Health inspection·April 30, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident was provided incontinence care in a safe manner for 1 of 3 residents (R1) reviewed for safety in the sample of 3. This failure resulted in R1 falling from the bed during care and sustaining bilateral toe fractures. The findings include: R1's Face Sheet shows that he admitted to the facility on [DATE] and has diagnoses of: morbid obesity, rheumatoid arthritis and history of falling. R1's Nursing Notes dated 4/21/25 at 2:20 PM shows that R1 is alert and oriented x 4, 2 assist with sit to stand and would be coming to facility after 2 PM. R1's Nursing Note dated 4/21/25 at 8:48 PM shows, Around 4:00 PM CNA (Certified Nursing Assistant) called this nurse and stated that the resident is on the floor .observed resident on the floor, laying a supine position, next to bed . On 4/30/25 at 9:22 AM, R1 was laying in bed. R1 had a bariatric bed. R1 had a splint to his right great toe. R1 had joint deformities to the fingers on his left hand. On 4/30/25 at 9:22 AM, R1 said that he had a fall out of bed and fractures his toes on both of his feet. R1 said that the aide came in to get him cleaned up and turned him to his right side. R1 said that once he turned, he was really close to the edge of the bed. R1 said that he was holding onto the side rail with his left hand. R1 said that due to his rheumatoid arthritis, he could no longer hold onto the railing so he let go and fell out of the bed. R1 said that he told the aide I am not going to be able to hang on much longer. R1 said that his top half fell off the bed first and he hit his head on the night stand and then his lower half fell and he hit his feet hard on the floor. R1 said that he was sent to the hospital and they told him that he had a fracture of his big toe on the right foot and two fractures on his left foot. R1 said that he returned to the facility and was unable to get out of bed until his orthopedic appointment that was 4/29/25. On 4/30/25 at 10:56 AM, V3, Certified Nursing Assistant (CNA) said that R1 had just admitted to the facility and the nurse practitioner told her that he needed to be changed so she went in to change him. V3 said that the nurse told her that he was a one assist so she was the only person in the room to provide the care. V3 said that R1 was in the center of the bed at the start of the care. R1 was turned to his right side by instructing him to grab the side rail with his left hand and she helped him turn his body to the side. V3 said that she was positioned on his left side of his bed. V3 said (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: 145304 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 145304 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Riverwoods 3705 Deerfield Road Riverwoods, IL 60015 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)