Health inspection·October 1, 2024

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on interview and record review, the facility failed to maintain resident safety during a mechanical lift transfer, failed to ensure the mechanical lift sling was correctly applied during transfers, and failed to use a two person assist during a mechanical lift transfer. This affected one resident (R1) of three residents reviewed for safety and mechanical lift transfer. This failure resulted in R1 sliding from mechanical lift sling, sustaining a 3cm (centimeter) laceration to the posterior scalp, being sent to the local hospital where 3 staples were required to close the laceration. Findings Include: Facility reported incident with date of occurrence of 8/27/24, reads in part: R1 had a witnessed fall during transfer from bed to wheelchair and was sent to ER (Emergency Room) for further evaluation. (R1) returned to facility with all diagnostic test negative for injury but required 3 stapled to back of head. Conclusion: on 8/27/24 at 1005, (R1) had a witnessed fall from mechanical lift. (R1) was placed into mechanical lift with sling, Agency CNA (Certified Nursing Assistant) was moving (R1) from bed towards wheelchair via mechanical lift when (R1) slid from mechanical lift sling. (V2 Director of Nursing/DON) called to the scene immediately and recognized that agency CNA incorrectly applied the sling to the lift. 911 (emergency response) was called, (R1) was sent to ER for evaluation, returned to facility with 3 staples to back of head. No other injuries identified. Hospital record dated 8/27/24, reads in part: (R1) status post fall at Nursing home, States the staff was moving her in her lift when she fell backward striking her head. (R1) had 3 cm laceration to posterior scalp. 3 cm in length and 2 mm (millimeter) in depth. Repaired with 3 staples. On 10/1/24 at 10AM, V2 (DON) stated that the incident was reported by V8 (CNA). V8 reported to V2 that there was a fall, and that V8 was observed to be visibly upset when V8 came to V2's office. V7 (Agency CNA) was transferring R1 and had a fall. V2 went to check on R1, R1 was on the floor, R1's head was resting on a towel but R1's head was closer to the metal leg based part the mechanical lift machine. V7 told V2 that R1 slid out of the sling. V2 observed the sling was still attached to the mechanical lift. It was apparent that V7 did not correctly attach and applied the divided leg sling to the resident and mechanical lift machine. The leg straps are supposed to crisscross and that is what would prevent the resident from sliding out of the sling. V7 used it as a chair sitting position, and straps did not go to a loop to prevent the resident from sliding out. V7 admitted V7 was doing the transfer by herself. V2 stated that V7 reported to her that at first, V7 asked for help and V8 came in the room and turned around and left. V2 interviewed V8 and stated that V8 was asked for help but when V8 went to R1's room, R1 was not prepared yet, not dressed or toileted, so V8 told V7 to get R1 ready and to let V8 know when V7 is ready to transfer R1. V8 left the room and assisted other resident, and when V8 walked passed the room of R1, observed R1 was on the floor and V7 was in 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: 145786 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 145786 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lincolnwood Place 7000 North McCormick Blvd. Lincolnwood, IL 60645 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)