F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on interview and record review the facility failed to treat a resident with dignity and respect for1 of 4
residents (R1) reviewed for dignity in the sample of 4. The findings include:On 1/14/26 at 10 AM, R1 was in
her room alert and pleasant. R1 said she gets scared, and it causes her anxiety when someone yells and
screams at her. My husband was abusive, yelling and screaming triggers me to be anxious. R1 said when
V5 (Registered Nurse) talks to her, V5 sounded like V5 (RN) was screaming and yelling. Also, R1 found out
that her physician was at the nursing home. V5 (RN) said because of your mammogram appointment, you
missed your visit from your doctor. R1 said V5's statement did not sit well with her-, I am a cancer survivor, I
had to go to my mammogram appointments. R1 said she complained to V5 about her feet hurting due to
bone spurs, V5 responded there's always something wrong with you. R1 said V5 make her feel like she did
not matter.On 1/14/26 at 11 AM, V5 stated to this surveyor, Even if you don't tell me the name, this is (R1),
she had said to me before you scream and yell at me but this was my normal voice, what can I do? I have
told R1, if she had an issue with me to tell the DON. (V2) V5 also confirmed that she told R1, she did not
see her doctor because she was out for her mammogram appointment. V5 said she was aware R1 was a
cancer survivor but did not know that R1 was offended by his comment. V5 said R1 has a lot of complaints
about the staff. I told R1, you are alert, you can tell your complaints to the DON yourself. V5 said R1 was
alert and can speak for herself. On 1/14/26 at 12 PM, V3 (Assistant Director of Nursing) said V5 had a
high-pitched voice, V5 might not realize how his voice was coming across to R1. V3 also said V5 has a
bubbly personality not sure if R1 was ok with that. V3 said all residents should be treated with respect.The
facility policy on Dignity (undated) documents, this facility will promote care for residents in a manner and in
environment that maintain or enhances each resident's self-esteem and self-worth.
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:
145434
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
145434
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/14/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Claridge Healthcare Center
700 Jenkisson
Lake Bluff, IL 60044
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview and record review the facility failed to ensure a resident went to her outpatient medical
appointment for 1 of 3 residents (R1) reviewed for medical appointments in the sample of 4.The findings
include:A Hospital document entitled After Visit Summary dated 11/13/25 show R1 had surgical pathology
of esophagogastroduodenoscopy (EGD). The results show, - Cratered ulcer in the middle third of the
esophagus. Due to severe ulceration and peeling appearance of the ulceration, scope and dilatation was
deferred. The document continues, Repeat EGD with interventional Gastroenterologist (G1) in 4 weeks.A
progress notes dated 11/26/25 documents, R1's EGD return appointment was scheduled for 12/10/25 at
9:45 AM.On 1/14/26 at 10:15 AM, R1 stated she had been having issues with swallowing, I feel there's
something here (pointing to her neck.) R1 said her G1 doctor has been trying to figure things out. R1 said
she had gone through testing and was supposed to have a return appointment last 12/10/25 for repeat
EGD. The appointment was cancelled by this Nursing Home due to no escort meaning no staff available to
go with her. R1 said she was upset about it; it delayed her treatment. R1 said while she was having issues
with swallowing, she had to wait more than a month for her repeat EGD due to no staff available to go with
her. The appointment was moved tomorrow (1/15/26.)On 1/14/26 at 11: 15 AM, V7 (Registered Nurse) said
due to no available escort, R1's appointment had to be cancelled. V5 said she called the Gastroenterology
office, explained the situation. R1's appointment was moved to 1/15/26 (tomorrow) more than a month from
the original appointment of 12/10/25. V5 said We can only do 1 medical appointment per day with escort
here at this facility due to no staff available to escort. On 1/14/26 at 11:52 AM, V6 (Receptionist) said due to
no staff available we can only do 1 medical appointment daily, that was an instruction from the DON.
(V2)On 1/14/26 at 1:30 PM, V2 said she will work with staff to see who were willing to go with residents to
escort when necessary medical appointments come up like R1's EGD.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145434
If continuation sheet
Page 2 of 2