Inspection·April 25, 2025

F 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to regularly re-evaluate, refer, and document any referrals to the local contact agencies for discharge planning and assessment for one (R3) of three residents reviewed. Residents Affected - Few Findings include: R3 is an individual whose current face sheet documents was admitted to the facility on [DATE]. Medical diagnosis include but not limited to: chronic obstructive pulmonary disease, unspecified, major depressive disorder, recurrent, unspecified, rheumatoid arthritis, unspecified, unilateral primary osteoarthritis, left knee. R3's MDS (Minimum Data Set) section C dated [DATE], documents R3 's Brief Interview for Mental Status (BIMS) as 15/15 indicating R1's cognition is intact. MDS Section GG - Functional Abilities document's R3 requires supervision or touching assistance with eating, oral hygiene, Toileting hygiene, Shower/bathe self, Upper body dressing, Lower body dressing, putting on/taking off footwear. On 04/23/2025, at 10:57 AM, R3 was observed in his room laying on his bed. R3 was well groomed, alert, and oriented to person, place, time, and situation. R3 stated he was waiting for the facility to transfer him to an assisted living facility. R3 stated he met with a social worker who left the facility (no name provided) in November 2024, who told him he refereed R3 to the [NAME] program. R3 stated since then, no one has told him when he will be discharged . V8 (Social Services Assistant) has told him he will be handling his discharge arrangements, but he has not been given any update. R3 stated if the facility does not help him find a place, he has nowhere else to discharge to. R3 stated he does not do much at the facility and just stays in his room. R3 would like to be discharged to assisted living because he is independent with his activities of daily living and uses a cane to ambulate. R3 further stated he takes his medications as scheduled. On 04/23/2025, at 1:05 PM, V7 (Nurse Practitioner) stated R3 could be discharged to the community but he is homeless. V7 does not know the discharge planning process because social services is responsible. V7 stated after social services plans the discharge and informs her there is placement for the resident, she would come evaluate the resident for discharge. On 04/23/2025, at 1:25 PM, V8 (Social Services Assistant) and V3 (Social Services Director) stated residents who have been in the facility for more than 60 days qualify to be referred to the [NAME]-[NAME] program for assistance with housing and discharging into the community. V8 further stated R3 is a resident who would benefit from being referred to the [NAME]-[NAME] program because he is stable. V8 stated R3's care plan was last updated on 10/10/2024. Residents' care plans should be updated (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 04/25/2025 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)