F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** The facility
failed to ensure the resident's call light device was within reach for two residents (R1, R3) out of three
residents reviewed for quality of care. This failed practice placed the resident at risk for not being able to call
for help, if needed.
Residents Affected - Few
Findings include:
On 10/22/2024, 10:41 AM R1's call light was on top of 3 pillows without pillowcases that are on top of R1's
nightstand. R1 was sleeping, easily arousable, and in no apparent distress. R1 states that she is not sure
when she first came to the facility. R1 states I have memory loss, maybe about 6 months ago, I don't like it
here. R1 cannot remember the names of the staff that take away her call light. R1 states that when they do
come to check on her, R1 states that she forgets what she even yelled out for. R1 cannot remember when
she yelled out for help. R1 states that currently, she cannot reach her call button. R1 states look and see
they took it away from me, I can't reach it.
On 10/22/2024, 10:55 AM V3 (Certified Nursing Assistant) states that call lights must be in reach of the
residents. V3 states that she has not heard any resident yell out for help. V3 reports that residents who are
more vulnerable and must have their call light within reach is contracted, if a resident has some confusion,
or residents that are non-verbal or non-ambulatory. V3 states that residents should not be ignored if they
are yelling for help because they might need or want something, or they can be slipping. V3 and surveyor
entered R1's room and V3 states that R1's call light is not within reach. V3 grabbed R1's call button that is
on top of the pillows on the nightstand and placed it within R1's reach. R1 states thank you. V3 states that
she has not taken away call lights form any resident because that is neglect.
R1's Face sheet documents that R1 is a [AGE] year-old female admitted to the facility on [DATE], who has
diagnoses not limited to: paraplegia, major depressive disorder, insomnia due to other mental disorder,
bipolar disorder.
R1's Minimum Data Set (MDS) Section C, dated 10/02/2024, documents R1 has a Brief Interview for
Mental Status (BIMS) of 12 out of 15, R1 is moderately cognitive impaired.
R1's Minimum Data Set (MDS) section GG dated 10/02/2024, documents in part R1 needs
substantial/maximal assistance for ability to roll from lying on back to left and right side and return to lying
on back on the bed.
On 10/22/2024, 11:05 AM R3 was lying in bed, covered in a white sheet, in no apparent distress. R3's call
button attached to the lowest part of the right bed side rail. R3 states I need a diaper
(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:
145661
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
145661
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/25/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Ryze West
5130 West Jackson Boulevard
Chicago, IL 60644
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 0558
change; I don't have the call light as R3 looked around for his call button.
Level of Harm - Minimal harm
or potential for actual harm
On 10/23/2024, 10:09 AM R3's call light button noted on the floor. R3 states that his nurse gave him some
medicine earlier.
Residents Affected - Few
On 10/23/2024, 10:12 AM surveyor and V9 (Licensed Practical Nurse) entered R3's room and V9 states
that the call button should not be on the floor. V9 states it probably slipped off of him. It was on his chest. I
did initially go to him because he pulled the call light. V9 states that she did not move R3's call light away
from him. V9 denies any resident complaining of this to her. V9 states that it is important for residents to
have their call light within reach just in case an emergency happens or if they ask for something simple as
some water.
R3's Face sheet documents that R3 is a [AGE] year-old male admitted to the facility on [DATE], who has
diagnoses not limited to: adult failure to thrive, history of falling, syncope and collapse, generalized anxiety
disorder, major depressive disorder, recurrent, unspecified, legal blindness.
R3's Minimum Data Set (MDS), dated [DATE], documents R3 has a Brief Interview for Mental Status
(BIMS) of 14 out of 15, indicating R3 is cognitively intact.
R3's care plan dated 5/14/2024 documents in part R3 has a potential for falls. R3 had an actual fall.
Interventions include encourage to utilize call light for staff assistance, have commonly used items within
reach.
Facility policy dated 01/10/2024, titled Call Light Response documents in part, to provide the staff with
guidance on responding to residents' requests and needs. Ensure the call light is always within the
resident's reach. When the patient or resident is in bed or confined to a bed or chair, provide the call light
within easy reach of the patient or resident.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145661
If continuation sheet
Page 2 of 2
