Inspection visit
Inspection
14 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 14 deficiencies, 2 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interviews and record review, the facility failed to follow their call light policy. The
facility failed to place call light within reach. This deficient practice affects three residents (R15, R41 and
R71) of three residents reviewed for call light placement in a total sample of 25 residents.
Residents Affected - Few
Findings Include:
On 8/15/23 at 10:30AM, Observed R71 in bed, observed call light placement not within reach. Call light was
on the floor on the right side of R71's bed. R71 stated that she does not know where her call light is. Also
stated that when her call light is not within reach, R71 will yell or call for help.
On 8/15/23 at 10:35AM, V13 (RN) confirmed that the call light of R71 is on the floor and not within R71's
reach. V13 also stated that she will inform the maintenance that the call light needs a clip.
On 8/15/23 at 10:45AM, R15 in bed, observed call light wrapped in left upper side rail, No clip. R15 said
she don't know where her call light is at that moment. Pointed at the left side rail, and R15 said I cannot see
or reach it.
On 8/15/23 at 10:50AM, V13 also confirmed that the fall light placement is not within reach of R15. State
surveyor asked R15 if she is able to reach the call light, R15 said No. V13 again said she will let the
maintenance know that the clip is not available.
On 08/15/23 11:27AM, surveyor asked R41 to activate her call light. R41 said she cannot activate her call
light because she cannot reach the call light.
On 08/15/23 11:27AM, R41's call light was not accessible and was on the floor in back of R41's wheelchair.
R41's left arm is in a splint and was not able to reach the call light on the floor. V30 (CNA) noted R41's call
light on the floor and in back of R41's wheelchair. V30 was able to reach behind and attach the call light to
the side rail and ensure call light is R41's in reach.
On 8/17/23 at 1:45PM, V28 (DON) stated that call light should be within residents' reach.
Use of Call Light Policy reads in part: To respond promptly to resident's call for assistance. When providing
care to residents, position the call light continently for the resident's use. Tell the residents where the call
light is and show him/her how to use the call light and provide reminders to use the call light as needed. Be
sure call lights are placed within resident reach at all times.
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 11
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
08/18/2023
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
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview and record review the facility failed to follow their prevention and treatment
of pressure injury policy and failed to implement preventative measure appropriately by not following the
operation manual for a pressure injury preventative mattress. This deficient practice affected one resident
(R38) of three residents reviewed for skin alterations in a total sample of 25 residents.
Residents Affected - Few
Findings Include:
On 8/15/23 at 11:00AM, observed R38 in bed, using a low air loss mattress (pressure injury preventative
mattress). Machine checked and it is set on 230lbs (pound in weight).
On 8/15/23 at 11:10AM, V14 (LPN) confirmed that the machine is set for 230 lbs. Stated that the low air
loss mattress is supposed to be set to the weight of R38 and that she will check the weight of the resident
and change the setting as necessary.
On 8/16/23 at 10:00AM, observed R38 in bed, using a low air loss mattress (pressure injury preventative
mattress). Machine checked and it is set on 280lbs (pound in weight). Machine for the low air loss mattress
had six lights for weight by lbs. The light goes in 80lbs, 130lbs, 180lbs, 230lbs, 280lbs, and 340lbs.
On 8/16/23 at 10:35AM, V5 (Wound Care Coordinator) stated that the mattress machine setting check is
done randomly by her wound care team and they make adjustments when needed. The light should be
close to the weight of the resident. The weight light lit in the machine should show closer to the weight of
R38. R38 had a history of pressure injuries but they are already healed and we are using the special
mattress as preventative measure for R38. R38 is assessed as moderate risk for skin alteration. We follow
the recommendation setting of the manufacturer of the mattress, which to set it for the weight of the
resident using the machine. It defeats the purpose of the machine if the recommendation is not followed. I
will in-service the staff and educate them about the importance of the low air loss mattress in the right
setting.
R38's weight in July 2023 was 144.6lbs and in August of 2023 was 146.6lbs.
Braden Scale Assessment (predicting pressure injury risk) dated 6/3/23 shows R38 scored 14 (Moderate
Risk).
R38 has a care plan for alteration of skin integrity related to moisture to under breast and a history of
pressure wounds to bilateral buttocks. R38 requires extensive assist in ADL care, bed mobility, and
transfers. R38 has occasional incontinece of bowel and bladder and intentional friction of buttocks against
bed. Intervention initiated: pressure redistribution support-low air loss mattress in bed.
