Health inspection·December 18, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that a resident received care and services in accordance with professional standards of practice to promptly intervene, monitor, and escalate treatment for severe hypoglycemia for a resident. This failure applied to one (R1) of three residents reviewed for nursing care and resulted in R1 experiencing prolonged hypoglycemia of over two hours with decreased responsiveness, requiring emergent hospital transfer. R1 subsequently expired at the hospital the same day.This failure was identified as an Immediate Jeopardy. The Immediate Jeopardy began on November 18, 2025. V1 (Administrator) was notified of the Immediate Jeopardy on December 17, 2025 at 1:07PM. The surveyor confirmed by observation, interview, and record review that the Immediate Jeopardy was removed on December 18, 2025, but noncompliance remains at Level Two because additional time is needed to evaluate the implementation and effectiveness of the removal plan. Findings include:R1 was a [AGE] year-old male who originally admitted to the facility on [DATE], discharged to the hospital on [DATE], and later expired. R1 had multiple diagnoses including but not limited to the following: anemia, ESRD dependence on dialysis, type II DM, CHF, colitis, pleural effusion, adult failure to thrive, and deep vein thrombosis.R1 expired at the hospital on [DATE]. Hospital record documents that upon arrival to the hospital at 10:31AM, R1 was found to be: desaturating into the 80s and placed on a non-rebreather at 15L. R1 was intubated and sedated at this time.On 11/18/2025, R1 experienced a hypoglycemic episode that was identified at 6:50AM by V6 (Former Licensed Practical Nurse).According to vital signs flowsheet report and progress notes, R1 experienced the following Blood Glucose levels and interventions on 11/18/2025:At 6:50AM, R1 was assessed by V6 to have a blood glucose of 42 mg/dl. V6 administered an emergency dose of Glucagon at this time.At 7:20AM, V6 rechecked R1's blood glucose to be at 43 mg/dl. V6 administered another emergency dose of Glucagon and apple juice was given to R1.At 7:30AM, R1's blood glucose was checked to be at 46 ml/dl. At this time V6 endorsed and gave report to day shift nurse, V5 (Licensed Practical Nurse).At 8:45AM, R1's blood sugar was checked to be at 52 mg/dl. V5 administered another emergency dose of Glucagon.At 9:20AM, R1's blood sugar was checked to be at 50 mg/dl. At this time, R1's vitals were checked, and it was noted that R1 was having labored breathing and decreased respirations. Per documentation, V7 (Nurse Practitioner) was notified and ordered to send R1 to the hospital via 911.At 9:23AM, R1's blood glucose was checked to be at 48 mg/dl.At 9:30AM, R1 left the facility with paramedics.Fire Department Field Care Report dated 11/18/2025 shows team was called to the scene for R1 having a diabetic problem. R1 was found in a seated position on his bed, unresponsive, head tilted forward, non-rebreather on. Staff states that R1 is normally alert and oriented x 4. Staff states R1 blood glucose was 42 at 7:00AM. Staff gave one dose of glucagon at that time. Staff rechecked R1's blood glucose at 9:00AM and found that it was still low at 48 mg/dl. Then called 911.It is to be noted that there is no documentation that the physician or the nurse practitioner was notified prior to 9:20AM. It is also to be noted that R1's Residents Affected - Few Page 1 of 4 145237 145237 12/18/2025 Generations at Regency 6631 Milwaukee Avenue Niles, IL 60714

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few blood glucose levels remained under 70 ml/dl for estimated two hours and thirty minutes before the nurse practitioner or 911 was called.On 12/16/2025 at 12:05PM, V6 (Former night LPN) said around 6:45AM, I went into R1's room. I noted R1 was not at his baseline, and I had to vigorously shake him to get him to arouse. I took R1's vitals and noted a blood glucose level of 42 mg/dl. I administered Glucagon at this time. I rechecked a bit later and noted his blood glucose level did not rise much. I then administered another dose of Glucagon.At this point, V5 (Morning LPN) arrived and gave him some apple juice, which he was able to drink. My understanding was that V5 was going to monitor R1 and I left the facility.On both 12/15/2025 at 11:25AM and 12/17/2025 at 11:10AM, V5 was interviewed. V5 said I arrived to my shift on 11/18/2025 between 7:00-7:30AM. I sat with V6 at the nurses' station and received report. V6 had mentioned that R1 was experiencing low blood glucose. After report, V6 and myself went into R1's room. No one was in R1's room when we arrived.We checked R1's blood glucose and I remember it was