Inspection·September 23, 2025

F 0552 Level of Harm - Actual harm Residents Affected - Few assessment, due to recent hospitalization, to truly determine what is the safest way to transfer him.On 09/16/2025 at 12:46 PM V2 (Director of Nursing) said, If a resident adamantly refuses something, the staff should accommodate resident's request to the best of their ability, unless the refusal poses risk of any type of injury or compromises safety. If a mechanical lift is resident's recommended mean of transfer based on an assessment, we don't advise staff to look for another way because it poses safety concern. A resident should be given choice and education related to risks and safety concerns during transfer by other means than recommended by the assessment. For example, if a resident returns from dialysis and refuses to be transferred to bed via mechanical lift, we should educate a resident, but we still have to use a mechanical lift because a resident cannot stay in the chair. It is a safety concern for both resident and staff to change means of transfer if they are assessed to be safely transferred only with a mechanical lift.On 09/16/2025 at 2:02 PM V6 (Licensed Practical Nurse) said, I worked on 09/15/2025 between 3:00 PM and 11:00 PM. No one ever told me that R1 was in pan during a transfer. I went into R1's room when he returned form the dialysis, I actually went in there couple of times, and R1 never told me that he had an issue related to a mechanical lift transfer, that he was in pain, nor that he needed a pain medication.On 09/16/2025 at 2:48 PM V5 (CNA) said, I worked yesterday (09/15/2025). I assisted V4 (CNA) with R1's transfer. It was around 4:30 PM - 5:00 PM. R1 returned form the dialysis and needed to be transferred back into bed with mechanical lift, so there had to be two CNAs. R1 got agitated during the transfer. R1 really didn't want to be transferred with a mechanical lift. R1 kept saying No, no, no! As we set up a mechanical lift, R1 was attempting to take straps of the mechanical lift sling loops. V4 (CNA) and I proceeded with the transfer anyways. We continued because R1 was assessed to be transferred with a mechanical lift, so there was no other choice. We have resident rights in-services; I think they are done quarterly but I don't remember last time we had it.On 09/17/2025 at 11:44 AM V9 (Attending Nurse Practitioner) said, R1 was admitted to the facility (07/23/2025) for post left foot amputation skilled therapy. R1 was working with physical therapy and was able to transfer with some help into the wheelchair; however, shortly after, R1 had to be hospitalized due to low hemoglobin and was recently readmitted to the facility (09/12/2025). V9 said R1 is a very difficult resident, who is not compliant with care and recommendations. R1 is non-weight bearing on his left foot and has a right hip arthritis that had been treated with injections to alleviate the pain in the past. Surveyor asked about R1's arthritic right hip and pain that R1 experiences, V9 said, R1's small frame and movement or pressure would cause bone-on-bone frication causing inflammation, which would result in R1's additional pain. Surveyor asked V9 to elaborate on resident rights in relation to resident care, V9 said a resident can make decisions related to their care, even though, R1 might not have deep understanding of simultaneously occurring processes. V9 said, A resident can refuse patient care. Staff should document and educate a resident of the risks of not having care done. Residents are allowed to say No. Honoring resident right is important due to residents' autonomy. Transferring R1 against his wish could have caused his emotional distress.Absent is any documentation prior to 09/17/2025 to show R1's mechanical lift transfer refusal or provided education related to mechanical lift transfers.Absent is any care plan prior to 09/16/2025 to show R1's recommended means of transfer.V4's (CNA) and V5's (CNA) most recent resident right in-service dated 09/16/2025 reviewed. No prior V4's (CNA) and V5's (CNA) resident right in-service available upon request.The facility Resident Rights policy last reviewed on 01/04/2019 reads in part, Purpose: To promote the exercise of rights for each resident, including any who face barriers (such as communication problems, hearing problems and cognition limits) in the exercise of these rights. A resident, even though determined to be incompetent, should be able to assert these (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145630 If continuation sheet Page 2 of 3 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 145630 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care North Branch 6840 West Touhy Avenue Niles, IL 60714 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 0552 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete rights based on his or her degree of capability. Guidelines: Notice of resident rights will be provided upon admission to the facility. These rights include the resident's right to: Exercise his or her rights. Exercising rights means that residents have autonomy and choice, to the maximum extent possible, about how they wish to live their everyday lives and receive care, subject to the facility's rules, as long as those rules do not violate a regulatory requirement. The facility will not hamper, compel, treat differentially, or retaliate against a resident for exercising his/her rights. Facility practices designed to support and encourage resident participation in meeting care planning goals as documented in the resident assessment and care plan are not interference or coercion. Event ID: Facility ID: 145630 If continuation sheet Page 3 of 3