Inspection·March 28, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure that a dependent resident's call device was answered promptly for 1 of 9 residents (R3) reviewed for care. Residents Affected - Few Findings include: R3 is [AGE] year old with diagnosis including but not limited to: Secondary malignant neoplasm of brain, abnormalities of gait and mobility, unspecified lack of coordination, unsteadiness on feet, and other specified soft tissue disorders. R3 has a BIMS (Brief Interview of Mental Status) score of 14, which indicates cognitively intact. On 03/26/2024 during investigation, R3 was observed lying in bed in her room. On 03/26/2024 at 2:21 PM, R3 activated her call device by pressing the button on her device to call for help from her nurse assistant or nurse. The light outside of R3's bedroom was illuminated to indicate that R3's call device was activated. On 3/26/2024 at 2:48 PM, as R3 waited patiently for her someone to come to her room to assist her, R3 said, This happens frequently. There has been times that I have fallen asleep waiting for someone to answer my call light. When I need help being cleaned or transferring back to my bed, I have to wait hours for help. On 3/26/2024 at 2:51 PM, V8 (CNA/ Certified Nurse Assistant) entered R3's room to assist R3. At that time, V8 (CNA) said, I think that R3's nurse is on lunch break and I was receiving report on my patients because I just started at 2:00 PM. I am not sure where the other floor nurse is. Surveyor asked how soon the call lights were usually answered. V8 said, Usually, we try to answer call lights within a 5 minute period because you just never know. The patient can be trying to get out of bed to get to the toilet or something and hurt themselves. On 3/26/2024 at 2:58 PM, V20 (Licensed Practical Nurse/ LPN) said, R3's nurse is on break. I'm not sure how long R3's call light has been on. Typically the call lights are answered within 15-20 minutes. (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: 145336 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 145336 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Warren Barr Gold Coast 66 West Oak Street Chicago, IL 60610 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)