Inspection·July 9, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to thoroughly investigate an injury of unknown origin to 1 of 3 residents reviewed for unknown origin in the sample of 4. Residents Affected - Few The findings include: R1's electronic face sheet accessed last 7/9/25 documents, R1 96 y/o readmitted to the facility last 4/2/25 with diagnoses that include acute respiratory failure, kidney failure hypertension and diabetes. R1's progress notes dated 4/6/25 by V3 (RN) show [R1] refused to eat and drink, no urine output, family requested to send resident to the hospital. R1 was sent out to the ER. R1's Hospital Records dated 4/6/25 documents, 96 y/o presenting with decreased output, ordered hip X-ray. R1's radiology report dated 4/7/25 with final result -left femoral neck fracture. R1's hospital records dated 4/8/25, R1 underwent surgery -left hip hemiarthroplasty (left hip replacement) On 7/9/25 at 11:30 AM, V7 (R1's daughter) said she was told in the hospital that R1 had a new hip fracture to her left hip. V7 said that was the reason why R1 needed surgical repair because of this new left hip fracture. V7 said she called the Nursing Home and asked them to investigate how R1's left fracture came about. V7 said from 4/2/25 when she came back to the Nursing Home, until 4/6/25 when R1 was sent back to the ER, no one told her that R1 had a fall at the facility, but even if R1 did not fall, did it happen during care? or when she was being turned?, I do not know, I just need them to tell me what they've found in their investigation. On 7/9/25 at 1:47 PM, V2 (Director of Nursing-DON) said when R1 was found to have a left hip fracture but had no falls at the facility, it was assumed that it was the same hip fracture that R1 sustained in the past. V2 (DON) then showed this surveyor a document dated 5/5/21 (approximately 4 years ago) that show closed fracture of left pubis. When asked if V2 spoke to any hospital staff to ask more information about R1's hip fracture, V2 said she did not call the hospital to clarify if the fracture was old or new, since it was the same side as the old one. V2 also said she spoke to some staff but not all staff that took care of R1, since we thought it was the same fracture R1 sustained way back in 2021. V2 said R1 was also on therapy but she did not interview any of the therapists that took care of R1. V2 said she did not know R1 had hip surgery last 4/8/25 until she started reading R1's hospital records. (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 07/09/2025 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)