Inspection·April 3, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their change in condition policy and did not notify a family member of a resident's (R2) change in condition and need to be sent out to the hospital for one (R2) out of four residents reviewed for change in condition in a total sample of seven. Findings Include: R2 is a [AGE] year old with the following diagnosis: psychosis, mood disorder, suicidal ideation, and anxiety disorder. A Social Service note dated 3/27/25 documents R2 became verbally and physically aggressive with staff. R2 attempted to go to the patio but the patio was currently closed. Staff redirected R2 back to R2's assigned unit, but R2 refused. R2 became increasingly agitated R2 then attacked staff by slapping them and kicking them in the stomach. A behavioral code was called, and CPI (Crisis Prevention and Intervention) methods were applied to stop R2 from attacking staff. R2 was escorted back to R2's unit once calm. Social services attempted to educate R2 on house rules and behavior expectations but R2 continued to display inappropriate verbal behavior. R2 was placed on 1:1 monitoring. A Nursing note dated 3/28/25 documents the nurse received in report that R2 was being sent to the hospital for a psych evaluation due to aggressive behavior and suicidal ideation. Transportation was called and R2 left the facility around 4:10PM. There is no documentation that family was notified of R2's behavior or that R2 left the facility that was documented before R2 left the facility. A Late Entry Nursing note dated 3/28/25 documents R1 remained on 1:1 monitoring for verbal threats to staff. The physician was notified and ordered to petition R2 to the hospital for a psych evaluation. All responsible parties were notified including family members. This note was entered into the charting system on 4/2/25 at 10:47PM. A Nursing note dated 3/29/25 documents R2 remained at the hospital for a psych evaluation. On 4/1/25 at 12:47PM, V1 (R2 Family Member) stated R2 called V1 on the evening on 3/28/25 to tell V1 that R2 was in the hospital. V1 reported R2 did not remember how or why R2 was sent to the hospital. V1 stated V1 tried calling the facility to confirm what R2 said but calls to the facility went unanswered. V1 reported V1 tried to call the facility eight to nine times but no call was answered. V1 stated V1 came to visit R2 at the facility on 3/29/25. V1 reported V1 was given badges to go up to (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: 145778 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 145778 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midway Neurological / Rehab Center 8540 South Harlem Bridgeview, IL 60455 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)