Inspection·December 23, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect one resident (R1) out of 9 from physical abuse. This failure affected R1 who was pushed in the elevator by R8. As a result, R1 had an unwitnessed fall, R1 was sent to a local hospital. R1 sustained a left lateral tibial plateau fracture approximately 1mm (One millimeter) depression and small joint effusion. Findings include: R1's medical record admission record showed documentation that R1 was originally admitted to the facility on [DATE] with latest recorded admission date of 12/02/17. Listed diagnosis includes but not limited to Displaced fracture of lateral condyle of the left tibia, subsequent encounter to closed fracture with routine healing, type 2 diabetes mellitus without complications, muscle weakness (Generalized), paranoid schizophrenia, depression, unspecified fracture of shaft of left fibula initial encounter for closed fracture. R8's medical record admission Record showed that R8 original admission date as 08/22/2023 and latest admission date 11/02/2023 with diagnosis list that includes but not limited to hemiplegia and hemiparesis following cerebral infarction affecting left dominant side. Aphasia, weakness, unspecified abnormal of gait and mobility, furuncle of neck, restlessness, and agitation. On 12/16/24 at 11:45am R1 noted on the 1st floor of the facility ambulating around with a sit to stand roller walker. R1 was able to communicate in English as a second language. R1 was able to remember about what happened on 09/30/24 stating that one man pushed R1. R1 stated that I was next to the wall in the elevator (indicating that there was no other space to move in the elevator). R1 stated the man pushed R1 to the floor (Fall to the floor) and broke R1 leg. According to the facility Preliminary Incident Investigation Report dated 09/30/24. V1 (Administrator) documented that he (V1) was notified by a facility nurse that (R8) was physically aggressive towards (R1) in the elevator on the 4th floor. Both residents were checked for injuries. R1 was noted to have pain in the left knee. R1 was sent to the (hospital) for evaluation. V1 documented that R8 forcefully rolled into the elevator hitting R1 in the legs causing R1 to fall. R8 was interviewed and R8 stated that R1 would not let (R8) into the elevator and hit (R8). R8 stated R1 fell on (R1)'s own. V1 documented that (V10 Nurse) was interviewed and stated she did not see the altercation but heard yelling. V10 walked to the elevator and saw R1 on the ground complaining of knee pain. V1 documented that both resident (R1 and R8) files (medical Record) were reviewed. R1 was noted to have history of verbal aggression and R8 was noted to have history of verbal and physical aggressiveness. (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 5 Event ID: 145834 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 145834 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austin Oasis, The 901 South Austin Blvd Chicago, IL 60644 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)