Health inspection·December 28, 2023

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to follow the resident's care plan to provide the assistance of 2 staff during resident transfer. This failure resulted in a resident experiencing a fracture of the left lower leg (oblique fracture of proximal tibia and fibula of the left leg). This applies to 1 of 3 residents (R1) reviewed for transfers requiring assistance of 2 staff in the sample of 3. The findings include: R1's EMR (Electronic Medical Record) showed R1 was admitted to the facility on [DATE], and discharged on December 16, 2023. R1 had multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, dysphagia following cerebral infarction, unspecified fracture of the upper end of the left tibia, upper and lower end fracture of the left fibula, weakness, and Parkinson's disease. R1's MDS (Minimum Data Set) dated November 23, 2023, showed R1 had severe cognitive impairment and required assistance with ADLs (Activities of Daily Living) including needed substantial assistance with eating, bed mobility, personal hygiene, and transfer and dependent on staff for dressing, bathing, and toileting. R1's care plan dated November 21, 2023, showed R1 needed 2 staff assistance to transfer between surfaces. R1's EMR showed on November 22, 2023, at approximately 07:45 AM, V6 (CNA) went to R1's room to provide care. V6 attempted to transfer R1 from bed to wheelchair when R1 was unable to stand and was lowered to the floor. The EMR showed R1 was sitting on the floor next to his bed when V6 summoned for more staff assistance to R1's room. On December 27, 2023, at 12:35 PM, V6 (CNA) stated she was assigned to care for R1 on November 22, 2023, and had not been assigned to care for him prior. V6 stated she did not check R1's Kardex (abbreviated Care Plan that gives individual directions for care) prior to going into R1's room on November 22, 2023, to provide care. V6 stated on November 22, 2023, at around 7:45 AM, she (V6) assisted R1 to a sitting position on the side of the bed then she (V6) attempted to assist R1 into a standing position but R1 was not able to bear weight during the transfer, so she (V6) lowered R1 to the floor. V6 confirmed she transferred R1 by herself. V6 stated the Kardex should be reviewed prior to providing care to the resident, especially if unfamiliar with the resident's care needs. According to R1's EMR, R1 developed swelling and redness to the left lower leg during the day 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: 145522 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 145522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beacon Hill 2400 South Finley Road Lombard, IL 60148 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)