Inspection·October 31, 2024

F 0684 Levalbutirol inhaler. R1 stated R1 takes one puff every 4 hours. Level of Harm - Minimal harm or potential for actual harm Wixela inhaler. R1 stated R1 takes one puff twice a day. Residents Affected - Few Fluticasone inhaler. R1 stated R1 takes 2 puffs at nighttime. On 10/29/24 at 12:45 PM, Surveyor reviewed R1's electronic health records. R1 was admitted on [DATE] with included diagnoses not limited to Chronic Obstructive Pulmonary Disease, Atrial Fibrillation, and End Stage Renal Disease. R1's Minimum Data Set, dated [DATE] shows R1 is cognitively intact. R1's physician orders with active orders as of 10/29/24 shows no order for self-administration of medications. There were also no assessments or re-evaluations found in R1's records to determine if R1 is appropriate to self-administer R1's own medications. R1's care plan does not address if medication self-administration is appropriate for R1. R1's physician orders show medication orders for Apixaban 5 mg 1 tablet every 12 hours; Fluticasone-Salmeterol inhalation 1 inhale orally two times a day; Levalbuterol Inhalation 1 inhale orally via nebulizer every 4 hours; Losartan 12.5 mg one time a day; Metoprolol 50 mg one time a day every Monday, Wednesday, Friday, and Sunday; Renal Multivitamin 1 tablet one time a day; Sevelamer 800 mg 3 tablets three times a day; and Wixela Inhalation 1 inhale orally two times a day. There were no physician orders found for Neuriva, Prevagen, and Areds. On 10/29/24 at 3:13 PM, a phone interview was conducted with V7 (Registered Nurse). V7 stated [V7] never completed job orientation in the facility. V7 stated [V7] worked the 3rd floor night shift (10/28/24) until morning of 10/29/24. V7 stated it was V7's first time on the third floor and didn't know the residents there. V7 stated V7 did not know R1 was going to dialysis early in the morning. V7 stated, [R1] came up to me after 2:00 AM and asked me to give [R1] all [R1's] 9:00 AM medications. [R1] said [R1] is going to the dialysis and [R1] needed to take [R1's] meds with [R1]. [R1] directed me what medications [R1] wanted to take with [R1]. I checked the EMAR [Electronic Medication Administration Record]. I gave all of [R1's] 9:00 AM meds to [R1] in the clear pouch, and [R1] took the meds with [R1] to dialysis. [R1] told me [R1] would take them at 9:00 AM. On 10/30/24 at 10:04 AM, Surveyor reviewed R1's progress notes on 10/29/24. No documentation found if R1's missed morning medications on 10/29/24 were followed up with V8 (R1's Physician). R1's progress notes dated 10/29/24 at 10:43 AM written by V5 reads in part: During meds round, the nurse noticed that the patient still had the medication that the nurse from the night shift had given to him to take with him to dialysis. The patient was re-educated about the importance of taking the medication at the correct time. On 10/30/24 at 11:40 AM, inspected R1's medications inside 3rd floor team 1's medication cart with V9 (LPN). R1's inhalers and eye drops were not in the medication cart. V9 stated R1 keeps all [R1's] eye drops and inhalers at bedside and takes them on his own. On 10/29/24 at 1:05 PM, V2 (Director of Nursing) stated that nurses have to check from the resident's EMAR what medications they are administering to the residents. They have to wait until the resident takes the medications. They are not supposed to leave the resident's room without making sure that the resident took the meds. V2 stated that if residents are not monitored and made sure that the resident had taken their medications, then the resident could potentially take the medications with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145126 If continuation sheet Page 2 of 3 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 145126 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lincoln Rehab & H C Ctr 504 West Wellington Avenue Chicago, IL 60657 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other medications that could double the dose. V2 stated that if the medications are refused or they miss a dose, nurses have to call the physician and they have to check the full vital signs to check if the resident is stable from missing medications and find out how many times it's occurred. V2 stated V2 expects the nurses to follow the physician orders for medication administration. V2 stated V2 is not aware of the facility's policy regarding self-administration of medications because there are no resident currently residing in the facility that is self-administering their own medications. V2 stated that if a resident would like to self-administer their own medications, then there should be an evaluation or assessment to show that the resident is eligible and is safe to administer their own medications. V2 stated that resident evaluation should be done prior to giving the permission to the resident to self-administer own medications. V2 stated that the nurses need to do a lot of resident teaching and observation that the resident is taking the medication correctly. V2 stated that the education and assessment should all be documented in the resident's chart and needs to be re-assessed quarterly to make sure that the residents who are self-administering medications still have the ability to do that. V2 stated that self-administration of medication should be ordered by the physician. V2 stated that R1 is not self-administering their own medications and the nurses should be providing R1's medications and making sure that R1 is taking [R1's] medications. V2 stated that R1 is not allowed to keep [R1's] own medications at bedside. V2 stated all residents' medications should be securely stored in the medication carts. V2 stated, As far as I know there is no one here that is self-administering their own medications. The facility's SELF-ADMINISTRATION OF MEDICATIONS policy dated 9/20 reads in part: Residents will not be permitted to administer or retain medications in their rooms unless so ordered by the attending physician, assessed for their cognitive, physical, and visual ability to self-medicate, and approved by the care planning team. The Self- Medication Training Program will consist of the following: resident request to self-medicate, self-medication assessment completed initially and quarterly, MD order to participate in the program, plan of care with quarterly documentation to the progress of the established goal, and completion of the self-medication daily flow sheet. The facility's MEDICATION ADMINISTRATION policy dated 9/20 reads in part: Drugs must be administered in accordance with the written orders of the attending physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145126 If continuation sheet Page 3 of 3