Inspection·March 15, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 ensure comfortable temperatures for 3 of 8 residents (R1, R2, and R3), a comfortable bed mattress for 1 of 8 residents (R1), and odorless air for all 93 residents third-floor residents. Findings include: On 03/14/2024, during the investigation, the writer entered the third floor via elevator five different times from 11:00 AM to 3:00 PM. The third-floor entrance from the elevator, dining room, and 300 wing had a strong urine odor. Though the facility's third-floor flooring, residents' rooms, and bathrooms were clean, the mentioned areas had a strong odor of urine. 1. R1's face sheet showed R1 was admitted to the facility on [DATE] with diagnoses including catatonic disorder, schizophrenia, depression, encephalopathy, and urinary retention with acute kidney failure. At 11:28 PM, R1 was in bed, withdrawn, staring at the writer, and did not respond to the writer's interview. R1's bed was sagging in the center, urine odor was present by his door entry, and the room temperature was 85 degrees Fahrenheit. R1 got up and left the room. On 03/14/2024, around 2:00 PM, V14 (R1's volunteer and vice President of United Cerebral Policy (USP) said they provided support to R1 at home, and since 03/10/2024, staff has been volunteering to visit R1 at the facility. V14 said R1's room had a urine odor, and her staff also told her about R1's room and floor's urine odor. V14 said V12 (R1's family member) reported to V5 (Registered Nurse) on 03/10/2024 about his bed since R1 reported to V12 that he had neck pain due to the uncomfortable bed. On 03/14/2024 at 1:45 PM, V6 (Registered Nurse) said she saw in the nursing report that V12 (R1's family member) reported on 03/10/2024 to V5 (Registered Nurse) that R1's bed mattress had issues. V6 said the maintenance staff changed the bed mattress. At 2:42 PM, V5 said V12 (R1's family member) told her the head end of the bed was not rising and was uncomfortable. She endorsed it in the nursing report and was unaware of what happened afterward. On 03/14/2024 at 1:18 PM, V3 (Director of Maintenance) said no one placed the work order for R1's bed concerns and no one reported to him about R1's room's high temperature. V3 said the facility's temperature was checked daily. V3 said the facility runs on a water system, and even shutting off the water system takes a while to cool down the temperature as water pipes remain hot for a while. On 03/14/2024, around 1:30 PM, the writer toured the facility with V3 (Director of Maintenance), (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: 145329 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 145329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norridge Gardens 7001 West Cullom Norridge, IL 60634 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)