Inspection visit
Inspection
9 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 9 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interviews, and record reviews, the facility failed to follow the plan of care for a resident with a
pressure ulcer by not turning and repositioning the resident every two hours to aid in the prevention and
healing of a sacral pressure ulcer. This failure applied to one (R70) of four residents reviewed for pressure
ulcers in the sample of 53.
Residents Affected - Few
Findings include:
R70 is a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Chronic Respiratory
Failure, Chronic Embolism and Thrombosis of unspecified Deep Veins of Lower Extremities,
Hyperlipidemia, Encounter for Attention to Tracheostomy, and Encounter for Attention to Gastrostomy.
According to MDS (Minimum Data Set) dated 08/04/2022 under Section C, R70 has a BIMS (Brief
Interview of Mental Status) score of 15 indicating a high level of cognitive functioning; under section G, R70
requires extensive assistance in bed mobility with two+ person physical assist; under section M, R70 has
one stage IV pressure ulcer that was not present upon admission.
On 09/12/22 02:30 PM V15 (family member) expressed concerns regarding lack of repositioning, V15
stated, I'm here on Wednesday and when I'm in the room staff doesn't come to reposition R70, he remains
in the same position for hours.
On 09/12/22 02:35 PM Surveyor observed R70's wound care. V4 (Licensed Practical Nurse) and V3
(Licensed Practical Nurse) both indicated that they are substituting for a regular wound care nurse who is
absent at this time. Surveyor observed no dressing covering R70's sacral wound upon initial observation.
V3 (LPN) indicated that it must have fallen off during R70's transport to and from the doctor's visit earlier
that today. V3 proceeded to clean the site with normal saline and applied adaptic calcium alginate and dry
dressing as per order. Current wound size is 3cmx4.5cmx1.5cm at this time.
Wound care progress note dated 09/07/2022 reads in part, Sacral pressure ulcer, size 2cmx4.2cmx1cm,
indicating that wound has increased in size.
On 09/12/2022 at 3:07 PM V3 stated, R70 has had this wound for a very long time. I believe he acquired it
here (at the facility). R70 is prone to developing wounds due to several factors, such as comorbidities,
nutrient intake and others. Surveyor asked if repositioning would have an impact in acquiring sacral wound,
V3 indicated that lack of repositioning would have a negative impact on the wound not only in acquiring but
also healing.
On 09/13/2022 at 09:42 AM Surveyor observed R70 lying in bed positioned onto his right side.
(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 9
Event ID:
145557
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0686
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
On 09/13/2022 at 10:00 AM Surveyor observed two Certified Nursing Assistants reposition R70 onto
supine position. During continuous observations, surveyor noted that at 12:07 PM, R70 remained in supine
position after two-hour period.
Care plan for R70 focus area Alteration in skin integrity, dated 11/19/2019, reads in part, Avoid turning body
to sacral area with pressure ulcer as much as possible. Turn and reposition every two hours and as
need/tolerated.
Event ID:
Facility ID:
145557
If continuation sheet
Page 2 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0759
Ensure medication error rates are not 5 percent or greater.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review, the facility failed to administer medications as ordered
(at ordered times). There were 30 opportunities with 2 errors resulting in a 6.67% error rate. This applies to
one (R53) of five residents reviewed during the medication pass task.
Residents Affected - Few
Findings include:
On 09/13/2022 at 11:40 AM Surveyor observed V5 (Licensed Practical Nurse) administer the following
medications to R53:
1. Gabapentin Capsule 300 MG 1 capsule by mouth with apple sauce
2. Eliquis Tablet 5 MG 1 tablet by mouth with apple sauce
On 09/13/2022 R53's Order Summary Report state in part;
1. Gabapentin Capsule 300 MG 1cap by mouth three times a day
2. Eliquis 5 mg 1 tablet by mouth every 12 hours
On 09/13/2022 at 11:50 am, review of R53's Medication Administration Audit for 09/13/2022.
Gabapentin Capsule 300 MG has a Schedule Date of 09/13/2022, with scheduled administration times of
0800, 1400, and 2000.
Eliquis 5 mg 1 tablet has a Schedule Date of 09/13/2022, with scheduled administration times of 0900 and
2100.
On 09/13/2022 at 11:57 AM V5 stated, I administered R53's medications late because I had a busy
morning. It's important to give medications on time to prevent anything abnormal from happening and follow
doctor's orders. We do have a one-hour window before and after medication administration time. If morning
medications are administered late the expectation is to follow up with the doctor to see what needs to be
done with later doses.
