Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
Level of Harm - Actual harm
Residents Affected - Few
Based on interview and record review, the facility failed to follow its abuse policy by not ensuring that
residents were free from physical and verbal abuse. This affected two of three residents (R1 and R2)
reviewed for abuse. This failure resulted in R1 experiencing, a facility staff member directed inappropriate
and profane language toward R1. R1 reported feeling disrespected, childlike, and angry as a result of the
interaction. This also resulted in (R2) experiencing a facility staff member struck R2 on the head. Using the
reasonable person concept, this action would cause a R2 to feel fear and intimidation. Findings Include:
R1's brief interview for mental status dated 8/26/25 documents a score of fifteen which indicates cognitively
intact. Social service note dated 8/12/25 documents: Abuse investigation initiated on 8/6/25 concluded that
staff (V4) mistreated R1 by telling him FU (fu*k you) too. On 9/16/25 at 2:32pm, V1 (administrator) said, R1
was verbally aggressive with V4 (PRSC). V4 was terminated for responding to R'1's verbally aggression by
replying f**k you too. V1 said, V4's response could be considered as verbal abuse. On 9/16/25 at 3:56pm,
R1 who was assessed to be alert and oriented to person, place, time and situation, said he had been
informed to come in from a smoke break by V10 (cna). R1 said, he was walking down the stair from the
smoking shelter toward the building entrance. R1 said, V4 brushed pass the V10 (cna), began yelling, being
verbally aggressive and acting like a bully. R1 said, V4 told him it's time to come in now. R1 said, he replied
to V4 by saying, telling V4 not to talk to him like a child. R1 said, V4 and him were arguing. R1 said, V4 had
an attitude. R1 said, during the argument V4 cursed at him saying fu*ck him. On 9/17/25 at 2:06pm, V7
(asst. administrator) said, R4 was terminated for group three offense. Group III Offenses: 1st OffenseTermination of Employment: Use of vile, foul, or abusive language toward a supervisor, resident, resident
family member or other staff member. Arguing with a resident, family member, doctor or visitor.On 9/18/25
at 1:03pm, V10 (cna) said, R1 was notified twice to come in from the smoking patio because it was dinner
time. V10 said, R1 was an independent smoker and was allowed to be out of the patio without staff
supervision. R1 was taking his time coming back into the building but he was not causing a problem. V10
said, V4 told R1 he had to come in. V10 said, V4 was hostile and rude towards R1. V10 said, R1 replied, he
was already informed by V10 to come in. V10 said, V4 became agitated. V10 said, V4 did not attempt to
redirect R1. V10 said, the manner in which V4 spoke to R1 was not professional. R1 and V4 began to
argue. R1 cursed at V4. V4 called, R1 out of his name. V10 said, both V4 and R1 started cursing at each
other. V10 said, V4 told R1 fu*k you too. On 9/18/25 at 3:01pm, V1 said, he labelled that interaction as
mistreatment instead of abuse because one can argue that it was a back and forth conversation between
cognitive (alert) individuals. V1 said, in the general population, people argue and swear. People said, fu*ck
you in the community. V1 said, the word fu*ck you does not have the same stigma as it use too. V1 was
asked if his facility was general population or a skilled nursing facility. V1 reply, it's a skilled nursing facility.
V1 said, an employee should not be telling a resident fu*ck you which is why she
(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 3
Event ID:
145220
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
145220
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pine Crest Health Care
3300 West 175th Street
Hazel Crest, IL 60429
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 0600
Level of Harm - Actual harm
Residents Affected - Few
was terminated. Abuse Policy Employee Acknowledgement dated 3/25/25 documents: Residents of this
facility are to be treated with dignity and respect. Any individual who willfully abuses, or neglect a resident
or misappropriated a resident' property or money will be terminated. V4's name was signed and printed with
a witness signature. Facility Preliminary Incident Investigation Report Form dated 8/6/25 documents the
facility has an allegation that may involve one or more of the following reportable situations. Verbal and
Mental abuse was checked. The allegation: R1 approached V1 and informed V1 that a staff member (V4)
swore at him. Witness statement dated 8/7/25 documents: V4 originally stated that she did not curse at R1.
V4 stated, she wasn't truthful with V1 because she didn't think he would be understanding. V4 did admit she
was wrong for engaging with R1 and allowing him to get her upset Facility Final Incident Investigation
Report Form dated 8/12/25 documents: Allegation of mistreatment substantiated Corrective Action Form
dated 8/13/25 documents: Mistreatment of a resident. Abuse investigation initiated 8.6.25 concluded
employee (V4) engaged in resident (R1) mistreatment. Prior discussion or warning on the subject: No
formal warning. Instructed on work rules on 3.25.25. Resident shall not be abused or mistreated. Corrective
action required: Termination. Abuse policy dated 2011 documents: the facility affirms the right of our
residents to be free from abuse. Abuse means any physical or mental injury or sexual assault inflicted upon
a resident other than by accidental means. Abuse is the willful infliction or injury, unreasonable confinement,
intimidation, or punishment with resulting physical harm, pain or mental anguish. Verbal Abuse is the use of
oral written, or gestured language that willfully includes disparaging and derogatory terms to residents or
families, or within their hearing distance, regardless of their age, ability to comprehend or disability. Mental
Abuse includes, but is not limited to humiliation, threats of punishment or deprivation. R2 was diagnosed
with Schizophrenia. Brief interview for mental status dated 5/8/25 and 8/6/2025 documents a score of four
which indicate severe cognitive impairment. Facility preliminary incident investigation report dated 7/25/25
documents: Alleged victims mental status: R2 was alert and oriented times two. R2 is hard of hearing.