low, definitely below 50 mg/dl. We gave glucagon and apple juice which R1 drank. I rechecked a couple times, but it never got above 60 ml/dl. I gave the glucagon again and noted that he was having some abdominal, labored breathing. At this point, I hooked him up to the continuous vital monitor and noted his respirations were low. I called V3 (Assistant Director of Nursing) to help assist.On 12/15/2025 at 11:50AM, V3 said V5 called myself and another nursing supervisor to the floor to help assist. I would estimate that this was between 8:30AM-9:00AM. V5 said that R1's blood glucose was low and that she had given him Glucagon. We assessed R1 to not be at his baseline. R1's oxygen saturations were very low and they had him on a non-rebreather mask, receiving 25 liters of oxygen. At this point, we called 9-1-1 to send him out to the hospital.On 12/17/2025 at 10:05AM, V7 (Nurse Practitioner) said hypoglycemia to me, is anything below 80 mg/dl. If a resident is experiencing hypoglycemia, my expectation would be that the nursing staff offer juice to the resident if they are able to take food by mouth. If they are unable to do so or the blood glucose is very low, they should be given glucagon. They should continue to monitor the resident and the blood glucose. After fifteen minutes, if the blood glucose did not rise, they can give another dose of glucagon. My expectation would be for the nursing staff to immediately assess the patient, give the glucagon, and notify me as they monitor the resident. I should be notified of any resident that is experiencing hypoglycemia. I would also expect for a staff member to be with the resident at all times. V7 said, on 11/18/2025, I was notified by V5 that R1 was experiencing low blood glucose and that she had already given glucagon. She also said that at this time R1 was in respiratory distress. I told her to call 9-1-1 and send him to the hospital.On 12/15/2025 at 1:35PM, V2 (Director of Nursing) said V6 (former LPN) was terminated due to failing to follow our facility protocol. V6 should have notified V7 (Nurse Practitioner) right away when she noted R1 had low blood glucose, instead she endorsed it to V5 (LPN) when she came on her shift.Employee Disciplinary Action dated 11/18/2025 shows V6 received disciplinary action and was ultimately terminated for failure to follow MD/NP orders and notify MD/NP of change of condition.On 12/17/2025 at 2:37PM, V16 (Medical Director) said I would expect the nursing staff to promptly notify the attending upon any resident having a blood glucose level of 70 mg/dl or below.The ASCP (American Society of Consultant Pharmacists) hypoglycemia protocol, primarily for older adults in long-term care, uses the Rule of 15: if blood glucose (BG) is <70 mg/dL and the person can swallow, give 15g of fast-acting carbs (like glucose tabs/gel, juice), recheck in 15 mins, and repeat until BG >70 mg/dL; then provide a snack with carbs/protein, and for severe cases (unconscious/unable to swallow), administer glucagon and call 911. This protocol helps staff act without immediate physician orders in emergencies, following American Diabetes Association (ADA) guidelines. This protocol originated May 2023 and may be implemented without a physician's order.Facility Policy 145237 Page 2 of 4 145237 12/18/2025 Generations at Regency 6631 Milwaukee Avenue Niles, IL 60714

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few titled Hypoglycemia Management with last revision date of 11/2025 states in part but not limited to the following: Residents experiencing hypoglycemia (blood glucose below 70 mg/dl with or without symptoms) will receive prompt intervention. Treatment and Interventions: Blood Glucose <70 ml/dl and resident is conscious and able to take nutrition orally: Immediately give 15 grams of carbohydrates, staff to remain with resident at all times, repeat blood glucose and re-treat every 15 minutes until blood glucose is > 70mg/dl. If blood glucose <70 mg/dL and resident is unable or unwilling to consume nutrition orally: Immediately give ready to use glucagon. Staff to remain with resident at all times. In 15 minutes if the resident is not able or willing to consume nutrition within 15 minutes, give another dose of glucagon, and call for emergency help, i.e. 911.Facility Policy titled Change of Condition with last revision date of 2/2025 states in part but not limited to the following: The nurse will notify the resident's attending physician or physician extender when: there is a significant change in the resident's physical, mental, or psychosocial status; there is a need to alter the resident's treatment significantly; and it deems necessary or appropriate in the best interest of the resident. The nurse