Inspection·May 28, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their policy to conduct a contraband search on one (R1) of three residents reviewed for contraband possession. This failure resulted in R1 falling and hospitalized with a diagnosis of opioid overdose, and laceration of right eyebrow. Finding include: On 5/28/2025 at 11:52 AM, V3 (LPN) said that R1 did not fall on V3 shift. V3 said R1 is alert and oriented and makes his needs known. V3 said that R1 has a pass to go with relatives. V3 said that R1 went out with relative today about 8:30 am and was expected to be back to the facility around 2:00 PM. V3 said that the social service told V3 that R1 must be checked by the social service before R1 can get back into R1's room. V3 said that the social services are responsible for checking the residents before the residents return to their rooms. On 5/28/2025 at 12:04 PM, V4 (LPN) said that when V4 initially rounded on R1, R1 was alert and oriented and conversing. V4 said about less than ten minutes while V4 was walking the hall, V4 saw R1 on the floor in another resident's room. V4 called out to V2 (Director of Nursing) for help. V4 assessed the resident, V4 said that R1 was unresponsive, and 911 was called to transport to ER. On 5/28/2025 at 12:58 PM, V5 (Director of Social Services) said that R1 has never been out by himself. V5 said R1 is always accompanied by a family and friends. V5 said that R1's family comes and takes R1 out. V5 said that if R1 has not had any visitor to stay with him in the facility, but if he does have a visitor who wants to spend time with him in the facility, V5 said that the visitation will happen in the day room and monitored by the staff. V5 said that V5 was informed that R1 was unresponsive and was sent out to the hospital. Prior to 5/19/2025 incident, V5 said on 4/14/25 V5 observed R1 who appeared to be asleep, upon entering the room and getting closer R1, V5 observed a rolled-up dollar in R1's hand. V5 said that R1 was breathing, V5 shouted out R1's name and received no response. V5 said V5 notified the nurse and V5 removed the dollar from R1's hand, unrolled it and notice a white powdery substance on the dollar. V5 said that R1 was aroused and asked to identify the substance on the dollar in-which R1 refused to do so. V5 said that R1 was asked the question if there was any more of this white powdery substance in R1's possession and R1 stated I don't know what you are talking about. V5 said that R1's living area was searched and there was no contraband found. V5 said that after the incident, R1 was only allowed to go out with responsible party. V5 said that R1's belongings were supposed to be searched upon return from outing. V5 said that social services are supposed to search R1 belongings when he returns from outing. V5 said that V5 was not in the facility when R1 went out on pass on 5/19/2025. V5 said that V5 was not made aware that R1 was back into the facility. V5 said that V5 is not sure if any social worker searched R1 belongings when he returned from (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 3 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 05/28/2025 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)