Health inspection·July 12, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide residents with a clean, comfortable, home-like interior. This applies to 3 residents (R4, R7, R8) reviewed for sanitary and home-like environment. The findings include: 1. R4 is a [AGE] year-old male admitted on [DATE] with moderate cognitive impairment as per the Minimum Data Set (MDS) dated [DATE]. On 7/9/24 at 9:35 AM, R4 was in his second-floor room with a mild urine smell. R4 stated, They showered me this morning. There were dirty clothes on the floor and feces on the shower floor. The shower room was filthy and terrible. They clean my room, but not thoroughly. They never clean my room walls. 2. On 7/9/24 at 9:50 AM, the second-floor common shower room was observed with V4 (Licensed Practical Nurse/LPN) and was found with used gloves and dirty clothes inside the bathtub. V4 stated the dirty clothes and used gloves shouldn't be deposited in the bathtub. The facility presented the linen management policy revised on 5/18/24 documented: 6. Dirty linens are contained in a closed container or bag. 3. R7 is a [AGE] year-old female with severe cognitive impairment as per the MDS dated [DATE]. On 7/9/24 at 10:02 AM, R7 was observed on her bed with two soiled wound dressings left in her bed and a call light on the floor. The floor was also observed to have debris, including used alcohol wipes and their wrappers and a clean incontinence brief. One of R7's wheelchair wheels had run over the brief and rested on it. V5 (R7's Nurse/LPN) stated that the soaked wound dressing shouldn't be left on the bed. 4. On 7/9/24 at 10:30 AM, R8 was observed in his room with dirty linens on the floor. R8 stated, They might come and pick it up. After seeing the dirty clothes on the floor, V6 (staffing coordinator) stated that the dirty lines should be contained in a plastic bag. 5. On 7/9/24 at 10:40 AM, the writer observed the second-floor soiled utility with V12 (LPN) and found several dirty, used gloves scattered on the floor. On 7/10/24 at 2:20 PM, V2 (Director of Nursing/DON) stated the dirty linens shouldn't be left on the floor; they should be contained in a plastic bag, and staff should deposit used gloves in the trash bin instead of throwing them to the floor. (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: 145246 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 145246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Hinsdale, The 600 West Ogden Avenue Hinsdale, IL 60521 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)