Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to perform a blood glucose check on a diabetic
resident that was reporting symptoms of a low blood sugar for 1 of 3 residents (R1) reviewed for quality of
care in the sample of 3.
Residents Affected - Few
The findings include:
On 4/6/25 at 2:44 PM, R1 was seated in his wheelchair. R1 had bilateral above the knee amputations. R1
said he's had diabetes for a long time and knows when he feels off. R1 said usually his blood sugars run
high, but on that morning (3/17/25) he felt weird. R1 described weird as feeling lightheaded and sweaty. R1
said he went to find the nurse and asked her to check his blood sugar because he thought it was low. R1
said the nurse (V9 - LPN) told him she was busy. R1 said he knew something was wrong, so he went to his
room and called 911. R1 said he is a brittle diabetic meaning his blood sugar will be really high and then
drop down really low. R1 said he didn't eat much dinner the night before and he thought that was why his
blood sugar dropped. R1 said when the ambulance arrived, paramedics checked his blood sugar and it was
41 or 42. R1 said someone gave him a Glucerna to drink. R1 said the ambulance took him to the hospital
and he was starting to feel better on the way. R1 stated, I think my blood sugar came up into the 80s when
we were on the way to the hospital, the glucerna helped. R1 said he was at the hospital a few hours and
came back to the facility. R1 said the facility checks his blood sugar 2-3 times a day and he didn't
understand why V9 (LPN - Licensed Practical Nurse) wouldn't take it.
R1's Facesheet dated 4/6/25 showed he had diagnoses to include, but not limited to: epileptic seizures, lack
of coordination, bilateral BKA (below the knee amputations), weakness, and diabetes.
R1's facility assessment dated [DATE] showed he was cognitively intact
R1's Physician Order Sheet (POS) dated 4/6/25 showed he had orders for blood sugar monitoring as
needed and the doctor should be called if the blood sugar is less than 70 or greater than 400. R1's POS
showed he had an order for Glucagon Emergency Kit 1 mg if his blood sugar was less than 60 and he was
unable to swallow. R1's POS also showed that he was on scheduled long and short-acting insulin.
R1's Blood Glucose Summary showed his blood sugar was 380 on 3/16/25 at 5:18 PM. The next blood
sugar documented was on 3/17/25 at 4:29 PM. There was no documented blood sugar on or near 5 AM on
3/17/25.
R1's Progress Note dated 3/17/25 showed at 5:00 AM, R1 approached V9 (LPN) and requested she check
his blood sugar. This note showed V9 said she was finishing with another resident and R1 became
(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 3
Event ID:
145850
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
145850
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
City View Multicare Center
5825 West Cermak Road
Cicero, IL 60804
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 0684
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
upset. This note showed R1 went to his room and called 911 with his cell phone. This note showed the
paramedics arrived as V9 was going to R1's room to assess him. At 5:20 AM, R1 refused to allow blood
sugar check and resident was transferred to the hospital via ambulance. At 10:27 AM, R1 returned to the
facility.
On 4/6/25 at 10:59 AM, V7 (Nurse Supervisor) said he was working as the night shift supervisor on
3/17/25. V7 said he wasn't on R1's floor when the issue started. V7 said he was surprised to see the
ambulance because none of the nurses' had notified him that 911 was being called. I asked the front desk
person why the ambulance was here and they told me that someone on R1's floor called 911. V7 said that's
when he went up there. V7 said V9 (LPN) was R1's nurse. V7 said when he arrived to the floor, R1 was
there and the nurse and paramedics were talking. V7 said R1 looked okay. V7 said he's worked with R1
before and he knows that he is diabetic. V7 said the paramedics took the blood sugar and it was low. V7
said he didn't recall the exact number, but it was in the 40s. V7 said he gave R1 a Glucerna to drink and
tried to explain to the paramedics that the facility could provide care for R1. V7 said the paramedics said the
nurse refused to check R1's blood sugar. V7 stated, I wasn't there for that part. The nurse told me that she
was with another resident. V7 said R1's blood sugar is usually high, but it does fluctuate. V7 said there were
two functioning blood glucose monitors available on the floor. V7 said R1 was able to make his needs know
and could describe how he was feeling. V7 said R1 would be able to tell if he was hypoglycemic.