Operation Manual for low air loss mattress provided by the facility, reads in part: Pressure set up: users can
adjust the pressure level of the air mattress to the desired firmness by themselves or according to the
suggestions from a health care professional. Note: It is recommended to press auto firm on the panel when
the mattress is first inflated. Users can easily adjust the air mattress to a desired firmness according to the
patient's weight and comfort.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 2 of 11
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
08/18/2023
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
Braden Scale for Predicting Pressure Injury Risk policy, reads in part: To be completed for all residents to
assess level of risk for developing pressure injury. Regardless of the resident's total risk score, eacj risk
factor and potential cause(s) should be reviewed individually. Implement intervention according to the
resident's Braden Score and/or individual risk factors identified.
Prevention and Treatment of Pressure injury and Other Skin Alterations policy, reads in part: identify
residents at risk for developing pressure injuries. Implement preventative measures and appropriate
treatment modalities for pressure injuries and/or other skin alterations through individualized resident care
plan. Identify residents at risk for developing pressure injuries utilizing the Braden scale.
Event ID:
Facility ID:
145557
If continuation sheet
Page 3 of 11
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
08/18/2023
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 0693
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and
provide appropriate care for a resident with a feeding tube.
Based on observation, interview and record review the facility failed to label the enteral tube feeding bags
with the date and time it was initiated for four of thirteen residents (R24, R32, R52, R323) reviewed for tube
feeding in a sample of 25.
Findings include:
On 08/15/2023 at 10:32AM during observation, R52 was observed with enteral tube feeding attached to her
gastrostomy tube labeled with initiation date of 8/14/2023 with no time indicated. At 11:06 AM during
observation, R32 was observed with enteral tube feeding attached to her gastrostomy tube labeled with
initiation date of 8/14/2023 with no time indicated. At 11:10 AM during observation, R323 was observed
with enteral tube feeding attached to her gastrostomy tube without label indicating the resident's name, and
date and time it was initiated. At 12:13 PM during observation, R24 was observed with enteral tube feeding
attached to her gastrostomy tube labeled with initiation date of 8/14/2023 with no time indicated.
On 08/15/2023 at 12:02PM, V33 (Registered Nurse/RN) stated that they only write the date the feeding was
initiated on the enteral feeding not the time because they go by the electronic medication administration
record (eMAR).
On 08/15/2023 at 12:19PM, V34 (RN) said that she is not sure if the time has to be written down on the
enteral feeding.
R52's admission record indicated admission date of 07/08/2023 and diagnoses including dysphagia
oropharyngeal phase. R52's order listing report dated 08/17/2023 indicated active order of enteral feeding
with order date of 08/04/2023.
R32's admission record indicated admission date of 07/24/2020 and diagnoses including dysphagia and
encounter for attention to gastrostomy. R32's order listing report dated 08/17/2023 indicated active order of
enteral feeding with order date of 06/05/2023.
R323's admission record indicated admission date of 10/08/2021 and diagnoses including dysphagia and
encounter for attention to gastrostomy. R323's order listing report dated 08/17/2023 indicated active order
of enteral feeding with order date of 08/11/2023.
R24's admission record indicated admission date of 06/13/2023 and diagnoses including encounter for
attention to gastrostomy. R24's order listing report dated 08/17/2023 indicated active order of enteral
feeding with order date of 06/14/2023.
Facility Policy:
Title: Enteral Nutrition Feeding
Date: 09/2020
Procedure:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 4 of 11
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
08/18/2023
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 0693
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
13. Change enteral feeding solution and bag/bottle per manufacturer guidelines. Nestle: Enteral feeding
closed system can hang up for up to 48 hours. Enteral feeding in an open system bag should be changed
every 24 hours (bag itself). A carton/can (250 milliliters/ml) should be used/infused within an 8 hour hang
time. Label bag/container with name, date, time. Change spike set with each new ready to hang bottle.
Change irrigation set and/or piston syringe weekly and prn (as needed). Label with name, use and date.
Shake formula well and check for expiration date prior to administration.
Event ID:
Facility ID:
145557
If continuation sheet
Page 5 of 11
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
08/18/2023
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 0695
Provide safe and appropriate respiratory care for a resident when needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review the facility failed to provide an extra tracheostomy (trach) cannula
at the bed side and failed to have enough water in the aerosol bottle at the bed for two residents (R58 and
R322) of nine residents reviewed for Trach care in a total sample of 25 residents.
