F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
Based on observation, interview and record review the facility failed to notify a resident's representative
prior to starting a cognitively impaired resident on a new medication for 1 of 3 residents (R1) reviewed for
resident notification of changes and/or treatments in the sample of 3.The findings include:R1's care plan
dated 6/6/25 showed R1 was cognitively impaired related to her diagnoses of dementia and multiple
sclerosis. The plan showed R1 was very forgetful. The plan showed all information provided to R1 should be
provided directly to her advocate.R1's Power of Attorney (POA) for Health Care form dated 9/12/24 showed
V7 (Family of R1) was R1's POA. On 1/5/26 at 8:32 AM, V7 (Family of R1) stated R1 was started on
Losartan (medication to treat high blood pressure) in August 2025 however, V7 was not notified that R1 had
been started the medication until 12/17/25. V7 stated, No one told me (R1) was even having high blood
pressures. I am in the facility at least twice a week. I just happened to be talking to the cardiology nurse
practitioner (on 12/17/25) when she informed me that (R1) had been on Losartan for high blood pressure. I
had no idea. I have told the facility multiple times they are to call me with any changes. No one from the
facility notified me of any of this despite it being all over (R1's) chart they are to call me day or night with
any changes, including medications. V7 stated R1 is cognitively impaired and cannot remember what
medications she is taking. Physician progress notes and a physician order, both dated 8/8/25 for R1,
showed R1 was started on Losartan 25 mg (milligrams) once a day due to a new diagnosis of
hypertension. The physician note showed the new medication was discussed with R1; however, the note
showed no documentation V7 (Family of R1) was notified of R1's elevated blood pressures and/or R1 being
started on Losartan.A cardiology note dated 12/17/25 showed the cardiology nurse practitioner contacted
V7 (Family of R1) who reported that she (V7) was not aware R1 had taking Losartan for high blood
pressure. On 1/5/26 at 10:15 AM, R1 was in bed. R1 was awake but confused to place and time. When R1
was asked what month it was, R1 responded, Sunday. R1 stated she didn't know if she was on a
medication for high blood pressure. R1 stated, I don't know. They talk to (V7 Family of R1) about all my
medications. On 1/5/26 at 10:03 AM, V3 Social Services stated, I have always known (R1) as confused and
forgetful. Her short-term memory is impaired. (V7 Family of R1) is very involved in (R1's) care. (V7) has
stated multiple times she wants to be informed of any changes involving (R1).On 1/5/26 at 11:35 AM, V2
Director of Nursing (DON) stated if a resident is started on a new medication, the resident and/or resident
representative should receive education on the medication and consent to taking the medication prior to
administration of the medication. V2 stated a resident's representative should be contacted if the resident is
cognitively impaired. V2 stated R1 was confused, V2 stated V7 (Family of R1) had requested to be notified
of any medication or condition changes for R1. V2 stated the facility did not notify V7 prior to starting R1 on
Losartan in August 2025. V2 stated, (V7) was not notified that (R1) had been on Losartan for high blood
pressure until December (2025). Best practice would have been that we had notified (V7) of the new
medication for (R1) prior
(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:
145819
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
145819
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Warren Barr Buffalo Grove
150 North Weiland Road
Buffalo Grove, IL 60089
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 0580
to starting the medication in August (2025).
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145819
If continuation sheet
Page 2 of 2