will record in the resident's medical record any changes in the resident's medical condition or status.The Immediate Jeopardy that began on 11/18/2025 was removed on 12/18/2025, when the facility took the following actions to remove the immediacy. On 12/18/2025, the survey team verified by observations, interviews, and record review, that the facility implemented the following to remove the immediacy.The facility abatement plan includes the following: TaskActionStatus (ongoing or completed with date of completion)Responsible PartyAction taken for affected resident.1) Juice was provided to the resident to improve the blood glucose level2) Glucagon was administered3) Blood glucose monitoring was performed4) NP was notified and resident transferred to ER via 9115) R1 no longer resides in thefacility.6) 1:1 education was provided to the day shift nurse and night shift supervisor who worked on 11/18/25 regarding hypoglycemia protocol, change of condition policy, following physician orders, and emergency response associated with severe hypoglycemia.7) The night shift nurse whoworked on 11/18 is no longer employed by the facility.11/18/25 12/15/2025 DONIdentification of other potentially affected residents and action1) Residents who require blood glucose monitoring can potentially be affected2) DON/designee conducted a whole-house audit of residents who require blood glucose monitoring to ensure blood glucose results are within the ordered parameters, and if physician / NP is notified if the results are outside the parameters. As a result of the audit conducted, no newfindings were identified.12/15/25DON/ADON TaskActionStatus (ongoing or completed with date of completion)Responsible Party 3) Residents who are at risk for hypoglycemia (residents with diagnosis of diabetes, receiving insulin) were reviewed to ensure the plan of care includes a physician order for parameters of blood glucose level to monitor signs and symptoms of hypoglycemia, administer interventions for treatment of hypoglycemia, and physiciannotification. Systemic measures to prevent recurrence1) Staff education was conducted by the DON, Regional Nurse Consultant and shift supervisor. Education included: Notification of a change in condition Medical emergency procedure associated with hypoglycemia Following the physician's orders Hypoglycemia Protocol All licensed nurses received education prior to working their next scheduled shift. Staff not on site for education were contacted by telephone and received verbal education. They will sign in-service education forms at the time of their next shift. This includes PRN staff.Understanding of the in-service content was evaluated at the time of in-service through questions and answers.12/15/2025Education was initiated on 12/15/2025 and completed on 12/15/2025DON/ Nurse Consultant/ Shift supervisor The facility does not use an agency for licensed staff.One staff member is out of the country and unable to receive education. This staff member will be educated at thetime of return to work. TaskActionStatus (ongoing or 145237 Page 3 of 4 145237 12/18/2025 Generations at Regency 6631 Milwaukee Avenue Niles, IL 60714

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few completed with date of completion)Responsible PartyPerformance effectiveness and monitoring (must include review by QA Committee) Director of Nursing or designee will audit resident records to ensure prompt notification to physician/ NP of an episode of hypoglycemia (change in condition) and following the physician's orders for notification of blood sugars outside of established parameters. Director of Nursing or designee will review the clinical record to monitor staff response to residents with signs and symptoms of hypoglycemia, monitor residents experiencing hypoglycemia, including severe hypoglycemia, administer interventions for treatment of hypoglycemia, and when emergency transport (911) and the medical provider are notified. Audits will be conducted 5 times a week for 2 weeks for all residents with blood glucose monitoring orders. Audits will be conducted weekly for 4 weeks for a sample of 10% of residents with blood glucosemonitoringAudits initiated 12/16/2025.DON/designee TaskActionStatus (ongoing or completed with date of completion)Responsible Party Results of the audits will be presented to the QAPI committee for recommendations of further auditing andactions as appropriate. Ad-Hoc or Full QA committee meetingRoot cause analysis is completed, and the action plan is discussed and approved by the Ad-Hoc committee.Medical Director: [NAME] Administrator: [NAME] DON: [NAME] ADON: [NAME] RNC: [NAME] 12/15/202512/18/2025Medical Director Administrator DONADON RNC 145237 Page 4 of 4