Health inspection·March 25, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on interview and record review, the facility failed to ensure a resident was supervised for 1 of 4 residents (R1) reviewed for safety and supervision in the sample of 4. This failure resulted in R1 falling and sustaining fractures to her pelvis. The findings include: On 3/25/25 at 12:01 PM, V3, Licensed Practical Nurse (LPN), said she was R1's nurse on 3/6/25. V3 said V3 said R1 kept trying to get up out of her wheelchair and she kept reminding R1 to sit back down. V3 said she stepped away from the dining room where R1 was sitting with other residents and the next thing she knew; a hospice nurse was telling her that R1 had fallen. V3 said R1 needed one on one monitoring; you cannot really take [your] eyes off her. V3 said the Certified Nursing Assistants (CNAs) were monitoring the dining room, but they were busy, and they were not present at the time. On 3/25/25 at 1:35 PM, V4, CNA, said she was assigned to care for R1 when R1 fell on 3/6/25. V4 said she was passing meal trays in the dining room with V3 and V7, CNA, where R1 was eating. V4 said she told V3 she was going to leave the dining room to feed residents in their rooms. V4 said she returned to the dining room after feeding a resident in their room and R1 was on the floor. V4 said she did not see R1 fall. V4 said she heard V3 say she was just there (in the dining room) five minutes ago. V4 said she had been told to monitor R1 more closely in report. V4 said R1 would try to get up out of her wheelchair and they would have to remind her to sit back in the chair. On 3/25/25 at 3:00 PM, V7, CNA, said she was assigned to R1's unit when R1 fell in the dining room (on 3/6/25). V7 said V4 was R1's CNA. V7 said she was with some residents; she heard commotion and then saw everyone going toward R1. V7 said she did not see R1 fall. V7 said staff should always monitor residents when they are in the dining room. V7 then said she does not remember what happened, she cannot recall everything since it's been such a long time. V7 said if she gave a statement at the time, it must be correct. On 3/25/25 at 2:26 PM, V2, Director of Nursing (DON), said R1 was a frequent faller. V2 said she investigated the fall. R1 was found on the floor in the dining room on 3/6/25 around 1:20 PM. V2 said V3 said she was passing medications and did not see anything. V2 said it was an unwitnessed fall and R1 was not able to describe what happened. V2 said residents are supposed to be monitored by staff when they are in the dining room. V3 documented the following excerpt in R1's Progress Notes on 3/6/25 at 3:07 PM, This resident since the beginning of the shift has been trying to get up from her wheelchair and every attempt to (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: 145460 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 145460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Thrive of Lake County 850 E US Highway 45 Mundelein, IL 60060 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)