Inspection·July 30, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to assist residents who needed help with toileting, grooming, eating, and transfers.This applies to 5 out of 5 residents (R1, R2, R6, R7, and R8) reviewed for activities of daily living. The findings include:1. On 7/29/2025 at 9:30 AM, R1 was in bed. R1 said he required staff assistance with his toileting hygiene because he was incontinent of bowel and had an indwelling urinary catheter. R1 said he filed a grievance concern on 7/25/2025 because he was not assisted with his request for incontinence care. R1 said he then developed skin irritation on his scrotal area and was uncomfortable. At 9:50 AM, V4 (Registered Nurse/RN) assessed R1's catheter and scrotal area. R1's catheter tubing had soiled residue present, was not secured properly and the catheter's port was directly rubbing on his right inner thigh area. R1 also had a gauze dressing on his scrotal area. V4 removed the dressing, and R1 had soiled dry residue and skin irritation on the area. V4 applied a new gauze dressing to R1's scrotal area without cleaning the area and provided no toileting hygiene care.On 7/29/2025 at 1:30 PM, V8 (Wound Nurse) said R1 scrotal irritation was dermatitis related to moisture. V8 said staff was to apply incontinence barrier cream to R1's scrotal area every shift and as needed.R1's care plan, initiated on 2/27/2025, said R1 had an ADL self-care performance deficit, including with personal hygiene and toileting. The care plan's interventions said The resident requires x1 staff assist with personal hygiene and toileting. R1's care plan also said he was at risk for skin impairment, and skin should be kept clean and dry.2. On 7/29/2025 at 9:25 AM, R2 was in bed. R2 said he had been calling for assistance with his morning daily care, including toileting and transferring. R2 said he tried his best to dress himself but was unable to pull his pants up. R2 said he was unsure who his assigned CNA (Certified Nurse Assistant) was because no one had responded to his care request. R2 said he required staff assistance with toileting and transfers because he was incontinent of bowel and required the use of a mechanical transferring lift. At 10:20 AM, V6 (CNA) responded to R2's request for assistance with his ADL care. V6 said she was assigned to R2's care since 6:30 AM but had not assisted him earlier with his ADL care request. V6 then assessed R2's incontinent brief. The brief was soiled with dried feces.R2's care plan initiated on 4/18/2025 said R2 had required extensive to total assistance with his ADLs because he had impaired mobility and was incontinent of bowel. The care plan's interventions said staff were to assist R2 with his ADLs, including dressing, transferring, mobility, and toileting hygiene needs. 3. On 7/29/2025 at 12:00 PM, R8 was sitting in the dining room trying to eat her lunch by herself. R8 was blind and cognitively impaired and was having difficulty eating. R8 used her fingers to try to eat her meal. R8 was served an unopened milk carton and puree food items (non-finger food item). R8's care plan initiated on 7/23/2024, said R8 had an ADL self-care performance deficit, including with eating. The care plan's interventions last updated on 10/10/2024, said Provide finger foods when the resident has difficulty using utensils and The resident requires supervision by staff for her eating needs.R8's ADL documentation report dated 7/29/2025 for eating said R8 required setup Residents Affected - Some (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 07/30/2025 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)