Health inspection·January 4, 2026

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide a working call light for one (R4) of five residents reviewed for call lights. This failure resulted in a delay of staff helping R4.Findings include: R4 is a [AGE] year-old male, admitted to the facility on [DATE] with diagnoses not limited to End Stage Renal Disease, Heart Transplant Status, Depression, Unspecified, Type 2 Diabetes Mellitus Without Complications, Essential (Primary) HypertensionR4's care plan documents in part: Focus: dated initiated:12/31/2025 Goal: I (R4) will be free of falls through Date initiated: 12/31/25 Interventions: I would like staff to provide me a safe environment: even floors, free from spills and/or clutter; adequate, glare-free light; a working and reachable call light, the bed in low position at night; Side rails as ordered, handrails on walls Date Initiated: 12/31/2025On 1/2/2026 at 12:41pm R4 was sitting in chair in his room alert, able to make needs known, dressed and groomed. As surveyor was touring facility, R4 was calling out for help and repeating that he needed help. Surveyor knocked on door and R4 stated, surveyor could come in. R4 stated was not able to state how long he was calling for help, but he needed help getting back in bed and no one was coming. R4 further stated, he had been pushing call light, and it was not working, and the light did not come on. R4 was able to reach call light and was told if he needed something to use his call light so he could get help. Surveyor observed R4 pressing call light and the light did not come on above door, the light on the call light panel was not on, and there was no audible sound. On 1/2/2026 at approximately 12:45pm Surveyor approached V11 (Restorative Aide) and informed her that R4 needed help. V11 stated, staff was passing out lunch trays, but V11 and surveyor entered R4's room and V11 asked R4 what was needed. R4 showed V11 that he was pressing call light button. V11 stated, the light is supposed to light up outside the door and residents use the call light to let staff know they need help. R4 further stated, he wanted to go back to bed. On 1/2/2026 at 12:48pm V7, Agency Licensed Practical Nurse (LPN) was asked how residents get help if their call light does not work. V7 stated, that is a good question, without the call light we would not know the resident needs help. With R4's permission, Surveyor and V7 entered R4's room and V7 attempted to re-plug in call light. V7 stated, the light is not working for bed one or bed two, maintenance will have to be called. On 1/2/2026 at 12:52pm V12 (Maintenance Assistant) came to R4's room to check call light. V12 stated, when the resident presses the call button, the light is supposed to come on over the door. V12 stated, call lights are checked once a month, but if I go into a room, I will check everything. I just fixed this call light. Sometimes when the cord is wrapped around the bed it can get pulled out the wall. Both call lights for bed one and two go into one unit. If one does not work, the other will not work. If I cannot fix the call light, the resident will get a bell or moved to another room.On 1/2/2026 at 1:00pm V12 and surveyor entered R4's room with R4's permission. V12 stated, the call light is not working, it is not connected. Somehow it came off the wall the other day and I fixed it; it must have come lose. V12 detached the panel and Residents Affected - Few Page 1 of 2 145734 145734 01/04/2026 Avantara Evergreen Park 10124 South Kedzie Evergreen Park, IL 60805

F 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wire not connected. V12 stated, I need to solder it back. Neither call light will work. I last fixed this call light the Saturday before Christmas. I will solder it back, it may have been pulled out.On 1/2/2026 at 1:04pm V6, Certified Nursing Assistant (CNA) stated, he was the CNA for R4, and he can pull the call light if he needs help, it is by him. I check him because he is a fall risk, and he has mats on the floor. V6 stated, if the call light does not work, they call maintenance. The resident is supposed to press the call light if they need help. Surveyor asked V6 if call light does not work, how does resident get help. V6 stated, that is a good question.On 1/2/2026 at 1:13pm V10, Nurse Manager stated, residents use their call light to get help. If a call light is not working, we do frequent rounds until maintenance can get to them. Anyone can notify maintenance that equipment needs to be fixed. For new admissions we check call light and maintenance checks call light. When toileting residents staff make sure call light works.On 1/2/2026 at 1:49pm V2, Director of Nursing (DON) stated, we always make rounds every 2 hours and the resident will use the call light. If the call light does not work, we call maintenance and let them know the call light is not working. We have a sheet for maintenance, and we put what room and bed the call light is not working. We tell the resident if they need help to press the call light. I have never experienced a call light not working. No one complained to me that the call light is not working. They are supposed to press the call light if they need help, that is the purpose of the call light. The nurse and other staff make rounds as well. Residents are instructed to press their call light if they need help. If the call light is not working consistently check on resident until the call light is repaired. On 1/3/2026 at 12:08pm V4, Assistant Administrator, stated call light system is routinely checked. If there is a problem with the call light will call maintenance and if they cannot fix will call the company to come out. If the call light does not work, we give a bell or change a room. The call light is used when the resident needs assistance. Residents are told to press the call light if they need something. On 1/3/2025 at 1:45pm V12 stated. We do not put what we fix in log if we fix when we are here.Review of Maintenance Request Log shows on 12/30, location R4's room, Work Requested - Call Light, Status - check marked in box, V12 unable to show if call light was fixed and what was the concern with the call light.Facility Call Light Policy Revised: 6/30/25 documents in part: Policy Statement It is the policy of this facility to ensure that there is prompt response to the resident's call for assistance. The facility also ensures that the call system is in proper working order. Procedures 1. Facility shall answer call lights in a timely manner. 3. Nursing staff shall check all call lights daily and report any report defective call lights to the administrator I maintenance immediately for repair. 4. If a call light is not functional, evaluate and provide another means in order for the resident to call for assistance (i.e. bell} until the call light is fixed. 6. Be sure that when the call light is triggered, it will either alert the staff visually or audibly or both. 145734 Page 2 of 2