Health inspection·October 15, 2023

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and document review the facility failed to maintain its nurse call system in full functioning condition on 3 of 3 resident floors. This affects all 123 residents in the facility. Residents Affected - Many Findings include: On 10/14/23 at 10AM the facility nurse call system was tested. V2 Director of Nursing (DON) and V4 (Maintenance/Housekeeping Director) were present during observations. Room A corridor light above room door does not function when call is activated. R2 and R3 corridor light above room door does not function when call is activated. When R2 and R3 toilet room nurse call is activated for the following rooms R8's room, B, C and D rooms light up at the 2nd floor nurses station nurse call panel. When the room B room nurse call is activated rooms R8's room, B, C and D rooms light up at the 2nd floor nurses station nurse call panel. When R8's room nurse call is activated in rooms R8's room, B, C, D and E rooms light up at the 2nd floor nurses station nurse call panel. R2 and R3's corridor light above room door does not light when call is activated. Room F lights up at 2nd floor nurse call panel when the room nurse call is activated. On 10/14/23 at 9:50AM R2 stated the nurse call in our room does not work. It has been like this for a long time. On 10/14/23 at 9:55AM R3 stated my nurse call doesn't function. The facility knows about it. It has been like this for at least two weeks. I am worried if I have a heart attack or something I won't be able to get staff to my room. On 10/14/23 at 11:52AM V6 Registered Nurse (RN) stated there has been issues with the nurse call system. Some of the lights on the panel stay on when the switch in residents' room is turned off. Sometimes several lights come on the panel at the nurses station when one room is pulled. On 10/14/23 at 10:45AM V4 (Maintenance Director) stated I do not have the facility nurse call (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: 145806 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 145806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Warren Park Health & Living Ctr 6700 North Damen Avenue Chicago, 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)