Inspection·February 20, 2026

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of records and interviews, the facility failed to ensure interventions were in place to prevent weight loss for 1 out of 3 residents (R3) reviewed for nutritional care. These failures are not in accordance with facility's nutrition policy and affected 1 resident (R3) who sustained multiple significant weight loss.Findings include: R3 [AGE] year-old resident initially admitted on [DATE]. R3's medical diagnosis includes intracerebral hemorrhage, encephalopathy and dysphagia among others. R3 was on enteral feeding upon admission and does not take any food and fluids by mouth. All nutrition will be administered via tube feeding. Weight history records show that R3 sustained multiple significant weight loss from 07/25/2025 initial date of admission to 01/04/2026 three (3) days prior to resident (R3) transfer to hospital on [DATE]. Per R3's weight history, R3's weight upon admission dated 07/25/2025 was 165.0 LBS. On 10/27/2025 R3's weight was 161.8 LBS. On 11/24/2025 R3's weight was 150.0 LBS, a decrease of 11.8 LBS or 7.3% for a period of 28 days. On 12/07/2025 R3's weight was 150.8 LBS. On 12/14/2025 R3's weight was 143.5 LBS, a 7.3 LBS or 4.84% for a period of 7 days or 1 week. On 01/04/2026 R3's weight was 142.5 LBS, a loss of 22.5 LBS or 13.64% for a period of 163 days or 5 months (30 days per month) and 13 days. Per facility's policy on Nutrition Care Significant Weight Loss dated 01/2028: A significant weight loss is 5% in one month, 7 1/2 % in 3 months and 10% in 6 months. Full care plan of R3 was reviewed, significant weight loss was not included or addressed. On 02/19/2026 at 12:55 PM, V3 (State Guardian of R3) stated R3 was transferred to another facility due to hospital doctor recommendation that R3 was not being fed properly in the facility. According to V3, hospital doctor informed him that R3 has poor laboratory results during evaluation that shows R3 was not properly fed. R3 currently is on another facility. Per R3's laboratory results dated [DATE] done in the facility, R3 results on BUN (Blood Urea Nitrogen) 181 mg/dL normal range between 7 to 23 mg/dL. Sodium level 178 mg/dL normal range between 133 to 148 mmol/L. Chloride level 133 mmol/L normal range between 95 to 112 mmol/L. BUN (Blood Urea Nitrogen), Sodium level and Chloride level results are at critical results. Nursing notes of V12 (Registered Nurse) dated 01/07/2026 documents that R3 transferred to hospital due to oral bleeding. V12 received critical laboratory results after R3 was transferred to hospital. V2 (Director of Nursing) on 02/18/2026 stated that R3 has several hospitalizations that may contribute to R3's weight loss. Residents that have weight loss need collaboration from nursing, the dietitian, doctor and family. V2 after reviewing R3's full care plan stated, I mean weight loss should be addressed in the plan of care, but resident has a lot going on. V8 (MDS Coordinator) on 02/18/2026 at 11:34 AM stated that care plan needs to be updated according to the schedule and as needed. Newly identified problems or concerns including pressure sores or significant weight loss need to be care planned. V8 reviewed R3's full care plan stated: No, I don't see a weight loss care plan in there. V7 (Registered Dietitian) on 02/18/2026 at 12:21 PM stated that R3 was NPO or does not take food with mouth since admission in July 2025. All nutrition is given via enteral feeding or tube feeding. V7 stated that R3 did have Residents Affected - Few (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: 145688 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 145688 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Princeton Rehab & Hcc 255 West 69th Street Chicago, IL 60621 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)