Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0679
Provide activities to meet all resident's needs.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to ensure residents were notified, invited, and
engaged to attend meaningful activities that incorporate residents' interests for 2 (R1, R4) out of 3 residents
reviewed for residents' rights.
Residents Affected - Few
Findings Include:
On 2/23/25 at 8:55 AM, R1 was observed lying in bed alert and able to verbalize needs. R1 is blind and
can't read. R1 can only see contrast and forms. R1 stated R1 would like to go to activities like bingo but
staff does not tell R1 of what activities are going on in the facility each day. R1 stated that R1 also likes to
go to church and listens to gospels. R1 stated staff used to hand out a sheet about activities, but it's been a
while since R1 gotten one. R1 stated R1 does not know what other things are going on in the facility for
today.
On 2/23/25 at 10:30 AM, R4's up in bed alert and able to verbalize needs. R4 was interviewed about
activities in the facility. R4 stated, Since I've been here nobody tells me what activities are going on in the
facility. I've been here for 3 months. I would like to do some activities if something interests me.
On 2/23/25 at 11:01 AM, Surveyor observed V11 (Activity Aide) conducting yoga/meditation session on the
third floor for activities. R1 and R4 were not in attendance.
On 2/23/25 at 11:06 AM, interviewed V11 and stated that there are activities in the facility every day held on
third floor or fourth floor. The calendars are posted on the board. V11 stated, We go around to all residents
and invite residents of what activities I'm doing. We let them know every morning. V11 stated V11 did not
stop by this morning to notify and invite R1 about today's activities. V11 stated V11 did not stop by this
morning to invite R4 to activities either.
On 2/23/25 at 11:46 AM, interviewed V2 (Activity Director) and stated that R1 refuses to go to activities. V2
stated activity calendars are posted on every floor. V2 stated V2's staff and [V2] invite the residents to
activities and encourage them to attend every day. V2 stated V2 did not invite R1 to go to activities this
morning. V2 stated there's one activity staff [V11] in the facility today and not sure if V11 invited R1 to
activities. V2 stated, That is the goal is to invite each resident to attend activities every day. We visit [R1] we
encourage [R1] to attend activities. [R1] said [R1] likes bingo. We explain to [R1] that we have bingo some
days. Normally [R1] just refuses to go to activities. We don't have other things for [R1] to do besides the one
on the calendar. V2 stated that R4 does not attend activities either. V2 stated, I can't remember if I invited
[R4] for activities this morning.
(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 4
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
02/24/2025
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)
F 0679
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 2/23/25 at 2:07 PM, Surveyor observed V11 (Activity Aide) conducting activities of gospel hour and
puzzles on the third floor. R1 and R4 were not in attendance. V11 stated V11's the only activity aide in the
building doing activities.
On 2/23/25 at 2:22 PM, R1's still in bed alert and awake. R1 stated V2 (Activity Director) just left and just
gave R1 a sheet of the week about activities. R1 stated, [V2] told me that there are activities from 10:30 AM
to 3:00 PM. Surveyor asked R1 if R1 is aware of the activity gospel hour that started at 2:00 PM listed on
the activity calendar for today. R1 stated, I would like to do gospel hour. I didn't know about that. Nobody
invited me to that. I would have had them get me dressed and attend to that one. R1 stated that R1 would
also have attended Zumba and daily chronicles this morning if staff had invited R1 to attend.
R1's Minimum Data Set (MDS) dated [DATE] shows R1 is cognitively intact with BIMS (Brief Interview for
Mental Status) of 15 and is total dependent on staff assistance for transferring from bed to chair. R1's
progress notes dated 2/3/25 at 12:55 PM documented by V13 (Licensed Clinical Social Worker) reads in
part: R1 has diagnosis of adjustment disorder with mixed anxiety and depressed mood. R1 continues to
have depression and anxiety due to being in the facility and loss of independence and home. R1 has
significant mobility decline. Specific goal for R1 is to engage in at least one facility activity one time per
week to reduce isolation and depression.
R4's MDS dated [DATE] shows R4 is cognitively intact with BIMS of 15 and can walk with supervision. R4's
activity care plan initiated 2/23/25 shows R4 engages in leisure/recreation pursuits: Music, Social
interaction, Television, Movies with one intervention documents in part: Encourage R4 to pursue formal and
informal leisure interest opportunities.
The facility's February Activities calendar shows on the 23rd activities include Zumba mix at 10:30 AM,
daily chronicles at 11:00 AM, gospel hour at 2:00 PM, puzzle mania at 3:00 PM, and pop in visits at 4:00
PM.
The facility's Activity Policy dated 7/12/24 documents in part: It is the facility's policy to provide meaningful
activity to residents. Provide group activities to residents that appeal to their interest on a daily basis.
