Inspection·January 15, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure patient care equipment was maintained to ensure residents were able to get out of bed for 4 of 4 residents (R1,R2,R3,R6) reviewed for full body mechanical sling lifts in the sample of 4. Residents Affected - Some The findings include: On 01/15/2025 at 9:10AM, the #2 full body mechanical sling lift inspection sticker showed inspection was performed October 2024 and is due for re-inspection January 2025. On the lift arm that supported the resident there was exposed wires and what looked like part of a broken cover. At 9:30AM, there was a sign on lift #2 that showed, OUT of ORDER. The #8 full body mechanical sling lift inspection sticker showed, Preventative Maintenance 05/31/19. On 01/15/2025 at 9:20AM, V3 Maintenance said, I have not received any reports from the Nursing Staff on the need for mechanical lift maintenance or repair. There is a portal in our computer system that generates a workorder, that would be the proper way to request maintenance. Usually staff just call me, leave a voice mail, email, or report directly to me, even leave me a note, all those options work well. On 01/15/2025 at 9:30AM, V3 Maintenance said, Lift #2 has an exposed load cell for the scale. There is a sharp areas exposed, it should be covered up. This equipment is used for people. This does not look pretty; it should be a priority for repair. Equipment used for people comes first. On 01/15/2025 at 9:46AM, R1 said, on 01/12/2025 it took three hours for the staff to find a full body mechanical sling lift to get me out of bed. I wanted to go to the activity room to play cards with my friends. By the time they found a lift, it was too late in the evening, so I just stayed in bed. We need more full body mechanical sling lifts in the facility. On 01/15/2025 at 10:20AM, R3 said, I do not always want to get up for meals, but it would be nice to get up for an activity occasionally. I was told they ordered a piece of equipment and are waiting for it to be delivered before they can get me out of bed. On 01/15/2025 at 10:35AM, R2 said, I do not find it hard to get out of bed when I make the request, it's getting staff to put me back to bed with the full body mechanical sling lift. Usually it is two people to transfer me with the lift .every so often the CNA will do it alo ., .well, we could use some more staff .not agency staff though. On 01/15/2025 at 10:36AM, R6 said, we need more full body mechanical sling lifts in the facility. (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: 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 01/15/2025 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)