F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to follow physician orders and failed to follow the facility
community pass policy after no credible evidence of contraband was found for one (R72) resident. This
failure affected one resident (R72) in a sample of 72 residents. Findings include:R72 is [AGE] years of age
with diagnoses include not limited to: Alcohol Abuse, Anxiety Disorder, Unspecified, Major Depressive
Disorder, Recurrent, Unspecified, Post- Traumatic Stress Disorder, Chronic, Suicidal ideations, Anemia,
Unspecified, Insomnia, Unspecified, Other Psychoactive Substance Abuse, Uncomplicated, Schizophrenia,
UnspecifiedSection C - Cognitive Patterns (7/6/2025) documented BIMS 15 (cognitively intact)R72's
physician orders document an active physician order for independent community pass.R72's Community
Survival Skills Assessment documents (in part) Effective 9/9/2025 at 08:51 9. Documents 2. Cannot
Determine B. Recommendations and Outcomes 1. Recommendations 2. The resident does not appear to
be capable of unsupervised outside pass privileges at this time. (9/9/2025) Residents independent
community access restricted for 30 daysR72's progress notes (9/10/25) authored by V33 (Psychosocial
Rehabilitation Services Coordinator) documents in part that V33 had suspicion that R72 had contraband
and staff searched R72's room. Nothing was found. Staff attempted to receive a urine sample and R72
refused and got agitated, ultimately requesting a transfer in nursing home. There is no documentation with
R72's medical record that indicates that R72 had any symptoms of being under the influence of any illicit
substance or other indications that R72 was in possession of any illicit substance.On 9/11/2025 at 11:12
AM, R72 was visibly upset and explained that R72's community pass was restricted a couple days ago after
another resident made up a story about R72 bringing a marijuana pen into the facility. R72 stated, I didn't
do anything wrong, I went out for a couple hours and came back. (R17) was jealous or something that I
went out on pass and told them I had a weed pen to get back at me. I don't have a weed pen, I don't smoke.
They (facility staff) came in and searched my room and didn't find anything but (V33) still took my pass
away. It's not fair they have no reason to take away my pass!On 9/11/2025 at 1:29 PM, V33 (Psychosocial
Rehabilitation Services Coordinator) affirmed that V33 is the social worker assigned to R72 and was the
staff member that restricted R72's community pass. R72 explained that another resident had said R72 had
a weed (marijuana) pen. R72 searched the room and there was no weed (marijuana) pen found. R72 was
agitated after the staff searched R72's room and wouldn't give a urine sample so the V33 restricted R72's
community pass. V33 affirmed that there were no other indications that R72 may have been under a
controlled substance other than agitation. V33 was unsure if there was anything that R72 signed that
consented for forced drug testing or if it was part of the community pass program.On 9/11/2025 at 2:58 PM,
V34 (Psychiatrist) affirmed that V34 is a psychiatrist for the facility. V34 explained that residents under the
effects of marijuana present differently, but marijuana typically produces a calming effect (not agitation). In
some cases, marijuana can cause hallucinations and psychosis.Review of the
(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:
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
09/11/2025
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)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
community pass program policy that were signed by R72 documents in part that pass privileges will be
taken away for a minimum of 30 days if R72 comes back from pass intoxicated or under the influence of
drugs and that drug testing can be completed if the resident comes back from an overnight community
pass and is suspected to be under the influence (R72 was not out of the facility overnight).
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145784
If continuation sheet
Page 2 of 2