Activities may be based on specific needs, or interests, or culture, or background, etc. Program of Activities
includes a combination of large and small group, one-to-one, and self-directed activities.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145336
If continuation sheet
Page 2 of 4
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
02/24/2025
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)
F 0803
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be
updated, be reviewed by dietician, and meet the needs of the resident.
Based on observation, interview, and record review the facility failed to serve adequate food portions as
documented on the menu and meal tickets. This failure has the potential to affect all 213 residents receiving
food prepared in the facility's kitchen.
Findings Include:
On 02/23/25 at 8:45 AM, surveyor entered kitchen and observed the breakfast tray line still in progress.
Observed a 4-ounce ladle being used to portion out the grits and oatmeal for all of the diet (regular, ground
and pureed) and a number 12-scoop used to portion out pureed toast.
On 02/23/25 at 8:50 AM, V14 (Cook) stated she is the one who sets up the tray line with the serving
utensils which should be used to portion out the resident's food. V14 stated she looks at the meal tickets to
determine the correct portion sizes to be served. V14 stated the meal tickets do not say which serving
utensil should be used, it only gives portion measurements. V14 stated for example, the meal ticket will
read ¾ cup portion for grits/oatmeal, it does not say to use a 6-ounce ladle which is what we use to
serve the hot cereal. V14 stated because she has been working in the kitchen for a long time, she knows
which serving utensil gives what portion. V14 stated there used to be a diagram/poster guide which listed
the different scoop numbers and the servings they each yielded but that is not up anymore. V14 stated, it
must have fallen off the wall.
On 02/23/25 at 8:57 AM, reviewed with V14 the serving utensils being used on the tray line. V14 observed
the 4-ounce ladle being used to portion out the grits and oatmeal. V14 stated that is a 4-ounce ladle and it
should be a 6-ounce ladle. V14 observed all of the pureed food items being portioned out with a number
12-scoop. V14 stated those are not the correct serving utensils and they are a mistake. V14 stated the
kitchen should be using the correct serving utensils so the residents can get the full portion of food they are
supposed to base on the menu created for them.
On 02/23/25 at 9:00 AM, observed large container of different serving utensils including number ten scoops
and six-ounce ladles.
On 02/23/25 at 1:22 PM, V23 (Dietary Director) stated it is the cook's responsibility to set up the tray line
with the correct serving utensils to be used to portion out the food. V23 stated they should be looking at the
Diet Manual Spreadsheet to check which serving utensils are needed and that these are kept in a binder in
the kitchen for their reference. V23 stated the Diet Manual Spreadsheets are based on menus which are
created by and approved by a corporate Registered Dietitian. V23 stated it is important for the kitchen to
follow the Diet Manual Spreadsheets to determine which serving utensil should be used to make sure the
resident's nutritional needs are being met. V23 stated if the kitchen staff is using the wrong serving utensil
when portioning out the resident's food then the residents may not be receiving enough food which as the
potential to lead to malnutrition and weight loss.
Facility provided list of resident's diet orders based on census on 02/23/25. There are six residents who
receive nothing by mouth (NPO).
Facility provide policy titled, Menus dated October 2019 which documents in part,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145336
If continuation sheet
Page 3 of 4
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
02/24/2025
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)
F 0803
1.)
Level of Harm - Minimal harm
or potential for actual harm
it is the center policy that menus are planned in advance, and to meet the nutritional needs of the
residents/patients, will be developed utilizing an established national guideline.
Residents Affected - Many
2.)
The Registered Dietitian/Nutritionist (RDN) or other clinically qualified nutrition professional reviews and
approves the menus.
3.)
Menus are served as written.
Facility document titled in part, Illinois Diet Guide Sheet Sunday (Day 15) Breakfast documents in part for
¾ cup grits to be served to regular, chopped, and ground consistencies and for pureed diet
consistencies to receive number 6-scoop of grits and number 10-scoop of pureed toast.
Facility provided document titled, Portion Control Chart dated 12/29/2021 which documents in part, number
6-scoop to provide 5.33
ounces, number 10-scoop to provide 3.2 ounces and number 12-scoop to provide 2.58 ounces.
Facility provided recipe titled, Great Grits which documents portion size as ¾ cup.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145336
If continuation sheet
Page 4 of 4
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F679 - Activities
Provide activities to meet all resident's needs.
F803 - Menus and nutritional adequacy
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
FAQ · About this visit
Common questions about this visit
What happened during the February 24, 2025 survey of WARREN BARR GOLD COAST?
This was a inspection survey of WARREN BARR GOLD COAST on February 24, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at WARREN BARR GOLD COAST on February 24, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide activities to meet all resident's needs."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.