Inspection·April 17, 2025

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide appropriate services, equipment, and assistance to maintain or improve mobility with maximum practicable independence. This failure affected two (R1, R2) residents out of four residents who were reviewed for services and equipment. Findings include: R1 [AGE] year-old resident admitted to the facility on [DATE] to 2/26/2025 with diagnoses including but not limited to: enterocolitis to clostridium difficile, urinary tract infection, benign prostatic hyperplasia, hyperlipidemia, hypertension, epilepsy, Cerebral vascular accident with left hemiparesis, and dysphagia. R1's Minimum Data Set (MDS), dated [DATE], documents that R1 has a Brief Interview for Mental Status (BIMS) score of 6/15, which suggests that R1 is cognitively impaired. R2 [AGE] year-old resident admitted to the facility on [DATE] with diagnoses including but not limited to: tracheostomy, chronic kidney disease, encephalopathy, adrenal insufficiency, pituitary mass, Hypothyroidism, urinary retention, dysphagia, chronic respiratory failure, and percutaneous endoscopic gastrostomy. R1's Minimum Data Set (MDS) dated [DATE] documents that R1 has a Brief Interview for Mental Status (BIMS) score of 99, which suggested that R2 was not able to complete the interview. On 4/16/2025 at 12:00 PM V9 (Licensed Practical Nurse), I was the regular nurse for R1 while R1 was at the facility. R1 was on bed rest because of right-sided weakness. R1 required assistance with eating, and activity of daily living, and had a urinary catheter. I don't recall ever seeing R1 without the urinary catheter and R1 used to go to see the urologist for that. On 4/16/2025 at 1:30 PM V8 (Restorative Aide) said that R1 has two programs during the shift. One is the placement of the splint and bed mobility, but I only assisted R1 out of bed to go to the doctor's appointment. On 4/16/2025 at 1:36 PM V11(Family friend) said, I went to R1's doctor's appointment and had to bring R1's wheelchair to the facility because R1 did not have one and staff did not get R1's out of bed unless R1 had a doctor's appointment. On 4/16/2025 at 1:06 PM V7(Restorative Nurse) said, After I complete the assessment on admission, I make recommendations and start a program, also I complete annual, quarterly, and change of condition assessments. The goal is to maintain current ability or improve. After residents are discharged from therapy, the restorative nurse will follow recommendations per physical therapy and add at least two programs for the restorative aides to work with each resident. Every floor has a restorative (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: 145736 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 145736 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Town Manor Rehab & Hcc 6120 West Ogden Cicero, IL 60804 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)