Circumstances of the alleged incident: Two residents (R5 and R4) complained that a certified nursing
assistance (V6/cna) was loud while giving R2 activities of daily living (ADL) care and told R2 to pick up that
shit. They also noted that they heard R2 yell ow and were concerned that R2 might being mistreated or
abused.Witness statement dated 7/25/25 written by V8 (nurse) documents: R2 stated that she is sick of that
lady always knocking her around. R5 informed V8 (nurse) that V6 is verbally aggressive towards R2
everyday V6 works with R2. Final reportable dated 8/1/25 documents: R2 told the nurse (V6) cna was mean
to her. Later in the interview, R2 claimed the cna push her to stop wiping her bottom. On 9/16/25 at 2:36pm,
V1 (administrator) said, he received an allegation of abuse against V6 (cna). R4 reported that V6 was loud
with R2. R5 reported, that he overheard V6 telling R2 to pick that sh*t up then he heard R2 yell ouch. V1
said, he interviewed V6 who reported she told R2 to pick up her poo-poo off the floor. V1 said, V6 used the
verbiage poo-poo. V1 said, he could not substantiated the allegation of abuse so V6 was transferred to work
on second floor away from R2. V1's witness statement dated 7/25/25 documents: R2 said, V6 hit her in the
head with a towel and pushed her out of the bathroom. V1's witness statement dated 7/29/25 documents:
R2 said, she don't want her to take care of her anymore. She (V6) is always telling me what to do and
pushing me.On 9/16/25 at 3:14pm, R5 who was assessed to be alert and oriented to person, place, time
and situation, said V6 was yelling aggressively at R2. R5 said, the walls are very thin. R5 said, he shares a
common wall with R2. R5 said, he heard, V6 clearly through the walls. R5 said, R2 is hard of hearing, but
V6 was yelling louder than she needed too. R5 said, he has heard staff talk to R2 before and they wasn't as
loud as V6 was that night. R5 said, V6 told, R2 you sh*tted on
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145220
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
145220
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pine Crest Health Care
3300 West 175th Street
Hazel Crest, IL 60429
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 0600
Level of Harm - Actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
yourself. You got sh*t on the floor. R5 said, V6 was verbally abusive toward R2. R5 said, the way V6 spoke
to R2 was elderly abuse. R5 said, V6 is a bully and does not deserve to work with the elderly or in this
facility. R5 said, R4 also heard, V6 speaking verbally aggressive to R2. On 9/16/25 at 3:24pm, R4
requested that V1 be present during his interview, R4 who was assessed to be alert and oriented to person,
place, time and situation, said, he was in the hallway across from R2's room at the time of the incident. R4
said, he heard V6 speaking to R2 extremely loud. R4 said, R2 is hard of hearing. R4 said, a few times,
when V6 spoke to R2, it was a little more than just speaking loud because R2 was hard of hearing. R4 said,
V6's tone was extreme. R4 said, V6 spoke to R2 with a lack of respect. R4 said, he spoke openly to the staff
asking staff if they could hear the commotion between V6 and R2. R4 said, V6 was given R1 harsh
commands, V6 told R4 to go in the bathroom and take your clothes off harshly. R4 said, then he heard a
thud on the wall. R4 said, when V1 interviewed R2, V1 asked if V6 hit R2. R2 replied, she hit me on the
head. On 9/16/25 at 3:34pm, R2 was interview by V1 while surveyor stood inside of R2's room but out of
sight of R2. V1 asked, R2 what happen with V6 when V1 had to come in early. R2 said, I already told you.
R2 said, V6 use to hit me. R2 said, I was going to call the police on V6. R2 said, V6 hit me that day. V6 hit
me in the head that day. V1 said, R2 told four versions of the interactions with V6. V1 said, V6 hitting R2 on
the head was one version. On 9/17/2025 at 2:28pm, V8 (nurse) said, she spoke with R2 after her
interactions with V6 and being informed by R5. V8 said, R2 said, she was sick of her knocking her around.
V8 said, R2 did not specifically say V6 name. V8 said, has never heard R2 accused any staff member of
being physically aggressive, knocking her around or hitting her prior to this incident. Social service noted
dated 7/25/25 documents: Abuse allegation initiated this morning at 5:30 AM. Resident claims that she had
a bowel movement and kept digging at it thinking it was stuck, arguing with staff who said she needed to
stop and pointed out that she had made herself bleed because she was rubbing on her hemorrhoid. She
claimed that the CNA was pushing her to get out of the room and stop rubbing her hemorrhoid. Abuse
policy dated 2011 documents: the facility affirms the right of our residents to be free from abuse. Abuse
means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental
means. Abuse is the willful infliction or injury, unreasonable confinement, intimidation, or punishment with
resulting physical harm, pain or mental anguish. Physical Abuse is the infliction of injury on a resident that
occurs other than by accidental means and that requires medical attention, Physical abuse includes hitting,
slapping, pinching, kicking and controlling behavior through corporal punishment. Verbal Abuse is the use
of oral written, or gestured language that willfully includes disparaging and derogatory terms to residents or
families, or within their hearing distance, regardless of their age, ability to comprehend or disability. Mental
Abuse includes, but is not limited to humiliation, threats of punishment or deprivation.
Event ID:
Facility ID:
145220
If continuation sheet
Page 3 of 3
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
FAQ · About this visit
Common questions about this visit
What happened during the September 18, 2025 survey of PINE CREST HEALTH CARE?
This was a inspection survey of PINE CREST HEALTH CARE on September 18, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PINE CREST HEALTH CARE on September 18, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.