Residents Affected - Few
Findings Include:
1. On 8/15/23 at 11:30 am during screening R58's humidifier was observed with approximately 2 milliliters
of water in the bottle, no bubbles were seen in the aerosol bottle or in the large bore corrugated tubing
while still connected to R58's tracheostomy (trach) collar. There was no extra emergency tracheostomy
cannula at the bedside. V23 (LPN) was observed going out to request an extra cannula from the respiratory
therapist, V23 was informed by V24 (Respiratory Therapist) that there was an extra piece of cannula in
R58's cupboard. V23 did not know where to find the extra emergency tracheostomy cannula.
On 8/15/23 at 11:35 am, V23 and V24 both stated that there should be an extra tracheostomy cannula at
the bedside in case of an emergency. Both stated that, the humidifier bottle should have enough water to
keep the tracheostomy moist. V24 stated that the humidifier is used to prevent plug formation.
R58 was admitted on [DATE] with multiple sclerosis, functional quadriplegia, and dependence on
supplemental oxygen.
Care plan dated 7/28/23 reads, adjust oxygen to maintain saturation with adequate parameters, R58 has
alteration due to Trach and has potential for complications secondary to tracheostomy .
Facility policy dated 09/2020 titled, Oxygen Therapy Devices High Humidity.
Policy: Oxygen delivered with high humidity or high humidity without O2 will be set up to enhance
humidification of mucous membrane .
Procedure:
3. High humidity -with oxygen, can be provided using an aerosol bottle, large bore corrugated tubing, 02
device and 100% source .
2. On 08/15/2023 at 11:33AM during observation with V36 (Registered Nurse), R322 was observed with
tracheostomy attached to wall oxygen with no extra emergency tracheostomy kit and artificial manual
breathing unit (AMBU) at bedside.
On 08/15/2023 at 11:33AM, V36 said that residents on tracheostomy tubes usually have a spare
tracheostomy kit and AMBU at bedside but she does not know why R322 did not have one.
R322's face sheet indicated admission date of 07/10/2023, and diagnoses including paralysis of vocal
cords and larynx, bilateral, encounter for attention to tracheostomy and dependence on supplemental
oxygen. R322's order listing report dated 8/17/2023 indicated and active order for in case of emergency,
trained nurse may reinsert outer cannula of tracheostomy as needed with order date of
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 6 of 11
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
08/18/2023
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 0695
7/10/2023.
Level of Harm - Minimal harm
or potential for actual harm
Facility unable to provide policy.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 7 of 11
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
08/18/2023
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to discard expired house stock medications and
label multi-dose medications with open date for three of four medication carts and one of one medication
room observed for medication storage and labeling. This deficiency can affect all 126 residents residing in
the facility.
Findings include:
On [DATE] at 1:20PM during observation with V33 (Registered Nurse/RN), Cart 4 in C-wing was observed
with the following:
1. Opened house stock Lactobacillus acidophilus bottle with expiration date 7/23
2. R67's budesonide 0.5 milligrams (mg)/2 milliliters (ml) nebules in an open foil pouch with no open date
3. R9's budesonide 0.5 milligrams (mg)/2 milliliters (ml) nebules in an open foil pouch with no open date
At 2:05PM during observation with V14 (Licensed Practical Nurse/LPN), Cart 2 in B-wing was observed
with the following:
1. R22's opened 10ml vial of Heparin sodium 5000 units/ml with no open date
2. R12's opened 10ml vial of Heparin sodium 5000 units/ml with no open date
At 2:40PM during observation with V31 (LPN), B-wing medication room was observed with opened
multidose vial of tuberculin purified protein derivative (PPD) with no open date.
At 2:51PM during observation with V7 (LPN), Cart 1 of C-wing was observed with the following:
1. R110's opened 10ml vial of Heparin sodium 5000 units/ml with no open date
2. R110's opened latanoprost solution 0.05% eye drops with no open date with label that reads Discard 42
days after opening
3. Two opened 10 ml vials of R95's Heparin sodium 5000 units/ml with no open date
On [DATE] at 1:30PM, V33 said that the house stock lactobacillus bottles should have been discarded and
the budesonide foil pouch should indicate an open date once opened.
On [DATE] at 2:15PM, V14 said that she does not know why the vials did not have open dates. She added
that they should have an open date, so they know when to stop using it.
On [DATE] at 2:45 PM, V31 said that the PPD vial should have an open date so other nurses would
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 8 of 11
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
08/18/2023
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 0761
know when to discard it and not use it.
Level of Harm - Minimal harm
or potential for actual harm
On [DATE] at 3:10PM, V7 said all multidose vials should have an open date and the eye drops that has a
specific instruction of when to discard should be labeled with open date as well.
