Inspection·February 7, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to follow its Transfer policy by failing to provide a two persons assist while transferring a dependent resident from bed to wheelchair. This failure affected one of three residents (R1) reviewed for accidents. This failure resulted in R1 falling from a mechanical lift to the floor and sustaining a fracture of the left superior and inferior pubic rami medially, a sacral fracture and small hematoma. Findings Include: On 2/5/25 at 10:30am, V3 (RN) stated that she provided care to R1 on the day of the fall (2/3/25) and was called to the room by V4 (CNA) after R1 slid out of the sling to the floor during transfer from the bed to the wheelchair. V3 stated that she assessed R1 and noted a cut on the left outer ear. V3 stated that 911 was called and R1 was taken to the hospital for further evaluation. On 2/5/25 at 10:20am, V5 & V9 (CNAs) both stated that R1 is a two person assist with mechanical lift. Both stated that there is a color sticker on each resident's bed which indicates the residents transfer status. V7 (RN) stated that she has provided care to R1. V7 stated that R1 is a two-person mechanical lift transfer. On 2/5/25 at 10:30am, V6 (Private Caretaker) stated that she assisted V4 (Primary CNA) in transferring R1 from bed to wheelchair, she applied the right and left sling onto the right leg and left arm. On 2/5/25 at 11:00am V4 (Primary CNA) stated that R1 requires a mechanical lift with two persons assist. V4 stated that she and V6 (Private Caregiver) applied the sling onto R1. V4 stated that she applied the upper and lower left side of the sling while V6 applied the right side. V4 stated that during the process of moving the mechanical lift the left leg came out and R1 slid out to the floor. V4 stated that this is the first incident with R1 and she has worked for 30 years in the facility. V4 stated that she provides care to R1 regularly and receives in-services once a month on mechanical lift transfer. V4 stated that each resident has a color sticker on the head of the bed which let staff know the transfer status of the resident. On 2/5/25 at 11:30am, V2 (Director of Nursing) stated that the investigation is ongoing, and she does not know how the resident fell out of the sling. V2 stated that R1 is a two person transfer with mechanical lift. V2 stated that, a plan of correction is currently ongoing, and all steps are being taken to keep residents safe during mechanical lift transfer. V2 stated that R1 has never fallen in the past, and this is the first fall incident with R1. (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: 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 02/07/2025 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)