Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to implement their abuse prohibition policy by failing to
immediately report an allegation of staff to resident sexual abuse to the abuse the coordinator. The facility
also failed to report suspicion of a crime to local law enforcement. These failures affect 1 resident (R1) of 5
reviewed for abuse.Findings include:R1 was admitted to the facility on [DATE] for therapy due to left knee
surgery. R1's medical diagnoses include mood disorder, schizoaffective disorder, bipolar disorder, major
depressive disorder and generalized anxiety disorder. On 10/23/2025 at 08:16 AM, V3 (Community Case
Worker/Social Worker) stated that he worked with R1 before R1 was admitted in the facility as her social
worker. V3 stated that R1 was admitted in the facility on the evening of 10/21/2025. During that time V5
(Certified Nursing Assistant) gave her a sponge bath feeling her body and her breast leaning tried to kiss
R1, Making pass to go to bed. V3 stated that R1 told V5, No. And V5 backed off. V3 stated that R1 struggles
with anxiety and depression. V3 said, R1 is a nervous lady but super honest and lucid. V3 stated that R1
went to the hospital last night (10/22/2025) and went back to facility on the same night. V3 stated that he
did not see R1 after admission [DATE]) in the facility, but all information was made known by R1 to him (V3)
through text messages.On 10/23/2025 at 10:27 AM, R1 stated that she went to the hospital because
somebody sexually molested her. R1 stated that she was given a sponge bath and was touched by
towelette in her genital area. R1 described towelette as a disposable wipe. R1 said, He (V5) was wiping my
genitals, and he was really digging into them with fingers and stuff with a towelette. And at one point he was
kind of wiggling my clitoris. I did not say anything and trying to figure out what was he doing down there. I
don't think I was overreacting this was a real thing. R1 stated that it happened the same evening she was
admitted (10/21/2025) around 07:00 PM to 08:00 PM after dinner. R1 continued stating that V5 rubbed her
body, it's okay at first then V5 started massaging her breast telling her Does it feel good? R1 stated, I said
that's enough, and he (V5) stopped. He was bending over the bed kissed me touched everything on my lips
tongue entered my mouth. R1 stated that at that point she told V5, What's the matter with you stop it. He
(V5) goes oh okay and he stopped. And that's it. R1 said, I felt creepy not good. When I realized what he
(V5) was doing to me my heart was beginning to beat fast. R1 stated that she reported it to the female
nurse the next morning. R1 cannot recall the nurse saying, My memory sometimes blurry. R1 stated that
she went to the hospital, the doctor told her that she was okay. While she was in the hospital, police spoke
to her and report was done. On 10/23/2025 at 12:49 PM V5 (Certified Nursing Assistant) stated that he
worked and was assigned to R1 on 10/21/2025. According to V5 he did not perform sponge bath or bed
bath but changed R1 twice. First around 07:45 PM to 08:00 PM because R1 had been incontinent. V5
stated that he took off or removed hospital blanket that was around R1. R1 needs to be turn facing left and
facing right. During turning R1 was struggling with pain that he (V5) needs to be slow. During that time, V5
stated that R1
(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 3
Event ID:
145634
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
145634
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Astoria Place Living & Rehab
6300 North California Avenue
Chicago, IL 60659
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
informed him that she has surgery. V5 stated that after cleaning R1, he put a new brief, changed R1's gown
because it was wet on the back and changed the pad on the bed. V5 stated that the second time he
performed bedside care was around 10:30 PM before the end of his shift. V5 stated that he changed R1's
brief and pad again because it was wet. V5 stated that he used disposable wipes that is provided to the
staff/Certified Nursing Assistant for incontinent care. During incontinent care with R1 he cleaned around the
perineal area maybe around 1 or 2 times using the wipes and then cleaned the back area or anus or
rectum area. V5 denies cleaning R1's breast area, denies asking R1 if she feels good and denies kissing or
trying to kiss R1. V5 stated that R1 did not tell her about any concerns during those encounters. V5 said,
No protests have been made but she was grimacing pain during turning. On 10/23/2025 at 01:40 PM, V7
(Wound Care Nurse/LPN) stated that during wound assessment of R1 with V18 (Wound Nurse Practitioner)
and another wound nurse. She/V7 overheard R1 speaking on the phone talking that a CNA asking her are
you feeling good while cleaning her breast. And CNA bent over almost kissed her/R1. After R1 finished her
phone conversation, V7 asked R1 where it happened? R1 replied that it happened in the facility. V7 told R1
she must report it to V1 (Administrator). V7 stated that when she asked R1 if she feels uncomfortable? R1
said yes. V7 said that she then reported it to V1 and performed another assessment. The facility's Abuse
Initial Report dated 10/22/2025, V7 was the staff who first became aware of the incident. R1 was alleged as
a victim. And V5 was alleged as perpetrator. Report allegation reads, R1 reported that while cleaning the
resident (R1). Certified Nursing Assistant V5 touched her inappropriately. On 10/24/2025 at 01:20 PM, V13
(Registered Nurse) stated that she was the morning nurse of R1 on 10/22/2025. V13 stated that during
endorsement from the night shift nurse, R1 stated that she was assaulted by one of the CNA (Certified
Nursing Assistant). V13 said that the report was given around 8:00 AM by V17 (Agency Registered Nurse).
