F 0564
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Inform each resident of his or her visitation rights and ensure that all visitors enjoy equal visitation
privileges.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F564Based
on interview and record review, the facility failed to ensure residents had full and equal visitation privileges
consistent with resident preferences. This affected one resident (R1) in the sample reviewed for visitation
privileges. Findings include:R1's Minimum Data Set (MDS), dated [DATE], shows R1 is cognitively intact.
She was admitted to the facility on [DATE] with diagnoses including but not limited to adult failure to thrive,
encounter for surgical aftercare following surgery on the digestive system, ileostomy status, morbid severe
obesity due to excess calories, need for assistance with personal care, irritable bowel syndrome, and
unspecified open wound, right thigh. On 9/18/25 at 9:02 AM, V3 (R1's Friend) stated she visited R1 in her
room on Monday around 2:50 PM, and R3 (R1's Roommate) screamed at her to get out of the room
because she thought she was a funeral director. V7 (Certified Nursing Assistant/CNA), V8 (Licensed
Practical Nurse/LPN) and other staff came into the room and told her to leave the room, andV1 (Assistant
Administrator) will get back to her, but she did not get back to her. She has not been in the facility since the
incident to visit R1, and she does not know why the facility will not allow her to visit her best friend.On
9/18/25 at 9:20 AM, R1 was in her bed, and stated she has been in the facility for few months. A few days
ago (9/15/25), V3 visited her, as she does once a week. R3 told her to leave because she does not like her,
and R1 is angry that her right to receive her visitor was violated. V3 is her best friend, she helps to reload
her link card, buy groceries, and do her laundry because she cannot get out of bed. V3 has not been in the
facility since, but she wants her to visit because it is her right.On 9/18/25 at 9:26 AM, R3 stated she has
been in the facility for twenty-six years. On Monday around 3pm, V3 came to visit R1, and she told her to
leave the room because she is a funeral director, and she does not want her to give her funeral. V10 (Social
Services Director) came to tell her she should voice her concerns to staff instead of yelling at R1's visitor,
and she listened to him. R3 also stated V3 left the room, and she has not been back since to visit R1.On
9/18/25 at 12:57 PM, V7 (Certified Nursing Assitant/CNA) stated he has been in the facility for thirteen
years. On Monday 9/15/25, almost at the end of the morning shift, a former resident, V3, came to visit R1.
He heard R3 yelling. She told V3 to leave her room. V6, V7, and V8 (Licensed Practical Nurse/LPN) told V3
leave R1's room, and V3 left R1's room immediately. V7 also stated the facility allows visitors in the rooms,
and it is the right of R1, and another resident to receive visitor. On 9/18/25 at 1:11 PM, via telephone, V8
(Licensed Practical Nurse/LPN) stated he has been in the facility for ten years. On 9/15/25, he heard R3
telling V3, who came to visit R1, to get out of her room. V2 (Assistant Director of Nursing/ADON), V8, V10
(Social Services Director), and other staff escorted V3 out of R1's room, but R1 was upset for sending her
visitor out of her room. V8 also stated, We did not allow (V3) to go into (R1's) room, but (R1) has the right to
see/receive her visitor in her room.: He is not sure if V3 went down to see V1 to talk about the incident.On
9/18/25 at 1:35 PM, V10 (Social Services Director) stated he has been in
(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:
145765
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
145765
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park View Rehab Center
5888 North Ridge
Chicago, IL 60660
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)
F 0564
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
the facility over seven years. On Monday 9/15/25 at about 2:30 PM, he was informedR3 was upset, and she
wanted V3, who was visiting R1, to leave the shared room. V3 left the room; he offered reality orientation
that R1 is bed bound, she is allowed to have a visitor in her room. V10 also stated R1 has equal right to
receive visitor, even when R3 did not accept V3 in the shared room. The facility should have made another
alternative arrangement for R1 to see V3 instead of sending V3 away. On 9/18/25 at 2:21 PM, V1 (Assistant
Administrator) stated she has been in the facility since August 25th, 2025. She did not tell V3 she would like
to speak with her about the incident. She did not tell R1 to call V3 to continue with her visitation, and R1
has equal right as well to receive visitor in her room. V2 (Assistant Director of Nursing/ADON), V4 (Certified
Nursing assistant/CNA), V5 (Registered Nurse/RN), V6 (LPN), and V9 (CNA) all stated R1 has equal right
to receive her visitor. Progress Notes, dated 9/15/25, documents: Staff assisted visitor (V3) out of the (R1's)
room.Policy on Residents Rights, dated January/2016, documents: To exercise his or her rights as a
resident of the facility. Visitation Policy, undated, documents: (1) Therefore, the resident is permitted to have
visitors as he/she permits.
Event ID:
Facility ID:
145765
If continuation sheet
Page 2 of 2