Inspection·September 3, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow their employee handbook on cell phone usage by having a staff member take a personal phone call while providing care to a resident. This failure affected 1 (R1) of 3 residents reviewed for resident rights in a total sample of 6. Findings include:R1 is a [AGE] year-old male originally admitted on [DATE] with medical diagnosis that include and are not limited to: paraplegia, diabetes mellitus type 2, convulsions, hypertension, unspecified injury at unspecified level of cervical spinal cord, and colostomy status. Per the Minimum Data Set (MDS) dated [DATE], reads: Brief Interview for Mental Status score 15/15, cognitively intact.On 9/2/2025 at 11:17 AM, R1 stated an incident occurred on Thursday, 8/28/25 around 4:00 PM. R1 stated during R1's shower on the shower bed by the nurse's station shower room a Certified Nursing Assistant (CNA) was using her cell phone, using face time during R1's shower. R1 cannot provided the name of the CNA. R1 describes the CNA as a skinny African American women. R1 states that the CNA works morning shift, but on August 28, 2025, that CNA stayed until 5:00 PM. R1 states he told his family member about the incident that same evening and did not let management know. R1 stated he did not let management know about the incident because he gets nervous, or his heart begins to race, and he wants to prevent his seizures. R1 stated the incident only occurred 1 time. R1 stated the shower bed is broken. R1 states he does feel safe in the facility. R1 states he has not heard from other residents about cell phone usage during showers in the facility.On 9/2/2025 at 1:28PM, V6 (License Practical Nurse/LPN) stated V6 (LPN) worked day shift on Thursday, 8/28/2025 and was R1's nurse for the day. V6 stated V5 (CNA) was R1's CNA giving R1 a shower on Thursday 8/28/2025. V6 (LPN) stated on 8/28/2025, V6 (LPN) observed V5 (CNA) using V5's (CNA) personal phone and air pods (wireless headphones) while providing patient care to R1. V6 stated she told V5 (CNA) to get off her phone while V5 (CNA) provides patient care. V6 (LPN) reported the incident to the assistant director of nurse on 8/29/2025 day shift. V6 stated she did not observe V5 (CNA) on facetime. V6 stated it is expected for staff not to use their personal phones at while providing patient care.On 9/2/2025 at 2:11 PM V5 (CNA) stated she provided a shower to R1 on 8/28/2025. V5 stated R1 is dependent on staff for lower body related to patient's diagnosis of paraplegia. V5 (CNA) stated she received an emergency personal phone call on 8/28/2025 during R1's shower from V5's family member. V5 (CNA) stated she apologized to R1 for the phone call. V5 stated she was never on facetime. V5 (CNA) said she had her air pods on her ear and when her personal phone rang, it answered the phone call on its own. V5 (CNA) said she had education and had to sign a write up for using air pods/personal cell phone usage. V5 (CNA) states there is no reason why R1 thinks V5 was on facetime during R1s shower on 8/28/2025. V5 (CNA) states she should have not been using the air pods, cell phone during patient care. V5 (CNA) states it is expected for staff not to use their personal cell phone or wear air pod devices during patient care.On 9/2/2025 at 2:52 PM V8 (Director of Nurse/DON) stated she holds a monthly meeting (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: 145211 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 145211 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thryve of Burbank 5400 West 87th Street Burbank, IL 60459 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)