On 09/14/2022 at 02:04 PM V1 (Administrator) stated, My expectation regarding medication administration
is to give out medication on time. Medication administration window is one hour before and one hour after
medication administration time, but there are circumstances when medications get administrated outside of
the time frame. In such case, nurses should call the physician to notify of the change. There are certain
medications that have parameters and are time sensitive; therefore, it is even more important to notify
physician if these medications are given outside of the time frame. V1 further indicated that if medication is
scheduled multiple times a day, following doses get affected and physician's expertise is needed to be able
to proceed with further medication administration.
09/14/2022 at 02:37 PM Per record review, no indication of late medication administration physician
notification noted.
Medication Administration policy dated 09/2020 reads in part, Drugs must be administered in accordance
with the written orders of the attending physician.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 3 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0804
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review, the facility failed to serve food in a manner that
maintained proper holding temperatures. This failure affected all 89 residents that receive meals from the
kitchen.
Residents Affected - Few
Findings include:
On 09/12/2022 V1 (administrator) presented the survey team with the number of residents currently in the
facility. Facility census provided showed 121 residents. Of these residents V7 (dietary Manger) indicated
there were 89 residents receiving food from the kitchen.
On 09/12/2022 at 11:54am during an interview with Resident # 25 said when they bring my food in its cold
and dried out so I don't eat it I send it back. Sometimes I do ask for something else and sometimes I don't
be as hungry.
On 09/12/2022 at 12:32pm during an interview with Resident # 75 said The food here is sometimes a hit or
miss. It does be cool sometimes depending on what it is. Yes i have mention this to the dietary they
supposed to be working on it.
Hall trays are place on a hot heated food cart.
On 09/13/2022 at 12:18pm Test tray temperatures was completed with (V10 Dietary hostess). The
temperatures read:
Mash potatoes and gravy at 134 degrees Fahrenheit
Egg Noodles 118 degrees Fahrenheit
Puree beef Stroganoff is at 115 degrees Fahrenheit
Soup is at 140 degrees Fahrenheit.
On 09/14/2022 at 10:57am interview with V7 (dietary manger) said Some of our residents like their food to
be cold well not cold cold but not warm. We don't have a standard temperature we use. Food that come off
the steam table we have up to four hours to serve the food before bacteria start to grow. Our facility say we
have to serve it with in 30 minutes. The hot holding is 135 degrees Fahrenheit.
During a resident council meeting held at 10:07am on 09/14/2022 with fellow surveyor there was 10
residents that attended this meeting and all 10 residents was in agreement that the facility serves cold
meals and they prefer meal be a little warmer.
Record review of a document submitted by the facility titled Food Temperatures with no date noted under
policy states: Food will be served to the resident at a temperature that is palatable. Under procedure
number 4 states: Food will be transported via methods that maintain the proper temperature of the foods
being served. Number 5 states hot foods will be presented to the resident within 30 minutes of leaving the
steam table.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 4 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0804
Level of Harm - Minimal harm
or potential for actual harm
Record review of a document titled At risk hot food and Beverage Temperature service with a date of 5/19
under Procedure number 2 states: Food will be held at 135 degrees Fahrenheit or higher, minimizing
excessively high temperatures.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 5 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0809
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and
requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to
eat at non-traditional times or outside of scheduled meal times.
Based on interview and record review, the facility failed to provide and distribute nourishing snacks at
bedtime to all residents in the facility. This failure affects all 89 residents receiving food from the facility.
Findings include:
On 9/12/22 V1 (administrator) presented the survey team with the number of residents currently in the
facility. Facility census provided showed 121 total residents. Of these residents V7 (dietary manager)
indicated there were 89 residents receiving food from the kitchen.
On 9/12/22 at 11:45 am during the initial tour of the facility, R13 was observed in bed and spoke with the
surveyor about her some concerns. R13 stated, I am concerned about the food as sometimes I get cold
food given to me. I cannot walk or put myself on the wheelchair because I need a lot of help to do that so I
rely on staff to do this for me. I sometimes go to bed hungry and I can't get a snack at night or anything. I
have to wait until the next morning for breakfast before I eat and I am so hungry. Surveyor asked if she is
ever offered any snacks during bed time or whether anyone comes around to offer snacks in the evening,
R13 stated, Never. I'm told they are delivered at the nursing station but when I request for something, I
never receive any or I'm told that they are out of snacks. All I want is a cookie or something, anything.
Surveyor asked what time she usually has dinner, R13 stated, Dinner here is served really early so I get to
eat dinner around 5:00 PM or 5:30 PM and then like I said I have to wait until the next morning around 8:30
AM to eat breakfast. That's just way to long to lay here and starve.
