Health inspection·April 18, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure six (R5, R13, R23, R26, R32 R37) residents rights were maintained. This failure affected six (R5, R13, R23, R26, R32 and R37) of six residents reviewed for resident rights out of a total sample of 22. Finding include: R23 is a [AGE] year-old resident most recent admission to the facility on [DATE] with diagnoses of but not limited to severe intellectual disabilities, down syndrome, and Alzheimer's dementia. On 04/15/24 at 10:03AM, during random observation, R23 was in TV area with activity staff. R23 was observed sleeping in geriatric chair with mechanical lift sling visible underneath resident. On 04/15/24 at 10:34 AM R23 was observed in room sleeping in geriatric chair and mechanical lift sling visible underneath resident. R5 is a [AGE] year-old resident admitted to facility on 09/16/20 with diagnoses of but not limited to Alzheimer's disease, dementia and down syndrome. On 04/15/24 at 10:06 AM, R5 was observed in geriatric chair in TV area with activity staff V3. R5 was observed sleeping in geriatric chair with mechanical lift sling visible underneath resident. On 04/15/24 at 10:24 AM, R5 was observed awake in TV area watching television with mechanical lift sling visible underneath resident. R32 is a [AGE] year-old resident re-admitted to facility on 04/14/2023 with diagnoses including but not limited to profound intellectual disability, Alzheimer's disease, autism, dementia, and down syndrome. R13 is a [AGE] year-old resident admitted to facility on 07/15/2022 with diagnoses including but not limited to Alzheimer's disease and down syndrome. R26 is a [AGE] year-old resident admitted to facility on 06/07/2022 with diagnoses including but not limited to down syndrome and Alzheimer's disease. R37 is a [AGE] year-old resident admitted to facility on 09/13/2023 with diagnoses including but not limited to bipolar disorder, down syndrome, profound intellectual disability, and Alzheimer's (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 4 Event ID: 145839 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 145839 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Ridge Healthcare Center 665 Busse Highway Park Ridge, IL 60068 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)