Health inspection·March 23, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide a clean, comfortable, and homelike environment for 9 (R3, R4, R5, R6, R7, R8, R10, R11, and R12) of 12 residents reviewed for environment. The findings include: On 3/22/25 at 10:04AM R8's room has four tiles missing from the main room floor. R8 was observed in the bed, opened her eyes but did not respond to the surveyor's question. On 3/22/25 at 10:06AM R3's room was observed. The top veneer finish lifts off to expose plywood/particle board underneath. A round hole was [NAME] key lock fell out. 2 window curtains in the room, one is hung and can slide to open and close, but second curtain is partially hung. Curtain hooks/clips observed on the window ledge. Trim boards look dirty with discolored, dark black/brown grime. Black, dark, spotted discoloration along floor trim and floor that is along wall. R3 said her window curtains have been like that for a couple weeks. R3 said she is unable to open or close the windows, they stay like that. R3 said the dresser in the room was her room mates, it's been like that for some time. R3 said housekeeping has not been in to clean her room today. R3 said that was my roommate's dresser. R3 showed surveyor her bathroom. R3 turned on the cold-water faucet and then the faucet for hot water. Only a dribble of hot water came out. R3 said it makes it hard to wash up. There are four missing tiles in R3's bathroom. R3 said the floor has a lot of wear and tear, it's been like that so long as I can remember. R3 said some rooms are better than others. R3 said yes, she has reported the faucet, curtain, and tiles, but the staff have a lot to do. On 3/22/25 at 10:13AM R4-R7 are roommates. Three residents were in the room during observation. No window curtain in the room. On 3/22/25 at 10:15 R12's room has 1 square tile near bathroom door lifted up and some pieces cracked. On 3/22/25 at 10:23AM R10's bathroom is observed and the toilet seat has a brown substance smeared on it. On 3/22/25 at 10:30AM V2 (Certified Nurse Assistant-CNA), said R12 walks into the bathroom and uses the toilet, but she still needs staff assistance with toilet hygiene. V2 said R11 walks around but needs staff assist with toilet cares. V2 said R2 is bed-bound and won't use the bathroom. R2, R10 and R11 are roommates. (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: 145714 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 145714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Park Oasis 625 North Harlem Oak Park, IL 60302 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)