Health inspection·August 19, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide supervision to residents who obtained and consumed alcohol in the facility for 5 of 10 residents ( R1,R2,R3,R4 and R5) of the sample. This failure resulted in an unsafe environment for the residents in the facility.Findings include:5 Residents (R1,R2,R3,R4, and R5) were involved in consumption of alcohol on facility premises.R1 is a [AGE] year-old female, with diagnoses including Cerebral Palsy, Morbid Obesity, Anxiety Disorder, and Depression. R1 was first admitted to the facility on [DATE]. R1 has a BIMS (Brief Interview Of Mental Status) Score of 15/15, indicating intact cognition.R2 is a [AGE] year-old male, with diagnoses including heart disease with Heart Failure, Schizo-affective Disorder, and is an Identified offender. R2 was first admitted to the facility on [DATE]. R2 has a BIMS (Brief Interview Of Mental Status) score of 15/15.R3 is a [AGE] year-old male resident, with diagnoses including Hypertensive Heart Disease, and Peripheral Vascular Disease. R3 has a BIMS (Brief Interview of Mental Status) Score of 13/15.R4 is a [AGE] year-old female, with diagnoses including COPD (Chronic Obstructive Pulmonary Disease), Diabetes type 2, Hemiplegia and Hemiparesis following Cerebral Infarction, and Schizoaffective Disorder. R4 was first admitted to the facility on [DATE]. R4 has a BIMS (Brief Interview Of Mental Status) score of 15/15.R5 is a [AGE] year-old male with diagnoses including Hypertensive heart disease with heart failure, and COPD. R5 was first admitted to the facility on [DATE]. R5 has a BIMS (Brief Interview Of Mental Status) score of 15/15.On 8/19/25 at 9:50AM, V1 (Administrator) per phone, stated, On 7/30/25, (R1, R2, R3, R4, and R5) were found to be drinking alcohol on the 4th floor in the dining room. I don't know how they got the alcohol. All were put on a 30 day suspension from unsupervised community pass.On 8/14/25 at 11:42AM, V3 (Social Service stated, (R1) was caught drinking by a nurse that had approached her in the day room on 4th floor. There was a group of residents drinking at a table playing cards at around 7:30PM. The nurse reported incident to (R1s) doctor, and he ordered a urine test. I reviewed the camera and could see the group drinking alcohol from plastic drinking cups. The nurse also smelled liquor on the breath of (R1) and at the table of residents in the group. (R1, R2, R3, R4 and R5). As part of behavior agreement, (R1) was put on a 30 day restriction for unsupervised pass privileges. (R1) is receiving 1:1 psychosocial therapy. (R1) also participates in daily activities. I do not know where the group got the alcohol. None of the residents would provide any information. The other 4 residents were also put on a 30 day restriction. Today, (R1) wrote me a letter admitting to drinking alcohol that day. I have a copy in my files.On 8/14/25 at 1:33PM, V4 (Licensed Practical Nurse/ LPN ) stated, It was reported to me by a CNA (Certified Nursing Assistant), (V5), that (R1, R2, R3, R4, and R5) were seen in the dining room sitting at a table drinking alcohol. I tried to search belongings, but the residents wouldn't let me. I smelled alcohol at the table where the residents were sitting. I made them disperse. I contacted (R1's) physician and mother. The physician ordered a urine test to be done. That is all I can recall of the incident on (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: 145484 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 145484 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Chicago North 2451 West Touhy Avenue Chicago, IL 60645 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)