Health inspection·January 28, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** . Residents Affected - Few Based on observation, interview, and record review the facility failed to provide the necessary services to maintain good personal hygiene for 1 of 3 residents (R9) reviewed for activities of daily living in a sample of 3. Findings include: On 1/21/25 at 11:10 AM, observed R9 lying in a bariatric bed. R9 was alert, oriented x 3. R9 had disheveled hair, nails were overgrown in both hands and both feet and the nails had brownish debris underneath them. R9 stated, one day last week, no one provided her perineal care and she was left wet the whole shift. R9 could not remember the date. R9 stated, at the moment, her brief, bedsheet and her blanket were wet. R9 lifted her gown. Observed that R9 had a wet disposable brief. R9 stated, she had been wet for almost an hour. R9 stated, either she had to wait until someone comes in to check on her or she has to holler because her call light was not working. R9 stated, probably the CNAs (Certified Nursing Assistants) were on lunch break. R9's face-sheet showed she was admitted on [DATE] with diagnoses to include congestive heart failure, Parkinson's disease, bipolar disorder and anxiety. MDS (Minimum Data Set) dated 11/26/24 showed she was cognitively intact. R9 required moderate assistance with upper body functions and was totally dependent for lower body functions. Care-plan dated 11/26/24 addressed resident needs appropriately. On 1/21/25 at 10:00 AM, V11 (CNA) stated, she checks on her incontinent residents every 1-1.5 hours. On 1/21/25 at 11:35 AM, observed three CNAs (V10, V11 and V12) were sitting in the unit Dining Hall, chit-chatting. They stated, they were waiting for resident's lunch to arrive. On 1/21/25 at 12:15 PM, V12 (CNA) stated, she checks on her residents and changes them every couple hours. On 1/21/25 at 1:00 PM, observed that R9 still had a wet disposable brief. R9 stated, no-one had come to change her yet. On 1/21/25 at 2:15 PM, V10 (CNA) stated, she checks on her assigned residents every 1-2 hours and provides perineal care. (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 3 Event ID: 145420 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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)