Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
Level of Harm - Actual harm
Residents Affected - Few
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to prevent one resident (R1) from mental abuse caused by a
staff member and failed to ensure the staff member had limited access to R1. This failure applied to one
(R1) of three residents reviewed for abuse and resulted in R1 feeling on guard, untrusting and unsafe while
living in the facility.
Findings include:
R1 is a [AGE] year old female who admitted to the facility 2/16/24. R1 has diagnoses that include
Conversion disorder (functional neurological system disorder) and Generalized Anxiety Disorder for which
she is receiving treatment in the facility. R1 is cognitively intact and uses a wheelchair for mobility according
to the minimum data assessment dated [DATE].
On 8/21/24 at 8:34PM, R1 was observed resting in bed, alert and coherent. R1 was interviewed and
expressed an incident with a staff member (V3) that occurred a few weeks ago. R1 said that one evening,
she went to the kitchen because she was hungry and asked V3 Dietary Aid for some food. V3 refused to
give any food or snacks and called R1 a beggar. R1 said that she believed V3 was upset with her because
she offered V3 soda pops from her personal refrigerator, but later stopped.
R1 said, when she was refused food and V3 called her a name, she reported it to V1 administrator and V4
Dietary Manager via a letter. After the letter was received, the administrator had a meeting with R1, R1's
family member and V4 Dietary Manager to discuss the incident. The end result led to V3's termination. R1
continued and said that about three weeks later, V1 came to R1's room insisting that R1 give V3 another
chance because V3 was remorseful, and she should forgive V3 as [R1 is] a good Christian woman. R1
began crying as she continued. R1 said V1 then brought V3 into her room to make V3 apologize to R1,
however he just said a general apology, not anything that he did wrong. V1 rehired V3 to be a CNA
(Certified Nursing Assistant). R1 said, I was okay thinking that I wouldn't see V3 much because V3 was
working in the kitchen, but now as a CNA, I see V3 all over and V3 even comes in my room to drop off the
meals and take the tray. R1 said I feel so guarded around V3 because I don't trust V3. There have even
been times that V3 has backed me up into a wall away from the cameras where no one could see and say
ugly things to me. R1 continued to cry and said I thought I did all the things right by reporting and I don't
feel safe and secure when V3 is around. I am also concerned if what he is doing to me, he can be doing to
others that can't defend themselves.
On 9/21/24 at 1:10pm V4 Dietary Manager said they received a letter from R1 that said that while working
as a dietary aid, V3 was coming to her room drinking her personal drinks and watching television. V4 said
'there is no reason for any dietary aid to be going into a resident's room. When R1 told
(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 7
Event ID:
145779
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 0600
Level of Harm - Actual harm
Residents Affected - Few
V3 she didn't want him to come into her room anymore V3 refused R1 snacks such as cereal and
sandwiches. These things are allowed to be given when the kitchen is open by any kitchen staff.' After V4
received the letter, Guest Services Manager, the Administrator and V4 had a meeting with R1 and R1's
family member. After the meeting, V4 said that V1 Administrator initiated an investigation into the issue and
V3 was let go by Human Resources a day or two after. V4 found out V3 was terminated when V4 was told
to remove V3 from the schedule.
On 9/21/24 at 1:23pm V5 Human Resources Director said that V5 was aware of an incident with R1 who
stated that V3 called her a beggar. I spoke with V1, who followed up with V3 and I was told to terminate V3
for discourteous behavior which is based off the handbook and facility policies.
Employee Disciplinary Report reviewed for V3 dates the incident 9/2/24 with facts: Employee displayed
improper conduct and discourteous behavior with patient which has resulted in termination. The report was
dated 9/5/24 by V5.
V3 was interviewed via phone on 9/19/24 and 9/21/24. During both interviews, V3 was evasive, omissive
and unprofessional. During the interview on 9/19/24 at 10:16pm V3 said that V3 was irritated about being
questioned by this Surveyor. When V3 was asked about any incident that occurred involving R1 and V3, V3
said he was told about it by an unknown staff member, and that there was no allegation brought against
him. V3 also said that he had never been suspended or terminated.