On 9/14/22 at 10:10 AM, 10 residents present in the resident council meeting were interviewed on the
concerns and complements they had with the facility. During this meeting with the surveyor, R42 (resident
council president) stated to surveyor that obtaining evening snacks was an issue. Surveyor asked for
specifics, R42 stated, I've had residents complain to me and to management that bedtime snacks aren't
being passed around. I have no issue getting any but I am able to get around but some residents who are
bed-ridden can't get any snacks and sometimes I've experienced that when I go to the nursing station that
they even run out of snacks or the snacks never came out from the kitchen. Surveyor asked the rest of the
resident council participants if this was their experience, all 9 residents in attendance concurred and
wanted assistance from the surveyor to correct the issue.
On 9/14/22 at 11:30 AM, V7 was asked about the bedtime snacks, V7 stated, We usually bring out a tray of
snacks and they are placed at the nursing station. Surveyor asked who's responsibility it was for these
snacks to be distributed to residents, V7 stated, Not my staff, it's the nurses that should do this if the
residents ask for it. Surveyor asked whether any staff offer residents snacks, V7 stated, No that's the nurses
job.
Surveyor team asked V7 for any policies and procedures for the distribution of evening snacks but was not
provided any after several requests to do so.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 6 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review the facility failed to properly cover and label food items
stored in the refrigerator and failed to follow their food storage policy and food storage guideline policy for
the use of and discarding of foods. This failure has affected all 89 residents that receives meals from the
kitchen.
Findings include:
On 09/12/2022 V1 (administrator) presented the survey team with the number of residents currently in the
facility. Facility census provided showed 121 residents. Of these residents V7 (dietary Manger) indicated
there were 89 residents receiving food from the kitchen.
09/12/22 at 9:59am During the observation of the refrigerator the surveyor noted two pans of Jell-O in the
refrigerator not covered or dated, In the freezer there 4 packs of hot dog buns one noted with an expiration
date of 09/06/2022 the other three packs of buns did not have dates . The buns have freezer burn on all 4
packs of bread. Observation of the dry storage room surveyor noted one can of dented sliced apples on the
shelf mixed in with the non-dented cans, two packs of flour tortillas with the expiration date of 07/21/2022.
On 09/12/2022 at 11:10am interview with V7 (Dietary manger) said We had extra bread the use by date is
September 6th it can be frozen we kept it for emergency purpose we get bread delivered every Tuesday. If
the bread gets freezer burn we have to throw it away. The flour tortillas are staff food no they are not
allowed to have their food in the resident food storage. When we get dented cans we store them here but
the staff know not to use them. Yes they know not to use them then we give them back. Because they
automatically know not to touch it we store them with the regular cans and then give them back. Jell-O
should be stored in the refrigerator covered with the date on it but we was letting it cool and then we will
cover it and put the date on it.
On 09/13/2022 at 11:10am Interview with V8 (Dietary consultant) said Bread is good as long as it doesn't
have any sign of mold or spoilage. Yes we use the first in, first out (FIFO) the staff should be checking to
make sure the bread is good before serving it. The staff should be checking to see if the Hot dogs buns
have freezer burn and if it does they should throw them away. Dented cans should be put aside they should
not be stored with regular cans. Food items of staff should not be stored with the resident's food items.
Record review of a document titled Food storage guidelines with the dates of 7/17 and 8/18. Under policy
states: Food will be stored and used in an acceptable amount of time.
Under procedure number 5. Common terms letter C states Expiration date is the last day the product must
be used or eaten. The food is no longer safe to eat after the expiration date and will be discarded.
Record review of a document titled Food storage with the dates of 6/97, 2/12 and 7/17 under policy states
Food storage areas will be maintained in a clean, safe and sanitary manner. Under procedure number 3
states: Food inventory will be maintained using the first in, first out (FIFO). Food stock will be rotated by
placing new stock behind old. Items will be marked with date prior to storage. Number 6 states: Food taken
from their original container will be label by common name.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 7 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review, the facility failed to follow federal regulations and their
infection prevention and control program regarding donning personal protective equipment (PPE) prior to
entry into a resident's room who is under contact isolation precautions, failed to practice proper PPE use
and/or perform hand hygiene during food preparation to minimize the spread of infection. This failure has
the potential to affect all 121 residents that reside in the facility.
Residents Affected - Many
Findings include:
On 09/12/2022 at 11:50 AM, observed standard precaution and contact isolation signs both posted on the
outside of R73's room door which both indicated to don gloves and gown prior to entering. Also observed a
three-drawer bin next to the doorway of R73's room that contained personal protective equipment and
supplies.
Reviewed resident isolation list provided by the facility for September 2022 that showed R73 is under
contact isolation precautions for CRAB/ESBL in sputum/urine.
Reviewed R73's active physician's orders which showed contact precautions for extended spectrum
beta-lactamase (ESBL) in the urine and contact precautions for carbapenem-resistant Acinetobacter
baumannii (CRAB) in the sputum. Reviewed R73's immunization records that showed consent denied for all
Covid-19 vaccinations.
