a resident can self-administer medications, a skill assessment needs to be done. V2 stated that if the resident's BIMS (brief interview of mental status) is high enough and if the resident can demonstrate how to administer medication safely to themself, a physician order would be obtained. R7's BIMS, dated 3/27/25, notes R7's score is 15 out of 15. R7 is cognitively intact. R7's POS (physician order sheet) does not note an order for refresh eye drops, an order to self-administer or store these eye drops at bedside. R1's BIMS, dated 2/20/25, notes R1's score is 12 out of 15. R1's cognition is moderately impaired. R1's POS does not note a current order for loperamide (antidiarrheal) oral medication. There is no order to self-administer or store this medication at bedside. This facility's self-administration of medications by residents' policy, undated, notes an interdisciplinary team determines the resident's ability to self-administer medications by means of a skill assessment, in part: the resident is instructed in the medication, the resident is requested to read the label, and demonstrate the steps involved in self-administration of the medication. A further assessment of the safety of bedside medication storage is conducted. If the interdisciplinary team (continued on next page) 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 Page 1 of 6 Event ID: 145087 Printed: 05/15/2026 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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)