Health inspection·January 25, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident's right to return to the facility following hospitalization. This failure applied to one (R1) of three residents reviewed for discharge procedures.Findings include:R1 is an [AGE] year-old resident with diagnoses including vascular dementia, was cognitively intact per the 9/22/2025 MDS/Minimum Data Set (BIMS/Brief Interview for Mental Status) score 14/15). Psychiatric evaluation dated 8/31/2025 documented the resident as pleasant, calm, cooperative, and without behavioral issues.On 9/29/2025, R1 was transferred to the hospital after exhibiting agitation and did not return to the facility.On 1/24/2026 at 1:26PM the Director of Nursing (V2) stated, the Administrator and I decided not to allow R1 to return due to behavior concerns.Facility was asked to provide documentation of a physician assessment determining the reason that the resident could not be safely cared for in the facility and this was not provided during the course of the survey.On 1/24/26 at 1:50PM, R1's primary physician (V11) stated that he had not seen the resident and had no record of evaluation. No documentation was provided showing that a psychiatric reassessment following the behaviors cited by the facility.Record review revealed no written discharge notice, no discharge planning documentation, and no evidence the resident or representative was informed of appeal rights. There was no change in condition noted in R1's medical record.Surveyor asked facility to provide any and all documentation or assessments used in the determination of R1's involuntary discharge and none were provided during the course of this survey.Facility policy Bed Hold and Readmission (revised 6/26/2025) reads:Policy Statement: It is the facility's policy to adhere to the federal regulation on the bed hold and on readmission of the resident transferred out of the facility.The facility must permit residents who were transferred for hospitalization or therapeutic leave and whose absence exceeds the bed hold period, as defined by the State plan, to return to the facility in the first available bed.Facility policy Titled Discharge Planning and Instruction (revised 6/30/2025) reads:Policy Statement: It is the policy to conduct proper discharge planning for all residents and provide appropriate discharge instructions in preparation for discharge on ce a discharge order is obtained from the resident's attending physician. 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 01/25/2026 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)