Inspection·November 26, 2025

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide transportation services for a resident requiring an appointment with a medical specialist.This applies to 1 of 3 residents (R127) reviewed for social services in a sample of 35.The findings include:On 11/23/2025, R127's family member (R128) said he was concerned about R127's general medical decline related to her abdominal mass that was found in June 2025. R127's family member said she missed her ordered oncology consultation appointment in July because the facility did not make proper arrangements. R127's family member said the facility informed him that her appointment was missed due to her insurance coverage. He said he then accompanied R127 to her rescheduled appointment on 8/28/2025. R127's family member said V21 (Oncologist/Physician) inquired why she did not follow-up sooner, as originally ordered. R127's family member said she was then referred to another specialist (gynecologist-oncologist) and now requires a biopsy to determine her cancer treatment. On 11/24/2025 at 1:40 PM, R127 was sitting up in her wheelchair. R127 said she had returned from the hospital but was unable to provide information regarding her recent hospitalizations and recently diagnosed cancer.On 11/24/2025 at 12:40 PM, V4 (Nurse Practitioner/NP) said he assessed and reviewed R127's hospital documents when she was readmitted on [DATE]. V4 said R127's hospital CT (computer tomography) scan in June 2025 showed an accidental finding of an ovarian mass. V4 said he informed the facility of R127's required oncology consultation. V4 said R127 was finally seen by the oncology team on 8/28/2025, after she missed her original appointment on 7/03/2025. V4 said R127 was then referred to a gynecologist-oncologist specialist on 10/30/2025 and now required a biopsy. V4 said residents should follow up with a specialist as ordered to prevent delay in care management.V4's progress note dated 7/10/2025 said the facility staff was to coordinate R127's ordered consultation with V21 (Oncologist) for her 13 cm (centimeters) complex cystic solid mass found in her uterus.On 11/24/2025 at 1:45 PM, V20 (Licensed Practical Nurse/LPN) said she believed R127 missed her original oncology appointment because of her insurance. V20 said nurses completed a Resident Doctor's Appointment Transportation form when they received an order for medical appointments. V20 said the forms were then given to V18 (Transportation Scheduler) to ensure transportation arrangements were obtained.On 11/24/2025 at 1:25 PM, V18 (Transportation Scheduler) said R127's oncology appointment on 7/03/2025 was cancelled due to transportation. V18 said outside transportation services required four-day advance notifications and did not include weekends, and the facility also had their own bus transportation available for appointments if needed. V18 said she was not notified of R127's rescheduled appointment on 7/10/2025. V18 said she was notified of her rescheduled appointment on 8/28/2025, and transportation services were done with the facility's bus. On 11/24/2025 at 1:20 PM, V19 (Oncology Receptionist) said R127's appointment records showed her 7/03/2025 appointment was cancelled by the facility because V8 (Registered Nurse/RN) reported R127 was not feeling well. V19 said on 7/10/2025 for R127 was no show for her rescheduled appointment. V19 said they called the Residents Affected - Few (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: 145333 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 145333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West Suburban Nursing & Rehab Center 311 Edgewater Drive Bloomingdale, IL 60108 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)