Health inspection·November 26, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review, the facility failed to follow their COVID-19 policy and procedures by failing to establish control of the onset and spread of COVID-19 infection and roomed a COVID-positive resident with a COVID-negative resident . This failure had the potential to affect all 184 current residents in the facility.Findings include:On 11/24/25, V1 administrator presented survey team with the resident roster showing a total of 184 current residents. On 11/25/25, V16 Infection Preventionist provided survey team with the total number residents and staff affected by the COVID-19 outbreak. This list showed 14 total residents on several floors along with 6 affected staff that worked on all floors in the facility. R2 is a [AGE] year old with diagnoses including Osteomyelitis of the Vertebra, Fracture of the 4th Lumbar Vertebra, and MRSA infection. R8 is a [AGE] year old with diagnoses including COVID-19 infection, COPD, and hypertensive heart failure. On 11/24/25, at 10:35 AM, R2 was observed by the survey team in an isolation room with another other resident rooming with R2. Signs were posted on the door that the room was under isolation. The front receptionist offered masks to surveyors during the investigation and indicated that there was a current COVID outbreak in the facility. On 11/24/25 at 11:25 AM, V4 RN said that COVID residents were on all 3 floors and that the facility had an outbreak of COVID-19 that affected both residents and staff. V4 added that she thought the last day of isolation would either be ending today 11/25/25 but was not certain of the exact date. On 11/25/25 at 1:45PM V16, infection control nurse, said to survey team that R2 never had COVID but was placed in a room with a COVID positive roommate (R8). V16 stated, I didn't do the room assignment, the director of nursing V2 and Assistant Director of Nursing V3 did the room assignments. They are aware that R2's roommate (R8) was COVID-positive, but they still roomed him with (R2). V16 said, I know that R2 refused to go to another room that's why they kept him there. Surveyor asked if R8 was moved since that resident was the one positive and should be co-horting with another COVID positive resident, V16 said that she didn't make the decision and that V2 DON and V3 ADON ultimately made the final decisions. Surveyor clarified who the Infection Preventionist was, V16 stated, I am. Surveyors asked how long R2 and R8 were rooming together while R8 was COVID positive, V16 stated, It was for ten days because R8 was positive and isolation was started on 11/4/25 and discontinued on 11/14/25. I assumed they were together, but I did tell the DON and ADON they should be moved. Surveyors asked if R2 was ambulatory and could move about the facility, V16 stated, Yes he moves about freely in the facility with assistance but his roommate is not. V16 went on to say to survey team, A COVID positive patient should not be with a non-COVID patient, and no one has told me they were not moved. Surveyors asked if R2 was tested for COVID-19, V16 checked her records and said, Yes, I show R2 was tested on [DATE] and he was negative for COVID-19. Surveyors asked whether this would mean he should be moved or should stay with R8 who was positive, V16 repeated, No they should not be rooming together. Surveyors asked how many residents were impacted by the COVID-19 outbreak, V16 said, Around 14 residents and 6 staff. The Residents Affected - Many (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: 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 11/26/2025 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)