Health inspection·February 21, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure misappropriation of resident funds did not occur for 1 of 3 residents (R1) reviewed for misappropriation of resident funds in the sample of 9. Residents Affected - Few The findings include: R1's admission Record, provided by the facility on 2/21/25, showed she was admitted to the facility on [DATE] for aftercare following joint replacement surgery. R1's Progress Note dated 2/17/25 showed R1 was discharged home with a caregiver. R1's progress note dated 2/7/25 showed R1 had a follow up appointment with her orthopedic PA (Physician's Assistant) on 2/10/25. The note showed transportation was set up through Wheels on Wheels to take R1 to her appointment on 2/10/25. R1's 2/10/25 Progress note showed R1 went to her orthopedic appointment on 2/10/25. R1's facility assessment dated [DATE], showed she was cognitively intact and required substantial/maximal assistance from staff for dressing, toileting, and transfers. R1's care plan initiated on 1/30/25 showed she had limited physical mobility related to weakness after right hip surgery and required one staff assist with transfers. R1's care plan initiated on 2/2/25 showed she was on contact isolation related to shingles, and all services were to be provided in her room. R1's inventory list dated 1/29/25 was reviewed. No credit card was listed on the inventory list. On 2/21/25 at 10:40 AM, V1 (Administrator) said It was an odd scenario. V1 said V7 (R1's niece) claims she dropped the credit card off in a white hallmark envelope at the nurse's desk. V1 said V7 was not able to identify what the person looked like, only that it was a nurse in colorful clothing and was wearing two face masks. At 11:18 AM, V1 said she spoke with staff, and no one was aware of R1's credit card. V1 said the facility would have reimbursed R1, however, R1 said no, the credit card company was reimbursing her. On 2/21/25 at 11:23 AM, V7 (R1's niece) said she took R1 her credit card on 2/8/25. V7 said she put a piece of paper around the credit card and sealed it in a large white envelope like you would put a birthday card in. V7 said R1 was on isolation for shingles and she (V7) had a virus. V7 said she did not want R1 to get sick, so she left the envelope with R1's name and room number on it with a nurse at the second-floor rehab unit's nurse's desk. V7 said the nurse had on burgundy-colored scrubs, and two face masks. V7 said the nurse had on glasses, had her hair pulled back, and she believed the nurse was Filipino. V7 said the nurse was medium height and build, sitting at the nurse's station at a computer. V7 said the nurse took the envelope from her (V7) and set it next to her. V7 said the nurse said she would give the envelope to R1. V7 said she spoke to R1 before dropping it off and let her know that she was going to drop it off. V7 said R1 did not say anything about not getting the envelope until later. V7 said there were charges on R1's credit card that neither R1, nor her family made. V7 said after she dropped of the credit card, she left the facility. V7 said the reason she Page 1 of 4 145739 145739 02/21/2025 Lutheran Home for the Aged 800 West Oakton Street Arlington Hts, IL 60004

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dropped the card off at the nursing home was because R1 had an appointment on 2/10/25 that she needed the credit card for to pay for the transportation to and from the appointment. On 2/21/25 at 12:29 PM, R1 said when she filled out the inventory sheet, she did not put down that she had a credit card with her because she did not bring it to the facility with her. R1 said she was on isolation due to having shingles. She had an appointment coming up that she needed the credit card for to pay for the transportation. R1 said she phoned her niece (V7) and asked her to drop off the credit card she had with the same account number, to pay for the transportation. R1 said V7 put the card in an envelope and dropped it off at the nurse's desk. R1 said she paid for her transportation on 2/10/25 by having V7 give her the credit card number over the phone, and she wrote it down. R1 said when she called to cancel the card, there were charges on the card that neither she, nor her family made. R1 said she believed the charges were at local stores and restaurants. At 5:19 PM, R1 called back and said she spoke with someone at the fraud department for her credit card company and identified the charges to her card that were not made by herself, or her family were the following: On 2/10/25 at a Dollar Tree Store for $27.50 On 2/10/25 at a Michael's store for $36.28 On 2/10/25 at a Target store for $149.12 On 2/10/25 at Chick-fil-A for $22.15 On 2/10/25 at Ross Dress for Less for $60.47 On 2/11/25 at Five Below store for $16.01, and On 2/11/25 at Chick-fil-A for $35.34 R1 said she cancelled her card on 2/11/25 or 2/12/25. She could not recall which date. R1 said she does not do online banking and has not received her monthly statement in the mail yet. R1 was asked what town(s) the fraudulent credit card charges were made in. R1 said she got the information regarding the fraudulent charges from the fraud department at her credit card company. They did not say what town(s) the card was used in. R1 said when her monthly statement comes in, she could provide additional information if needed. On 2/21/25, at 11:59 AM, V4 (Registered Nurse-RN) said she did not see R1's family come in on 2/8/25. V4 said she does not know R1's family. V4 said she is not aware of any envelope containing a credit card for R1. On 2/21/25 at 12:09 PM, V5 (Certified Nursing Assistant-CNA) said she does not remember any family member visiting R1 on 2/8/25. V5 said she did not recall seeing any envelope with R1's name and room number on it. At 1:40 PM, V8 (RN) said she is a floating nurse and was not aware of any credit card for R1 that was missing. At 1:47 PM, V9 (Licensed Practical Nurse-LPN) said she did not see anyone bring in an envelope for R1 while she was working. At 2:08 PM, V10 (CNA) said she did not recall seeing any of R1's family members come in on 2/8/25 or see any envelope with R1's name on it. On 2/21/25 at 11:51 AM, V1 (Administrator) said the facility's electronic log in system showed V7 punched into the system at 10:39 AM on 2/8/25 and left at 10:42 AM. The facility provided a copy of 145739 Page 2 of 4 145739 02/21/2025 Lutheran Home for the Aged 800 West Oakton Street Arlington Hts, IL 60004

