F 0600
Level of Harm - Minimal harm
or potential for actual harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to protect the resident's right to be free from physical abuse.
Residents Affected - Few
This applies to 2 of 3 residents (R1 and R3) reviewed for resident-to-resident physical abuse.
The findings include:
The facility's 4/29/2025 Facility Reported Incident showed On 4/16/2025 resident [R2] had an altercation
with her roommate [R1]. Staff immediately separated . On 5/01/2025 at 11:30 AM, R2 was in bed. R2 was
confused and unable to be interviewed.
R2's EMR (Electronic Medical Record) showed she had multiple diagnoses including paranoid
schizophrenia, dementia with anxiety, and major depressive disorder. R2's MDS dated [DATE] showed R2
was cognitively impaired. R2's MDS also said she had symptoms of being short-tempered and easily
annoyed nearly every day.
R2's care plan initiated on 3/06/2018 documented, I have a hx (history) of becoming physically and verbally
aggressive with my peers and staff due to my medications/treatment noncompliance, poor coping skills,
and diagnosis of mental illness. The care plan said R2 had become aggressive towards a peer in 2023 and
on 4/07/2021 also struck a peer on the shoulder. R2's progress note dated 4/16/2025 from V7 (Psychiatric
Nurse) said Psych NP notified about increased aggression irritability and explosive behaviors, received new
order to reinstate Haldol 5 mg PO and IM Q 12 HRS, and cont to monitor.
R1's MDS (Minimum Data Set), dated 4/07/2025, documented R1 was cognitively intact.
On 5/01/2025 at 11:00 AM, R1 said on the morning of 4/16/2025, R2 hit her on the right side of the face
and head with her closed fist. R1 said R2 was unprovoked when she started yelling and then hitting her. R1
said she did not sustain an injury, but had pain 6 out of 10 (10 being the worst). R1 said then R2 left the
room and hit R3. R1 said she reported the incident to V10 (Registered Nurse/RN) and her daughter. R1
said V1 (Administrator) and the local police then interviewed her regarding the incident. R1 said she felt
abused after R2 physically assaulted her. R1 said she felt safe after R2 was moved to a secure unit.
On 5/01/2025 at 1:00 PM, V10 (RN) said R1 reported to him on 4/16/2025 that R2 attacked her in the room.
V10 said he reported the incident to the facility's administration.
R3's MDS dated [DATE] said R3 was cognitively intact.
(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:
145830
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
145830
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/02/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Aperion Care West Chicago
201 West North Avenue
West Chicago, IL 60185
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 0600
Level of Harm - Minimal harm
or potential for actual harm
On 5/01/2025 at 11:15 AM, R3 said on 4/16/2025 around noon, R2 approached her at the nurses' station
and unprovoked, started to hit her on the right side of the head with her closed fist. R3 said she did not
sustain an injury, but had pain 7 out of 10. R3 said the nursing staff that was present then took R2 to her
room. R3 said she reported the incident to V6 (Social Worker/SW), V14 (SW), and V12 (Certified Nurse
Assistant/CNA). R3 said she felt safe after R2 was moved to a secure unit.
Residents Affected - Few
On 5/01/2025 at 3:40 PM, V12 (CNA) said R3 reported to her on 4/16/2025 that R2 had hit her. V12 said
she reported the incident to the nurse on duty.
On 5/01/2025 at 2:00 PM, V1 (Administrator) said he was the Abuse Coordinator and investigated the
incidents involving R1, R2, and R3. V1 said R2 was agitated when she hit R1 and R3 on 4/16/2025. V1 said
R2 was moved to a secured unit for behavior management after the incidents to ensure no further incidents
occurred. V1 said the facility's abuse policy considers abuse when an incident results in a resident being in
pain or physical or emotional anguish.
The facility's policy titled Abuse Prevention and Reporting, dated 10/24/2022, documented, This facility
affirms the right of our residents to be free from abuse .In order to do so, the facility has attempted to
establish a resident sensitive and resident secure environment .Abuse means any physical or mental injury
or sexual assault inflicted upon a resident other than by accidental means. The term willful in the definition
of abuse means the individual must have acted deliberately, not that the individual must have intended to
inflict injury or harm. An example of a deliberate (willful) action would be a cognitively impaired resident
who strikes out at a resident within his/her reach .Having a mental disorder or cognitive impairment does
not automatically preclude a resident from engaging in deliberate or non-accidental accidental actions.
Physical abuse includes hitting slapping, pinching, kicking .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145830
If continuation sheet
Page 2 of 2
