Health inspection·April 30, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure a residents-controlled medication was misappropriated. This applies to 1 of 10 residents (R1) reviewed for controlled medications in the sample of 10. Residents Affected - Few The findings include: The Facility Reported Incident dated 4/28/25 states, Nurse (V4- Licensed Practical Nurse- LPN) wrote a statement stating she believed she threw the meds in the garbage. Writer looked through several garbage bags and was unable to locate the missing medication. Writer noted per narcotic sign out sheet that med was last administered 4/25/25 at 9:00 AM. Writer asked nurse if med was administered throughout her shift, and she stated yes. Writer asked why med was not signed out on MAR (Medication Administration Record) or paper record. Nurse stated she forgot and at this time she recorded administration. Nurse left the building at this time. This same document states, Cameras reviewed showing nurse in 200 preparing medications. Per video footage, nurse appears to empty bottle of tablets and toss the bottle in the garbage. On 4/30/25 at 10:00 AM V3 (Assistant Director of Nursing) stated, The resident's Ativan (Lorazepam) tablets are in a bottle- that is how hospice sends them to us. The resident is not able to say if she got an Ativan or not. (V4) was working a double shift and she said she gave the Ativan at 6:35 PM. We watched the cameras and saw her preparing the medication but never saw her administer the medication. They were doing the narcotic count from nights to days and (V5- LPN) noticed that the count was off and (V4) called me. There were 11 tabs in the bottle. I told (V4) to wait for me I would be there in 15 minutes but when I got here, she was gone. I called her and she returned in about 20 minutes. (V6- LPN) had gotten report from (V4) and said she had some paranoid behaviors. (V4) had access to the 200 and the 400 cart. At this point she is suspended and when the investigation is complete, she will probably be terminated. We are just trying to go through all the steps of the investigation. On 4/30/25 at 10:30 AM V6 (Wound Care- LPN) stated, I don't usually work the floor- I am the wound nurse. But that day they needed a nurse on the floor, and I came in early to help out until they could find someone. I got report from (V4) for the 400 hall. I asked her a question and she jumped back and said something like she didn't want anyone around her. She was acting very paranoid. I have not really worked with her, but the other nurses say that she raises her voice to them a lot and she is loud. On 4/30/25 at 11:00 AM V5 stated, We were doing the count and there was no bottle for the one paper. The resident (R1) had 2 bottles, and the one said 29 and it was correct. The other one said 11 and there was no bottle. The other nurse started looking for it and said she might have thrown it away. (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: 145443 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 145443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Zion 3615 16th Street Zion, IL 60099 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)