F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
Based on observations, interviews, and record reviews, facility failed to follow their policy to ensure
residents received medications according to the physician order for 3 residents (R1, R2, R6) out of of 3
residents reviewed for medication administration in a total sample of 6.
Findings include:
On 5/6/2025, at 11:00 AM, surveyor observed R2 in her bedroom. R2 stated that sometimes the nurses
take forever to administer medications. R2 stated that today she received her medications. R2 stated that
she is not sure when.
On 05/06/2025, at 11: 05 AM, surveyor asked V3 to show him the medication administration report for the
3rd floor residents. R1, R2, and R6's medication administration report (MAR) was marked red. Surveyor
asked V3 what does it mean when residents' reports are marked 'Red'. V3 stated that if the medication
administration report is 'red' that means the nurse has not documented that the medications were given. V3
stated that he is not sure if V4 (Registered Nurse) has administered all her medications yet.
On 05/06/2025, at 11:14 AM, R1 stated that he has not received his morning medications yet.
On 05/06/2025, at 11: 15 AM, R6 stated that he has not received his scheduled morning medications yet.
On 05/06/2025, surveyor observed V4 (Registered Nurse) administering medications to residents on the
3rd floor. R1 received scheduled 9:00 AM medications at 11:47 AM. R6 received scheduled 9:00 AM
medications at 11:50 AM:
On 05/06/2025, at 11:47 AM, R1 received Vitamin D 1000 MG, cetirizine 5 MG (milligrams) oral and
Arginaid 1 Unit packet.
On 05/06/2025, at 11:50 AM, R6 received Bupropion 150 MG oral tablet, Enoxaparin Injection, and
Topermate 50 MG oral tablet.
On 05/06/2025, at 12:00 PM, V4 (Registered Nurse) stated that she knows she administered some
medications two hours late today. V4 stated that the expected time to administer medications is within one
hour prior and after of the scheduled time. V4 stated it was because she had to escort R2 outside and she
got delayed to administering her medications.
(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:
145730
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
145730
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/13/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Continental Nursing & Rehab Center
5336 North Western Avenue
Chicago, IL 60625
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)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
On 05/07/2025, at 2:55 PM, V2 (Director of Nursing) stated that the expectation is for nurses to administer
medications either, one hour prior and/or one after the scheduled time. V2 stated that nurses are to
document immediately after administering medications. V2 stated that if it is not documented then the task
was not done.
R1, R2 and R6's Minimum Data Sheet Section C (4/10/2025) documents in part: R1, R2 and R6's Brief
Interview of Mental Status (BIMS) is 15, which means all three residents are cognitively intact.
R6's Medication Audit Report (5/6/2025) documents in part: Enoxaparin Sodium Injection Solution Prefilled
syringe. Inject 0.4 ML (milliliters) subcutaneously two times a day for DVT (deep vein thrombosis)
prophylaxis. Scheduled time: 5/6/2025, at 9:00 AM. Administration time: 05/06/2025, at 11:43 AM.
Bupropion oral tablet 150 MG. Give 1 tab one time a day for Depression. Scheduled time: 5/6/2025, at 9:00
AM. Administration time: 05/06/2025, at 11:43 AM.
R2's Medication Audit Report (5/6/2025) documents in part: Depakote oral tablet 250 MG give two times a
day for epilepsy. Scheduled time: 5/6/2025, at 9:00 AM. Administration time: 05/06/2025, at 11:56 AM.
Clozapine 200 MG tablet, give two times a day for schizophrenia. Scheduled time: 5/6/2025, at 9:00 AM.
Administration time: 05/06/2025 at 11:56 AM.
Facility Drug Administration Guidelines (undated) documents in part: Medications are administered within
120 minutes of scheduled time, except before or after meal orders. The individual who administered the
medication, records the administration on the resident's MAR at the time the medication was given. At the
end of each medication pass, the person administering the medication reviews the MAR to ascertain that
all necessary doses were administered, and all administered doses were documented.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145730
If continuation sheet
Page 2 of 2
