Health inspection·July 15, 2025

F 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the interview and record review, the facility failed to establish and maintain a system for recording and releasing resident funds based on generally accepted accounting principles. This applies to 1 of 3 residents (R1) reviewed for the resident fund in a sample of 8.R1 was an [AGE] year-old male admitted on [DATE] with moderate cognitive impairment as per the Minimum Data Set (MDS) dated [DATE].On 7/10/25 at 9:10 AM, V10 (R1's granddaughter) stated, After my grandpa (R1) passed away on 6/7/25, my mom received a phone call from the nurse that R1 had $200 cash and a cashier's check of $400 to be picked up. When my mom and my grandma (who passed away one week after my grandpa) stopped by to collect money, V1 (administrator) told them that the money had already been released. But we never received that money. They are saying my grandma (who passed away) picked it up in April (4/7/25). But my grandma doesn't even drive. Somebody must have driven her to the facility, and we would know if that happened.On 7/10/25 at 12:15 PM, V2 (Director of Nursing/DON) stated, A Couple of months ago, the administrator gave money to the wife and daughter. He might have forgotten to record it. On 7/10/25 at 1:12 PM, V1 (Administrator) stated, R1's wife showed up at the nurses' station on 4/17/25 (before R1's death) to collect the money which was in an envelope in V2's office. I texted V2 asking for money. The money was in V2's safe, and since V2 wasn't available that day, I instructed V13 (Staffing Coordinator) to retrieve it from V2's office. The money was in an envelope, which V13 was to hand over to R1's wife. Our normal process of releasing resident funds is to have the responsible party sign the receipt for the money. Somehow, I don't have any proof available that the fund was released to the family.A review of the grievance form documented that the facility filed a grievance form on 6/10/25 in regards to R1's granddaughter's inquiry about R1's fund ($240 in cash and check). A review of the clinical records and documentations for April 2025 indicates that no documentation stating that the fund was released to R1's family. 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 4 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 07/15/2025 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)