Inspection·January 2, 2025

F 0758 Level of Harm - Actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to monitor for behaviors and report the side effects of a resident's anti-psychotic medication. This failure resulted in R4 continuing to receive Seroquel and experiencing a hospitalization, increased falls, and inability to participate in his rehab care. This applies to 1 out of 3 (R4) residents reviewed for psychotropics. The findings include: R4's EMR (Electronic Medical Record) showed R4 was admitted to the facility on [DATE] with multiple diagnoses including a history of falls, metabolic encephalopathy, vascular dementia, depression, epilepsy, convulsions, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, urinary tract infections, and left femur fracture. R4's MDS (Minimum Data Set) dated 10/18/2024 showed he was severely cognitively impaired and receiving high-risk medications including antipsychotics, antidepressants, and anticonvulsants. R4's EMR showed he was transferred to the hospital on [DATE] and did not return to the facility. On 12/31/2024 at 8:50 AM, V8 (R4's Wife) said she would visit R4 frequently at the facility and became worried because he started to become overly sedated as if drugged and having multiple falls. On 1/2/2025 at 9:00 AM, V14 (Registered Nurse/RN) said she had been R4's routine morning nurse during his stay at the facility. V14 said R4 was nice but would become agitated when his wife was not present. V14 said R4 was a high risk for falls and had to be redirected frequently. V14 said R4 was hospitalized because he was noted to be too sleepy. V14 said R4 was non-decisional and V8 (R4's Wife) was his representative and decision-maker. On 1/2/2025 at 10:20 AM, V12 (Geriatric Nurse Practitioner/NP) said she had assisted in managing R4's primary care at the facility. V12 said she did not prescribe R4's Seroquel medication but had decreased, held, and discontinued it because she was informed he was too sedated. V12 said R4's behavior was difficult to manage and difficult to find the right balance of treatment. V12 said ultimately V13 (R4's Psychiatric NP) should have been notified as the ordering prescriber for Seroquel. On 1/2/2025 at 11:00 AM, V13 (Psychiatric NP) said she was consulted to treat R4 for behavior of agitation related to his dementia and managing his Seroquel. V13 said she last saw R4 on 11/7/2024 and decreased his Seroquel after she was informed of his fall. V13 said the facility should have called her first to inform her of R4's side effects as practice for managing residents receiving (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 4 Event ID: 145689 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 145689 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Elk Grove, The 1920 Nerge Road Elk Grove Village, IL 60007 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)