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few at 10:42 AM. The facility's incident investigation was reviewed. The investigation showed on 2/14/25, V13 (another of R1's nieces) reported that R1's credit card was missing. the report showed V1 and V6 (Social Services) went to speak with R1 and V13. V1 and V6 were informed that V7 had a cold and did not want to get R1 sick, so she left the envelope with R1's name and room number on it with a nurse in bright colored clothing and a double-mask on. The note showed she was not able to identify anyone outside of that. The 2/14/25 interview with R1 and V13 showed that it was discussed with R1 and V13 that there are many visitors, vendors, etc. that come in and out of the facility and maybe it was dropped or thrown out for someone to find and use. The facility's policy and procedure titled Abuse and Neglect of a Resident, with a revision date of 6/16/2023, showed The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation . The policy defines misappropriation of Property as the deliberate misplacement, exploitation, or wrongful, temporary use of a resident's belongings or money without the resident's consent. 145739 Page 3 of 4 145739 02/21/2025 Lutheran Home for the Aged 800 West Oakton Street Arlington Hts, IL 60004

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review, the facility failed to notify the police when a resident's credit card was missing and could not be located for 1 of 3 residents (R1) reviewed for misappropriation of residents' funds in the sample of 9. The findings include: On 2/21/25 at 10:40 AM, V1 (Administrator) said R1 and her niece (V13) reported to the facility on 2/14/25 that V7 (another one of R1's niece's) claimed she dropped off a credit card for R1 on 2/8/24 at 10:45 AM. V1 said it was reported that the credit card was dropped off at the nurse's desk in a white hallmark envelope. V1 said she was going to call the police to report it, however, R1 did not want her to. V1 said V13 asked her to please hold off for now because all of the charges that were made on the card would be covered by the credit card company. V1 said she did not report R1's missing credit card to the local police. On 2/21/25 at 12:29 PM, R1 said she did say she did not want the police notified at that time because she wanted to give the facility time to investigate it. R1 said she also did not want police officers walking down the halls of the facility because she was worried it might scare other residents. At 5:19 PM, R1 returned a previous call from this surveyor. R1 said she spoke to the credit card companies' fraud department, and they identified seven charges that were made to R1's credit card that neither she (R1) or her family made. R1 said the combined total of the charges that went through were $346.87. R1 said there was a charge from Amazon that did not go through; it was refused payment because she had reported the credit card missing by then. The facility provided a printout of the electronic sign in system. The document showed V7 signed into the system on 2/8/25 at 10:39 AM and left the facility at 10:42 AM. The facility's policy titled Abuse and Neglect of a Resident, with a revision date of 6/16/2023, showed 7. Internal Reporting .Examples of situations that would likely be considered crimes would include but are not limited to .Theft/Robbery. The policy showed 9. External Reporting of Abuse Allegations .The facility will notify local police and (the) Department of Public Health within two hours after first suspecting that a crime has occurred if the suspected crime involves serious bodily injury to the individual, or within 24 hours if there is no serious bodily injury involved. Examples of crimes may include, but are not limited to: murder, assault and battery, theft, drug diversion/theft, fraud and forgery. 145739 Page 4 of 4