Health inspection·July 16, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident was safely transferred with a mechanical lift, resulting in the resident sustaining a fractured toe. This applies to 1 of 3 residents (R1) reviewed for mechanical lift transfers in the sample of 3. R1's BIMS-Brief Interview of Mental Status dated 07/16/25 shows, R1 is Cognitively Intact.On 07/16/2025 at 9:51AM, R1 was sitting in her wheelchair. R1 was wearing a surgical shoe on her right foot. R1's right great toe had a grey/black bruise.On 07/16/2025 at 9:51AM, R1 said, I have used a wheelchair for the past 8 years. I used to be able to use a slide board with two persons assist. Currently, I am a full body mechanical sling lift. I have a displaced fracture to my right toe. On Sunday (07/13/2025) after lunch I was being transferred from the wheelchair to the bed with a full body mechanical sling lift. I was sitting back in the sling with my feet dangling in the air. Usually, the staff will guide my feet, this time my foot got caught between the center bars of the lift. As I was being lowered my foot got pinched between the bars forcing my great toe backward. The pain was very bad. I do not remember who was with me or how many staff were in the room. I remember saying, MY TOES! MY TOES! MY TOES! It hurt. It was a 9/10 painful pinching burning feeling. They had to lift my toes out from between the bars of the lift. It bothered me the rest of the day. About an hour later I noticed my toe was still hurting and it had turned purple.On 07/16/2025 at 10:45AM, V1 Administrator said, R1's injury is still being investigated. We do not know who was in the room performing the transfer. The facility's Staffing Schedule dated 07/13/2025 shows, V4 RN-Registered Nurse, V6 CNA-Certified Nursing Assistant, V7 LPN-Licensed Practical Nurse, V8 CNA, V5 CNA, worked in the facility on R1's unit 07/13/2025 on the day shift.On 07/16/2025 at 10:55AM, V4 RN-Registered Nurse said, I was the day shift nurse for R1 on 07/13/2025. Today is the first I have heard about R1's foot injury. Two people are needed for a mechanical lift transfer.On 07/16/2025 at 11:02AM, V6 CNA-Certified Nursing Assistant said, I did not take care of R1 on 07/13/2025. R1 is a full body mechanical sling lift transfer. R1 cannot transfer herself.On 07/16/2025 at 11:25AM, V7 LPN-Licensed Practical Nurse said, I have not provided any care to R1. I'm not even sure who she is.On 07/16/2025 at 11:33AM, V8 CNA-Certified Nursing Assistant said, I work in the opposite hallway. I was not called to assist R1 on Sunday (07/13/2025).On 07/16/2025 at 12:16PM, V5 CNA said, I was R1's CNA on Sunday (07/13/2025). Towards the end of my shift 5:30PM to 6:30PM, R1 started complaining of toe pain. R1 said, it happened when she was transferred back into bed when I was on break. I think V6 CNA transferred her. I do not know anything past that. I do not know who assisted V6 CNA with R1's transfer. I was working the middle hall, when I went on break V6 CNA took over my assignment. When I came back from break R1 was in bed. R1 is a full body mechanical sling lift. R1 cannot transfer herself. On 07/16/2025 at 12:40PM, V2 DON-Director of Nursing said, we obtained an order for a Xray at 9:30PM, 07/13/2025. The resident claimed she bumped into the mechanical sling lift when being transfer. I was not there; I do not know. Staff report (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: 145739 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 145739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lutheran Home for the Aged 800 West Oakton Street Arlington Hts, IL 60004 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)