Health inspection·March 4, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on records review and interviews, the facility failed to provide person-centered care planning for a resident ' s behavioral concern who refused psychotropic medication for 1 (R1) of 3 residents reviewed for inadequate nursing care. This failure impacted 1 resident (R1) who expressed behavioral concerns and continues to refuse medications that may help with behavioral concerns. Without adequate care planning addressing medication refusal, resident (R1) has the potential to continue to express behavioral concerns. Findings include: R1 is [AGE] years old, initially admitted on [DATE] with medical diagnosis of mood affective disorder, anxiety disorder, cocaine abuse, bipolar disorder, manic severe disorder. Per MDS (Minimum Data Set) assessment, R1 cognition is intact with a BIMS (Brief Interview for Mental Status) of 15. On 02/27/2025 at 11:17 AM, during initial review, facility staff V4 (Registered Nurse) noted that R1 was out on pass. R3 roommate of R1 was present during this time. R3 said, I think he is a guy that always something ain't right. R3 was asked to elaborate what he means with his statement. R3 stated, Something always wrong with him. I mean he always complaining. At 12:01 PM, V3 (Case Manager of R1 / Emergency Contact of R1) stated that R1 was complaining about mistreatment, and not getting respect he deserves. V3 stated that R1 told him that R1 had a verbal altercation with a staff member. And that R1 has repeatedly spoken his unhappiness in the facility. R1 did not say that staff hit him. V3 said, No, staff not physical aggressive but verbally negligence. V3 made as an example that R1 was asking for Robitussin 4 or 5 times. And after that, staff told R1 that there is no more Robitussin. V3 stated that he was informed by R1 that he refused medication because he does not trust staff in the facility that gives his medication. V3 was asked in his determination, R1 is a victim of abuse. V3 replied, No, I haven't witness it. I could not say that staff are abusive, I only have what he was saying. All I can say is what I witness. I cannot say staff was abusive with him. I can only say what I witness. Review of R1's notes documents multiple behavioral concerns between R1 to staff or other residents. R1 went to the hospital on [DATE] due to aggressive behavior towards staff and peers. Per V7 (Social Worker) notes dated 01/24/2025, it documents that V3 (Case Manager of R1) was given an update about R1's aggression towards staff and peers. R1 returned in facility on 01/29/2025. Per R1's physician orders psychotropic medication were ordered related to R1's behavior. Hydroxyzine HCl 25 MG (antianxiety) to be given twice a day for anxiety and agitation order date 01/22/2025. And Seroquel 50 MG (antipsychotic) to be given every 12 hours for bipolar and manic severe disorder with order date of 01/29/2025. (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 03/04/2025 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)