Health inspection·October 24, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the observations, interviews, and record reviews, the facility failed to return the heart monitor devices to the cardiology monitoring departments per physician orders and label instructions. Residents Affected - Few This applies to 2 of 3 (R2 and R3) residents reviewed for heart monitoring devices in a sample of 7. Findings include: 1. The EMR (Electronic Medical Record) showed R3 was a [AGE] year-old female with diagnoses including congestive heart failure, chronic pulmonary edema, pleural effusion, coronary artery diseases, atrial fibrillation, presence of coronary angioplasty implants and grafts, end-stage renal disease with dependent on dialysis. R3's Minimum Data Set, dated [DATE] showed R3 cognitively intact. On 10/22/2024 at 12:30 PM, R3 was in bed and said a cardiac monitor patch was applied to her because she was feeling dizzy and has a history of atrial fibrillation. R3 said her heart monitor was removed a few weeks ago, and V9 (Nurse Practitioner Cardiology) could not find the result. R3's Physician order dated 09/13/2024 showed R3 to have a 14-day (Heart monitor patch), return on 09/25/2024, place all equipment in a self-addressed pre-paid box, mail it back, and check with V9 (Nurse Practitioner Cardiology) for any questions. On 10/23/2044 at 11:46 AM, V9 (Nurse Practitioner Cardiology) said R3 was ordered a (heart monitor patch) for syncope episodes during therapy, and R3 has a history of atrial fibrillation. V9 said the (heart monitor patch) detects irregular heartbeats in the Electrocardiogram (ECG) data and helps to have a plan of care. V9 said the heart monitor was supposed to be sent on 09/25/2024 to the heart monitor company, and V11 (Facility Nurse Practitioner) removed and packed it on the same day. V9 said she kept looking for the results and followed up with the cardiac department and came to know that they never received the heart monitor. V9 said she escalated to V2 (Assistant Director of Nursing) and V1 (Administrator) and was upset about the situation. V9 further said R3 has very complicated cardiac conditions with multiple medications, and unnecessarily, R3's plan of care was delayed. On 10/23/2024 at 12:10 PM, V11 (Facility Nurse Practitioner) said on 09/25/2024, she removed the (heart monitor patch) from R3, put it in the box, per return label instructions, sealed it, and handed it over to V12 (Receptionist) around 11:00 AM - 11:30 AM, and she came to know that the device is pending return from the facility. V11 said R3 has very fluctuating blood pressure and heart rate with a history of A-fibrillation, and it takes two weeks for the result, and the result is very important for the plan of care. (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 10/24/2024 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)