Health inspection·November 10, 2024

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow physician orders to administer antihypertensive and pain medications to a resident (R1) with diagnoses of hypertension, recent back surgery, and chronic back pain. Residents Affected - Few This applies to 1 of 4 residents (R1) reviewed for significant medications in the sample of 4. The findings include: The EMR (Electronic Medical Record) showed that R1, a [AGE] year-old with diagnoses that includes spondylosis with radiculopathy, lumbar region, encounter for orthopedic after care, hypertension, hyperlipidemia, GERD (gastro-esophageal regurgitation disease), hypothyroidism, anemia, protein calorie malnutrition, lactose intolerance, s/p (status post) L5/S1 (lumbar and sacral) laminectomy on October 8,2024, and chronic back pain. R1 was admitted to the facility on [DATE] at 1:36 P.M., and was discharged home against medical advice on October 11,2024. R1 left the facility at 9:45 A.M. The POS (Physician Order Sheet) for the month of October 2024 showed physician orders dated October 10,2024 for the following antihypertensive and pain medications that included but not limited to: -Gabapentin 100 mg. 1 capsule by mouth every evening for pain scheduled to be given 6:00 P.M. daily -Losartan Potassium -HCTZ (hydrochlorothiazide) 100-12.5 mg., 1 tablet a day for hypertension scheduled to be given 8:00 A.M. The pharmacy delivery manifesto showed that R1's medications were delivered to the facility on October 11,2024 at 3:42 A.M. The medications that were delivered included Losartan Potassium- HCTZ 100-12.5 mg. with total of 14 tablets; and Gabapentin 100 mg with total of 14 tablets. The nurses notes dated October 11,2024 at 7:58 A.M., which was documented by V7 (LPN/Licensed Practical Nurse) showed that R1 was upset and wanted her medications, before she eats breakfast, immediately. V7 noted then that R1's blood pressure was 184/95 at 8:08AM. V7 documented that V10 (physician) was notified and ordered to give R1 her morning medications and added a new medication and directed V7 to check the blood pressure again. V7's notes document that R1 called her son and he picked her up at 9:25AM and R1 left the facility. On November 8,2024 at 1:20 P.M., V7 stated that R1 was upset on October 11,2024 around 8:00 A.M. V7 said that R1 was asking for the blood pressure medications. V7 said that upon checking R1's vital signs, R1 blood pressure was high. V7 said the BP was 184/95. V7 said that R1's antihypertensive (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: 145458 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 145458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alta Rehab at Oak Brook 2013 Midwest Road Oak Brook, IL 60521 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)