Health inspection·May 19, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect a resident's right to be free from misappropriation of resident property and/or exploitation. This failure affected one (R1) of three residents reviewed for misappropriation and/or exploitation as a result of R1's credit card being stolen by facility staff, who made unauthorized charges of more than $1000.00 on R1's account. Residents Affected - Few Findings include: R1 is [AGE] years old and was admitted to the facility on [DATE]. Past medical history includes, but not limited to displaced intertrochanteric fracture of right femur subsequent encounter for closed fracture with routine healing, major depressive disorder, Type 2 diabetes, chronic obstructive pulmonary disease, essential primary hypertension, anemia, generalized anxiety etc. Facility reported incident dated 4/27/2025 at 11:15AM documents the following: on 4/27/2025, V1 (administrator was notified by V10 (social worker) that V3 (Family Member) alleged that R1's credit card had been compromised with charges. No staff was identified in the original allegation. On 5/13/2025 at 11:01AM, V3 (Family member) stated that he noticed some charges totaling over $1000.00 on R1's credit card statement. He (V3) reported the incident to the facility, filed a police report and gave a copy of the report to the facility. The detective in charge of the case called him (V3) and said that they identified the person who used the credit card through a security camera. The officer stated he was going to reach out to the facility. V3 stated that he (V3) has not heard anything since then, he (V3) is not sure if the person is a regular staff or agency. On 5/13/2025 at 11:50AM, R1 was observed in her room, awake and alert with some confusion, stated that she just came back from therapy. A brown purse noted on resident's bed, surveyor asked R1 about her missing credit card, but she (R1) could not remember. V3 was at the bedside at this time and reminded R1 of her missing credit card and she (R1) said, Oh Yes, looked at surveyor and said, who did that? Surveyor asked V3 (Family member) if R1 still has the card and what were the total charges. V3 stated that he (V3) gave a screen shot of the charges to V1 (Administrator), the total charges were more than $1000.00, at local restaurants and stores. V3 added that the person who took the card never returned it. R1 does not have the card, and the family just canceled the card. 5/13/2025 at 12:00PM, V1 (Administrator) stated that the incident was reported to the social worker over the weekend, she (V1) became aware on Monday when she (V1) came back to work and initiated an investigation. The resident's family gave a card containing the police report number which she provided to surveyor. V1 also provided a copy of the charges that were made to the resident's card, a screen shot that was sent to her by V3. (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: 145700 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 145700 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Chicago Ridge 10300 Southwest Highway Chicago Ridge, IL 60415 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)