Residents Affected - Many
Facility Documents:
Title: Medicine Information Leaflet (Budesonide)
Patient Information and Instruction for Use:
How should I store budesonide inhalation suspension?
· Budesonide inhalation suspension vials can be stored for 2 weeks after opening the protective
aluminum foil envelope.
Patient Instructions for Use:
1. Budesonide inhalation suspension vials come in a sealed protective aluminum foil envelope.
· Do not open the sealed pouch until you are ready to use a dose of budesonide inhalation
suspension.
· Record the date that you opened the foil in the space provided on the envelope.
Policy Title: Medication Pass Guidelines
Date: 09/2022
16. House stock medications
· Check expiration dates of all medications before administration.
19. Eye medications
· Eye drops/ointments/gels are considered safe and effective for use until the manufacturer ' s
expiration date when stored according to manufacturer guidelines, unless otherwise specified by the
manufacturer or pharmacy.
Policy Title: Multi-Dose Vials, Use of
Date: 01/2022
C. Policy:
Multi-dose vials (MDVs) contain preservative, so they may be used multiple times. The opened and
beyond-use (expiration) dates will be noted and initialed at the time the vial cap is removed.
D. Procedure:
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 9 of 11
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
08/18/2023
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 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
4. If this is a previously opened vial, check that the opened and expiration dates are noted and initialed and
that the vial has not expired.
a. If the vial has been opened longer than 28 days, or has expired per the manufacturer ' s guidance, it
should no longer be used and should be discarded in a sharp container and a new vial of medication
should be obtained.
5. If this is a new vial, remove the cap from the vial. Using an ink pen, write the opened and expiration
dates, as well as the nurse ' s initials, on the vial ' s label or pharmacy-provided sticker.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 10 of 11
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
08/18/2023
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 and interview, the facility failed to properly store Bi-pap masks and Nebulizer mask
and left masks open to air on bedside table. This failure affected 2 residents (R8 and R88) of 3 reviewed for
oxygen equipment in a total sample of 25.
Residents Affected - Few
Findings include:
On 08/15/23 at 10:30 AM, observed R88's Bi-pap mask on the bedside table exposed to the air (not stored
in plastic bag) as observed by V14 (LPN). On 08/15/23 at 10:49 AM, observed R8's nebulizer mask on the
bedside table open to air (not stored in a plastic bag) as verified by V29 (CNA) and V29 immediately placed
nebulizer mask in plastic bag in front of surveyor.
On 8/17/23 at 11:48 AM, V2 (DON) said Bi-pap masks and nebulizer masks are stored in plastic bags. The
masks are kept in a bag to keep masks clean after being cleaned per policy.
On 08/15/23 at 10:30 AM, V14 (LPN) said the CNA is to inform the nurse and the nurse will place the
Bi-pap mask in the bag. V14 said she will place the Bi-pap mask in a bag to keep it clean.
On 08/15/23 at 10:49 AM, V29 (CNA) said it is the nurse's job to store nebulizer masks in a bag to keep it
clean.
On 08/15/23 at 11:01 AM, V31 (LPN) said the face mask is stored in a plastic bag for infection control.
Bi-Pap Policy (dated 9-20), Nebulizer Policy (dated 9-20), and Infection Control Policy were reviewed but
there was no guidance provided on mask storage.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145557
If continuation sheet
Page 11 of 11
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Back to topCitations
14 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.
F693 - Assisted nutrition and hydration
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
- 0281GeneralS&S Epotential for harm
Install proper backup exit lighting.
- 0293GeneralS&S Epotential for harm
Have properly located and lighted "Exit" signs.
- 0362GeneralS&S Epotential for harm
Ensure that corridors are separated from use areas by walls constructed to limit the passage of smoke.
- 0904GeneralS&S Epotential for harm
Have a properly installed medical gas master alarm panel.
F918 - Bathroom Facilities
Have generator or other power source capable of supplying service within 10 seconds.
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F919 - Resident Call System
Make sure that a working call system is available in each resident's bathroom and bathing area.
FAQ · About this visit
Common questions about this visit
What happened during the August 18, 2023 survey of ALDEN ESTATES OF BARRINGTON?
This was a inspection survey of ALDEN ESTATES OF BARRINGTON on August 18, 2023. The surveyor cited 14 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ALDEN ESTATES OF BARRINGTON on August 18, 2023?
Yes, 14 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriat..."
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.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.