On 09/13/2022 at 11:41 AM, surveyor observed V11 (Nurse Practitioner) enter R73's room without donning
gloves or an isolation gown. V11 then removed a stethoscope from around her neck and shoulders and
proceeded to auscultate R73's heart and lungs with this stethoscope. V11 (Nurse Practitioner) placed the
stethoscope back onto her shoulders then exited R73's room. Surveyor did not observe V11 sanitize the
stethoscope upon leaving R73's room. At 11:44 AM, V11 (Nurse Practitioner) said she is new to the facility
and did not notice the isolation signs on the door. Surveyor then observed a second nurse practitioner
rounding on hall 3 of C wing with her face mask flipped up, nose and mouth both were exposed.
On 09/14/2022 at 2:10 PM, V4 (Infection Preventionist) said R73 is under contact and droplet isolation
precautions for ESBL in the urine and CRAB in the sputum. At 2:16 PM, V4 (Infection Preventionist) said
her expectation is for the nurse who received lab results and new orders, to initiate antibiotic and must
inform floor staff of the type of isolation and PPE required. V4 then said all staff must wear an N95 mask
and face shield and apply proper PPE such as gown and gloves for example, if a resident has clostridium
difficile (c-diff) to avoid cross contamination. V4 (Infection Preventionist) added that the nurse practitioners
are contracted through the facility's medical providers and her expectations for contract staff are the same
as facility staff and are to follow guidelines for infection control purposes to avoid the spread.
Reviewed community level of Covid-19 transmission provided by facility for 09/06/22-09/13/22 that showed
high for facility's county. Reviewed list of fully vaccinated practitioners provided by facility that showed 17 in
total. Facility did not indicate V11's (Nurse Practitioner) vaccination status.
Reviewed facility's infection prevention and control program policy and procedures that showed the
following:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 8 of 9
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
145557
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/15/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Alden Estates of Barrington
1420 South Barrington Road
Barrington, IL 60010
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
The primary mission is to provide a safe, sanitary and comfortable environment and to help prevent the
development and transmission of communicable diseases and infections.
The policy for infection prevention and control is based upon information from facility assessment and
follows national standards and guidelines to prevent, recognize and control the onset and spread of
infection and shall include standard and transmission-based precautions to be followed to prevent the
spread of infections through selection, use of PPE, and hand hygiene procedures to be followed by staff
involved in direct resident contact.
The policy indicates that standard precautions include but are not limited to hand hygiene; use of gloves,
gown, mask, eye protection or face shield. Also, equipment or items handled in a manner to prevent
transmission of infectious agents (e.g., wear gloves for direct contact, properly clean and disinfect or
sterilize reusable equipment).
The intent is to implement standard precautions and when transmission-based precautions should be
utilized, including type of precautions for particular infections and organisms and require staff follow hand
hygiene practices consistent with accepted standards of practice. The elements of the program include
policies, procedures, and practices which promote consistent adherence to evidence-based infection
control practices such as managing food safety, including employee health and hygiene.
Observations and interview by a fellow surveyor noted during this survey include:
On 09/12/22 at 9:59am, entrance into the kitchen area surveyor noted two employees doing food
preparation without mask on. V12 Dietary Aide grab a mask off the counter and put the mask on but did not
perform hand hygiene before handling the food she was wrapping (salads and cut vegetables).
On 09/13/2022 at 11:32am, observation of lunch being served on B-wing V14 Dietary aid noted with her
N95 mask not completely on with one strap over her head and the other strap hanging from her chin. V10
Dining room hostess noted to readjust her mask with her gloves on and did not perform hand hygiene or
change her gloves before doing temperature of food.
On 09/13/2022 at 11:50am, V13 Dietary Aide picked a bowel off the floor and did not perform hand hygiene
or change her gloves before continuing her task of plating resident food.
On 09/14/2022 at 10:57am, interview with V7 dietary manger said If the staff have to readjust their mask
my expectation is that the staff have to wash their hands or use alcohol gel before doing the task. They
need to take the gloves of wash their hands and then put the gloves back on. They should pick up the dish
put it on the bottom of the cart then take their gloves off, wash their hands and put gloves back on to
complete whatever they was doing.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 9 of 9
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Back to topCitations
9 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F809 - Frequency of Meals
Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- 0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0324GeneralS&S Epotential for harm
Provide properly protected cooking facilities.
- 0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the September 15, 2022 survey of ALDEN ESTATES OF BARRINGTON?
This was a inspection survey of ALDEN ESTATES OF BARRINGTON on September 15, 2022. The surveyor cited 9 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ALDEN ESTATES OF BARRINGTON on September 15, 2022?
Yes, 9 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure medication error rates are not 5 percent or greater."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.