Health inspection·January 9, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review, the facility failed to report an allegation of resident to resident abuse to the State Survey Agency for two of two residents (R292 & R105) reviewed for abuse in the sample of 39 residents. Findings including: On 1/6/25 at 10:30 AM, survey team requested V1 (administrator and abuse prohibition coordinator) all reportable incidents within the last 90 days. V1 presented the survey team with 3 incidents reported to public health regional office (RO) however did not have the incident of 12/18/24 involving R292 and R105. On 1/7/25 at 11:15 AM, V1 (administrator) stated to survey team that the incident on 12/18/24 involving R292 did not warrant reporting as it did not involve another peer (resident).Surveyors asked who was involved in the incident altercation, V1 indicated that R292 struck the CNA V19. Surveyors clarified if R292 had any physical or verbal altercation with any resident during this incident, V1 stated, No, only with staff members. On 12/18/2024 at 19:20 PM, V8 (Social Services) wrote, Note Text: It was reported that this resident (R292) displayed increased agitation including making verbal threats towards peers (residents) and staff, making false allegations as exhibited by delusional thinking patterns. She was not easily redirected, despite attempts to intervene and decrease any further interventions by staff. Nurse offered PRN (as needed- medication) and this resident refused. She targeted female staff (striking and kicking female staff). Resident was escorted to the conference room removing her from other external stimuli. Police was called for assistance. Upon arriving to the facility, Officer and his partner entered the facility, attempted to calm and redirect this resident. She became assertive with the two officers. Nurse notified Physician and Mother/Guardian. There were orders to send her out to the hospital for a psych evaluation. Resident was transported with a petition to Hospital and escorted by EMT (Emergency Medical Technician) and police. On 1/7/25 at 11:40 AM V13 (CNA Scheduler) stated, I was the late night manager on duty and as I was coming in to the facility and (R292) was in the dining room/foyer area. She was aggressively trying to get to resident (R105) and she wanted to fight him. She said I am going to beat his ass and my CNA (V19) went around to get to the door and R292 hit her in the face. I grabbed R292 and walked her to the conference room to calm her down. We were sitting in conference room for a good hour. When she came in here to ensure to make sure she was okay we called police and she did the same thing to (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 2 Event ID: 145180 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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)