V13 stated that she was also informed the second time by V7 (Wound Care Nurse/Licensed Practical
Nurse) about the incident. V13 stated that V17 told her that it happened overnight. And it was a male CNA,
but there was no male CNA who worked during nightshift. On 10/24/2025 at 02:02 PM, V17 (Agency
Registered Nurse) was made aware that during change of shift report with morning nurse it was mentioned
that R1 had an incident. V17 stated that three of them, her/V17 with V13 the morning nurse and V15 the
night nurse assigned to R1 were talking about the incident at the nurse station. V17 stated R1 was saying
that V5 was trying to kiss her and trying to touch her sexually. V17 stated that she did not believe R1
because she is not in her sound mind. And per R1's admission report from the hospital, R1 has
Schizophrenia. Although V17 stated that personally she did not spoke to R1 during the whole shift. Per V17,
R1 statements can also be true but she knows V5 that is why she does not believe R1's statement. V17
stated that she did not report to V1 abuse coordinator because she did not know that she needs to report
the incident. And that she was not assigned to R1 during that time. V17 said, I am sorry about that, I should
have reported it. On 10/28/2025 at 08:02 AM, V15 (Licensed Practical Nurse) stated that she was assigned
and took care of R1 on 10/22/2025 11:00 PM to 07:00 AM shift. V15 stated that R1 mentioned to her that
male CNA (Certified Nursing Assistant) assaulted her. V15 stated that she did not ask R1 about the assault
of a male CNA because she was sleepy. V15 stated that allegation of sexual abuse needs to be reported
right away to the administrator as the abuse coordinator. V15 said, I should have reported it. V15 stated that
she knows that she can call or contact V1 (Administrator) anytime. On 10/23/2025 11:19 AM, V2 (Director
of Nursing) stated that regarding incident of R1, it was wound care nurse, either V4 or V7 who notified V1
around 09:00 AM on 10/22/2025. V1 started initial investigation, V9 (Medical Doctor) ordered R1 to transfer
to hospital to be check. V5 alleged perpetrator was made aware by R1 that he will be suspended pending
investigation.On
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145634
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
145634
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Astoria Place Living & Rehab
6300 North California Avenue
Chicago, IL 60659
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
10/24/2025 at 02:29 PM, V1 (Administrator) stated that he was informed by V7 (Wound Nurse/Licensed
Practical Nurse) the first time. V7 told him that during assessment, R1 reported that CNA touched her
inappropriately while cleaning her. V1 stated that R1 told him that when she was getting bath, or clean it felt
sexually inappropriate. V1 said, Yes, it falls under definition of sexual abuse. She said it was sexually
inappropriate. V1 stated that R1 reported to V7 giving description and gave V5's name. V1 stated facility did
not report alleged sexual abuse to the police because R1 refused it. Per V1, hospital reported it, but facility
did not. V1 said, They should have reported it to me if they knew about it. Abuse policy dated 06/26/2025:It
is the policy of the facility to provide professional care and services in an environment that is free from any
type of abuse. The facility follows federal guidelines dedicated to prevention of abuse and timely thorough
investigations of allegations. Sexual abuse is defined as non-consensual contact of any type with a
resident. Even if there is capacity to give consent, consent obtained through intimidation, coercion or fear is
considered sexual abuse. It includes unwanted touching of the breast or perineal area. A resident who
fondles or touches a person's sexual organs and the resident being touched indicates the touching is
unwanted through verbal or non-verbal cues. A report will be made to the local police department
immediately and not exceeding 2 hours after or within 24 hours of the allegation being made, forming
suspicion or allegation of sexual abuse.All allegations and/or suspicions of abuse must be reported to the
Administrator immediately. Abuse policy incorporate elements of the 1150B of Social Security Act to report
reasonable suspicion of crimes. Both abuse policy and 1150B of Social Security Act outlines the procedure
on reporting to law enforcement by long term care facility. The facility shall report to law enforcement
entities for the political subdivision in which the facility is located any reasonable suspicion of a crime (as
defined by the law of the applicable political subdivision) against any individual who is a resident of, or is
receiving care from, the facility. Per policy example of a crime in all political subdivision (city, township, or
village) include sexual abuse.
Event ID:
Facility ID:
145634
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation 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.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
FAQ · About this visit
Common questions about this visit
What happened during the October 28, 2025 survey of ASTORIA PLACE LIVING & REHAB?
This was a inspection survey of ASTORIA PLACE LIVING & REHAB on October 28, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ASTORIA PLACE LIVING & REHAB on October 28, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities."
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
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.