Inspection·September 25, 2025

F 0571 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Limit the charges against residents' personal funds for items or services for which payment is made under Medicare or Medicaid. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to inform residents of their monthly personal funds amount and failed to distribute residents personal fund monies monthly. This failure affected three of three residents (R8, R9, R10) reviewed for personal funds. The findings include:On 9/22/2025 at 2:03 pm, R8 stated she (R8) is not aware why she was not receiving her monthly sixty dollars from the trust fund. R8 stated V8 her nephew is the power of attorney over her healthcare, and she did not authorize V8 to have power of attorney over her finances. R8 stated the facility never notified her (R8) that the facility was giving V8 her monthly trust fund money. R8's Minimum Data Set Section C dated 9/2/2025 documents, in part, a BIMS (Brief Interview Mental Status) Score of 8 which is indicative of a moderately impaired cognition. R8's Social Security statement dated 3/2024 documents; in part, [NAME] is R8's representative payee. R8's money order receipts dated 9/3/2025 documents a payment of one hundred five dollars and sixty-four cents to [NAME] from R8 the remitter.R8's money order receipts dated 8/3/2025 documents a payment of one hundred five dollars and sixty-four cents to [NAME] from R8.R8's bank statement dated 7/24/2025 to 8/20/2025 documents, in part, a withdrawal of eighty-eighty dollars and eighty-four cents from [NAME] Financial Group Life Insurance Company. R8's bank statement documents a deposit of one hundred sixty-five dollars and sixty-four cents from a pension company on 7/30/2025.On 9/23/2025 at 11:36 am, V8 (R8 Family Member/FM) stated he (R8FM) has had power of attorney for property since December 1, 2010. V8 stated R8 receives a Social Security Check, and the facility is the representative payee. V8 stated R8 also receives a small pension check in the amount of one hundred and sixty-five dollars and sixty-four cents. V8 stated he (V8) takes sixty dollars from pension funds to pay R8's life insurance policy in the amount of eighty-eight dollars and provides the remaining one hundred five dollars and sixty-four cents to the facility in a money order. V8 stated he (V8) pays the remaining twenty-eight dollars needed to pay R8's insurance premium. V8 states his (V8's) aunt will not remember the power attorney information because she has dementia. V8 stated he V8 buys R8's clothes, snacks, personal grooming supplies, and restaurant food upon her (R8's) request. V8 stated he will bring the Financials.On 9/24/2025 at 1:38 pm, V1 (Administrator) stated V11 (Business Office Manager) meets with the residents monthly and have the resident sign for their funds. V1 stated residents who receive Social Security Benefits are deposited in a trust fund account and each resident will receive thirty dollars or sixty dollars monthly. V1 stated he (V1) was made aware this week that V8 (R8's Family Member) was receiving R8's pension fund, deducting sixty dollars from the pension fund for R8's insurance policy, and providing the balance of the pension fund to the facility. V1 stated typically every resident should receive a check monthly check from Social Security and another check for thirty or sixty dollars is allocated to the residents monthly. V1 stated a resident has the right to know about their personal funds account and he is not sure why R8 does not receive personal funds monthly. On 9/24/2025 at 2:01 pm, V21 (Director (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: 145429 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 145429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wentworth Rehab & Hcc 201 West 69th Street Chicago, IL 60621 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)