Health inspection·May 24, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failured to ensure no medication was kept at the resident 's bedside without a physician order. The facility also failed to assess a resident for safe medication self-administration. This deficiency affects one (R41) of three residents in the sample of 26 reviewed for Medication safety. Residents Affected - Few Findings include: On 5/22/24 at 10:02AM, Observed R41 sitting on her bed. She is alert and oriented x 3, and able to verbalize her needs to staff. She said her buttocks hurt due to her bed sore. She said the wound care nurse gave her medication to apply to her buttocks for pain. She opened her bedside drawer and showed the surveyor the medicated ointment- Calmoseptine. She also showed the surveyor her other medications kept at bedside such as Bio freeze roll on and artificial tears eye drops. She said that she uses the Bio freeze roll on daily and as needed for her pain on her right shoulder due to her frozen shoulder. She demonstrates how she is having difficulty applying the medication to her right shoulder using her left hand due to limited movement. She added that medications in her drawer are disorganized because she was recently transferred from the 3rd floor to 2nd floor. She said that the staff helped her to transfer her personal belongings. She said the nurses are busy and does not want to bother them. On 5/22/24 at 10:30AM, Informed V3 Assistant Director of Nursing of above observation made. She said that residents are not allowed to keep medication at the bedside without a physician order. She said that a resident who request to keep and take their medications by herself will be assessed for Self-administration medication safety. On 5/22/24 at 3:00PM, Informed V1 Administrator and V2 Director of Nursing (DON) of above concern. V2 DON said that resident medication is not kept at the bedside without a physician order. If a resident request for self-medication administration, the interdisciplinary team (IDT) will assess the resident for safety of medication self-administration. R41 was admitted on [DATE] and re-admitted on [DATE] with diagnosis listed in part but not limited to Osteoarthritis. Active physician order sheet does not indicate order for: Calmoseptine ointment, Bio Freeze roll on and artificial eye drops. No order indicates to keep medication at bedside. Care plan indicates she has potential for pain related to diagnosis of Osteoarthritis. She is at risk for alteration in skin integrity. Her care plan does not indicate Self-medication administration at bedside. Facility's policy on Medication Storage revised 7/2/19 indicates: (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 6 Event ID: 145683 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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)