On 9/21/24 at 4:05pm, V3 said that there was a day that R1 came to the kitchen to ask for food, but the
staff were about to leave and V3 told R1 the kitchen was closed. V3 said R1 always come to the kitchen
asking for food, and V3 didn't give her any when she asked. V3 said V1 investigated an allegation against
him but V3 didn't take the accusation seriously. Then V3 said I got fired for some b*****t. V3 said V1
Administrator asked V3 to come back as a CNA and was asked to apologize to R1. V3 said, he went to R1's
room with V1 but said, I didn't apologize, I just said I'm sorry.
On 9/21/24 at 2:45pm V1 Administrator said V1 was unaware that R1 was emotionally upset that V3
became a CNA and is giving direct care in the facility because V1 believed that after V3 issued an apology,
R1 had forgiven V3. V1 said V3 should not be going into R1's room or giving care to R1, however it's
possible that R1 would see V3 working elsewhere in the facility.
Concern form dated 9/2/24 taken by V1 Administrator stated, Resident stated a dietary aide went into her
room and took a beverage. Corrective actions taken: Writer interview the dietary aide (V3) Dietary aide
stated he removed the dietary tray after mealtime. Offer to replace beverage declined.
Abuse Prevention and Reporting policy revised 4/22 states in part; The resident has the right to be free
from abuse, neglect, misappropriation of resident property, and exploitation.
Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting
physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a
caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial
well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause
physical harm, pain or mental anguish.
It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or
enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must
have acted deliberately, not that the individual must have intended to inflict
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 2 of 7
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 0600
injury or harm.
Level of Harm - Actual harm
The abuse policy was acknowledged and electronically signed by V3 on 8/27/24 at 4:10PM.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 3 of 7
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 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 protect a resident from misappropriation of resident
property. This failure applied to one (R1) of three residents reviewed for misappropriation of property.
Residents Affected - Few
Findings include:
R1 is a [AGE] year old female who admitted to the facility 2/16/24. R1 has diagnoses that include
Conversion disorder (functional neurological system disorder) and Generalized Anxiety Disorder for which
she is receiving treatment in the facility. R1 is cognitively intact and uses a wheelchair for mobility according
to the minimum data assessment dated [DATE].
On 8/21/24 at 8:34PM, R1 was observed resting in bed, alert and coherent. R1 was interviewed and
expressed an incident with a staff member (V3) that occurred a few weeks ago. R1 said at one time, she
was friendly with V3 Dietary Aid and offered some of her own personal soda from her refrigerator. R1 said
she began to get uncomfortable when V3 would come into her room while she was napping and asked V3
to stop coming to the room. At the time, R1 didn't have a roommate, and then she got a roommate, R1 told
V3 he couldn't come into the room anymore out of respect for the roommate.
On 9/21/24 at 2:45pm V1 Administrator said, R1 informed them of a concern that V3 was taking and
drinking her drinks.
Concern form dated 9/2/24 taken by V1 Administrator stated, Resident stated a dietary aide went into her
room and took a beverage. Corrective actions taken: Writer interview the dietary aide (V3) Dietary aide
stated he removed the dietary tray after mealtime. Offer to replace beverage declined.
According to V3's personnel file, V3 was terminated 9/5/24, related to this incident.
Employee Disciplinary Report reviewed for V3 dates the incident 9/2/24 with facts: Employee displayed
improper conduct and discourteous behavior with patient which has resulted in termination. The report was
dated 9/5/24 by V5.
Abuse Prevention and Reporting policy revised 4/22 states in part; The resident has the right to be free
from abuse, neglect, misappropriation of resident property, and exploitation.
The abuse policy was acknowledged and electronically signed by V3 on 8/27/24 at 4:10PM
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 4 of 7
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to report an allegation of misappropriation of property for a
resident and failed to timely report an allegation of physical abuse for one resident to the Illinois
Department of Public Health (IDPH). These failures applied to two (R1, R3) of three residents reviewed for
abuse.
Findings include:
R1 is a [AGE] year old female who admitted to the facility 2/16/24. R1 has diagnoses that include
Conversion disorder (functional neurological system disorder) and Generalized Anxiety Disorder for which
she is receiving treatment in the facility. R1 is cognitively intact and uses a wheelchair for mobility according
to the minimum data assessment dated [DATE].
