Inspection·May 30, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their policy to provide professional care and services in an environment free from misappropriation of property from one (R2) of three residents reviewed for misappropriation of property. This failure resulted to R2 missing her money in the sum of $50.00. Residents Affected - Few Findings include: On 5/30/2025 at 1:37 PM, V4 (CNA) said that occasionally R2 is assigned to (V4). V4 said that R2 mentioned to her once that R2 told her that, someone stole something from her purse, it looks like $50.00 dollars. V4 said that V4 could not imagine how that could be possible because R2 always carry her purse even when V4 is giving R2 a shower. V4 said that she did not report to anyone that R2 told her that someone stole her money because V4 did not think that can be possible. V4 said that should have reported it to the administrator. On 5/30/2025 at 3:38 PM, V8 (Assistant Director of Nursing) said that V4 notified the management today that R2 complained to her that R2 lost her money. V8 said that V4 did not notify the management on a timely manner. V8 said that the facility frequently gives in - services on abuse including other topics. V8 said that the facility is immediately investigating and filing police report. V8 said that her expectation is for staff to report residents' complaint especially any form of abuse to the administrator immediately because theft is a form of abuse. On 5/30/2025 at 4:38 PM, V2 (Director of Nursing) said that it was news today to her that R2 lost her money. V2 said that V2 has called a police department to investigate. V2 said that her expectation is for staff to report immediately to the abuse coordinator. On 5/30/2025 at 4:55 PM, V1 said that as soon as she was made aware that there is an allegation of missing item, that she followed up immediately by filing a police report. V1 said that the expectation is for staff to report any allegation immediately to the administrator who is the abuse coordinator, so that investigation can be initiated promptly. V1 said the facility has initiated investigation and police department have been notified. R2 is a an [AGE] year-old female admitted on [DATE]. R2 had a BIMS score of 14. On 5/30/2025 at 11:45 AM, R2 said that she had $50.00 dollars stolen from her wallet. R2 said that she always carries her bag because she had things stolen from her before. R2 said that she told the social worker and everybody. R2 said that everybody knew about it, and she even mentioned it to the big boss upstairs. R2 said that 2 or 3 weeks ago, she walked down the hall without carrying her purse. R2 said that she saw the CNA walked towards her room. R2 said that when she returned to her room and brought out her wallet, she noticed that the wallet was not closed all the way. R2 said that when she opened the (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: 145667 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 145667 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Park Ridge 1601 North Western Avenue Park Ridge, IL 60068 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)