Health inspection·August 30, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews the facility failed to make reasonable accommodations toward assisting one resident, R1 of three R5, R6 residents to maintain independent functioning and well being with R1's own needs and preferences. Residents Affected - Few Findings inlude, R1's clinical record indicates in part, R1 is an eighty-five-year-old admitted with medical diagnosis of transient cerebral ischemic attack, vitamin D deficiency, atherosclerotic heart disease of native coronary artery, chronic obstructive pulmonary disease, weakness and retention of urine. R1's minimum data set indicates R1 is cognitively intact. On 8/27/24 at 1:45 PM, R1 stated I have back pain and need to use my cane for short distance. I use my walker for long distances. I have not hit anyone with my cane. I have not fallen since I been here in the facility. One day the social worker lady took my cane and did not tell me why. Therapy told me I could use my cane for short distance and use the wheelchair for long distance. I do not know why the social worker took my cane; she did not tell me the reason. I came here with my own cane that I paid for, she had no right taking my cane. I been crying over my cane; they gave me a walker that I do not use it makes my shoulder hurt and makes me stiff. I almost fell a few times because I did not have my cane to go to the bathroom. The social worker took my cane, for no reason. I have never used my cane as a weapon, nor have I ever hit anyone with my cane. I have used my cane for years to help me get around independently and safely. I have been asking V1 (Administrator) for my cane back, but he has nothing to say, nor has he gave it back to me. On 8/28/24 at 10:00 AM, V20 (Director of Therapy) stated, When R1 was admitted she came to the facility with her own cane. R1 started physical therapy on 3/29/24 thru 6/24/24. With the use of her walker at the beginning of therapy, she could walk with her cane, for 25 feet, but needed staff minimal assistance. For longer distance, R1 needed to use her wheelchair. R1 was also given a front wheel walker to use at her convivence for short distance but did not need any staff assistance. R1 has three assistive devices she can use. Its all what R1 prefers. R1 has not had any falls or hit anyone with the cane to my understanding. I was told that her cane was taken away, because R1 was walking with the cane up in the air and not on the ground. Upon R1 completing physical therapy she was much stronger than she was at the start of therapy, R1's mobility had improved. R1 was safe to use her cane. The goal for all residents is to keep them at their highest level of mobility. If a resident is able to walk with a cane, they should use their cane to keep their strength and mobility functioning properly. If resident mobility assistive devices are not being used it could decrease their mobility and make the resident potentially weaker. On 8/29/24 at 11:33 AM, V21 (Restorative Nurse) stated, R1 is alert and oriented x3. R1 used her (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: 145343 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 145343 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ambassador Nursing & Rehab Center 4900 North Bernard Chicago, IL 60625 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)