Concern form dated 9/2/24 taken by V1 Administrator stated, Resident stated a dietary aide went into her
room and took a beverage. Corrective actions taken: Writer interview the dietary aide (V3) Dietary aide
stated he removed the dietary tray after mealtime. Offer to replace beverage declined.
On 9/19/24 at 10:49pm, V1 Administrator said (V1) did not report the incident with R1 to Illinois Department
of Public Health because (V1) didn't recognize the allegation as misappropriation of resident property.
An initial investigation was reported to IDPH the following day on 9/20/24.
R3 is a [AGE] year old female who admitted to the facility 6/18/24 with diagnoses that include multiple
fractures and autism. On 9/20/24 at 3:56pm V3 was observed in bed alert and coherent. V3 called their
representative and POA (Power of Attorney) on speaker phone during this interview. V8 (R3's Family
member) said sent an email regarding concerns that R3 shared about V6 CNA (Certified Nursing Assistant)
roughly providing care. V8 also notified nursing staff but was unable to recall who (V8) spoke to.
V1 Administrator provided the email confirming that V8 communicated the allegation on 9/14/24. On
9/19/24 at 10:49pm, V1 Administrator said (V1) did not report the incident to IDPH until 9/16/24, because
(V1) didn't check the email over the weekend.
According to V8's time sheets, V6 was on duty and provided care 9/14/24 and 9/15/24 after V8 reported the
allegation to V1.
Abuse Prevention and Reporting policy revised 4/22 states in part; The resident has the right to be free
from abuse, neglect, misappropriation of resident property, and exploitation.
All resident, visitors, volunteers, family members or other are encouraged to report their concerns or
suspected incidents of potential abuse, neglect, exploitation, mistreatment, or misappropriation of resident
property to the administrator or an immediate supervisor who must then immediately report it to the
administrator or the person acting as administrator in the administrator's absence. Such reports may be
made without fear of retaliation. Anonymous reports will also be thoroughly investigated.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 5 of 7
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 0609
Reports should be documented, and a record kept of the documentation.
Level of Harm - Minimal harm
or potential for actual harm
Employees of this facility who have been accused of abuse, neglect, exploitation, mistreatment or
misappropriation of resident property will be removed from resident contact immediately until the results of
the investigation have been reviewed by the administrator.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 6 of 7
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
145779
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/22/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Elevate Care Palos Heights
12550 South Ridgeland Avenue
Palos Heights, IL 60463
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 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview and record review, the facility failed to provide evidence that an allegation of
misappropriation of property was thoroughly investigated for a resident. This failure applied to one (R1) of
three residents reviewed for misappropriation of property.
Residents Affected - Few
Findings include:
On 9/21/24 at 2:45pm V1 Administrator said, R1 informed (V1) of a concern that V3 Dietary Aid was taking
and drinking R1's personal drinks. V1 said (V1) did not ask any other residents or staff about this allegation
and V1 was unable to provide any written documents related to a related investigation.
Concern form dated 9/2/24 taken by V1 Administrator stated, Resident stated a dietary aide went into her
room and took a beverage. Corrective actions taken: Writer interview the dietary aide (V3) Dietary aide
stated he removed the dietary tray after mealtime. Offer to replace beverage declined.
Abuse Policy revised 4/22 states in part; Investigation Procedures: Residents to whom the accused has
regularly provided care, and employees with whom the accused has regularly worked, will be interviewed to
determine whether any one has witnessed any prior abuse, neglect, exploitation, mistreatment or
misappropriation of resident property by the accused individual.
Confidentiality: .Even if the facility investigation is not complete, the administrator will cooperate with any
Department of Public Health investigation in the matter.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145779
If continuation sheet
Page 7 of 7
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Back to topCitations
4 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
F602 - The resident has the right to be free from abuse, neglect, misappropriation of re
Protect each resident from the wrongful use of the resident's belongings or money.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
FAQ · About this visit
Common questions about this visit
What happened during the September 22, 2024 survey of ELEVATE CARE PALOS HEIGHTS?
This was a inspection survey of ELEVATE CARE PALOS HEIGHTS on September 22, 2024. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ELEVATE CARE PALOS HEIGHTS on September 22, 2024?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.