Health inspection·August 7, 2025

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based upon record review and interview the facility failed to follow policy procedures and failed to ensure that the advance directives care plan was correct for one of four residents (R4) reviewed for change in condition.Findings include:R4's ([DATE]) POLST (Practitioner Orders for Life-Sustaining Treatment) Form states No CPR (Cardiopulmonary): Do Not Attempt Resuscitation. R4's ([DATE]) POS (Physician Order Sheet) includes Do Not Resuscitate. R4's care plan (revised [DATE]) states Advance Directive - Full Code [which is incongruent with R4's POLST & POS]. On [DATE] at 2:33pm, surveyor inquired about R4's current code status V6 (Director of Nursing) stated He's a DNR (Do Not Resuscitate). Surveyor inquired if R4's ([DATE]) advance directive care plan states DNR V6 reviewed the care plan and responded He (R4) has full code, it was revised but it's not accurate. It looks like the information that we (facility) have on advance directive code status is not accurate, he's technically a DNR this needs revised. The (9/24) advance directives policy states for the purposes of this policy and procedure Advanced Directives means a written instrument, such as a living will or life prolonging procedure declaration, appointment of health care representative and power of attorney for health care purposes. Advanced Directives shall be addressed on the resident's plan of care. 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: 145784 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 145784 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briar Place Nursing 6800 West Joliet Indian Head Park, IL 60525 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)