On 4/6/25 at 11:29 AM, V12 (Firefighter/Paramedic) said they responded to a call at the facility for diabetic
problems. V12 stated, When we arrived on the floor, the staff appeared confused. Then a [V9 - LPN]
realized [R1] had called 911 from his own phone. While we were talking to the nurse the resident wheeled
around the corner. [R1] told us he felt like he his blood sugar was low and he wanted a (sugary drink). V12
said the V9 said R1 was fine. V12 said he asked V9 what R1's blood sugar was. V12 said she told him that
she didn't check his blood sugar and she didn't have an order to do so. V12 said V9 was rude to the
paramedics and argumentative. V12 said R1 was showing signs of hypoglycemia (complained of
lightheadedness, feeling dizzy, and he was pale and sweaty). V12 said he checked R1's blood sugar and it
was 42. V12 said that is dangerously low and R1 could have suffered serious consequences if his blood
sugar was properly treated. V12 said the facility provided R1 with a drink and R1 was taken to the hospital
for evaluation. V12 said R1's blood sugar was checked in route to the hospital. V12 said R1's blood sugar
improved and R1 reported feeling better. V12 said the call was early in the morning, but he was not sure on
the exact time.
On 4/7/25 at 12:22 PM, V11 (LPN) said she was working 3/17/25, but she was not assigned to R1. V11 said
she missed the beginning of the interaction. V11 said she became aware when the paramedics arrived. V11
said she was surprised to see the paramedics. V11 said R1 called them from his personal phone. V11 said
V9 was the nurse and she was arguing with the paramedics. V11 said V9 was trying to tell the paramedics
that R1 appeared fine. V11 said the paramedics asked V9 if she checked R1's blood sugar and she said no.
V11 stated, At that point, I just wanted to check R1's blood sugar. V11 said the paramedics took R1's blood
sugar and it was low. V11 said R1's blood sugar was concerning and he needed to be provided some sugar
and more monitoring. V11 said some signs and symptoms of hypoglycemia (low blood sugar) include pale
skin, sweating, confusion, and possible loss of consciousness. V11 said R1 knows his body. V11 said, If he
asked for his blood sugar to be checked, then she should have checked it. V11 said she wasn't aware if the
facility had standing orders for treatment of hypoglycemia, but if R1 was alert and able to swallow, she
would give him juice and recheck his blood sugar. V11 said if he couldn't swallow, then we have an
emergency sugar medication we can give.
On 4/7/25 at 2:49 PM, V2 (DON - Director of Nursing) said R1 was alert and oriented and could make
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145850
If continuation sheet
Page 2 of 3
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
145850
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
City View Multicare Center
5825 West Cermak Road
Cicero, IL 60804
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 0684
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
his needs know. V2 said R1 knows his body and would be able to tell the nurse if he thought his blood
sugar was low. V2 said there are glucometers available and if a resident is complaining about a low blood
sugar, then the nurse should check the blood sugar. V2 said R1 can become angry and impulsive when his
needs are not met immediately. V2 said it's possible the nurse was providing care to someone else, but
when they are finished they should make checking the blood sugar a priority. V2 said she was not aware of
a reason a nurse should refuse to check a resident's blood sugar. V2 said R1 is noncompliant with diabetic
diets and occasionally refuses blood sugar checks. V2 said R1 normally runs high, but 42 is dangerously
low. V2 stated, I'm sure he felt bad, if it dropped that much.
A policy for Management of Diabetic Residents was requested and not received. V1 (Administrator) said the
closest policy they have was Following Physician's Orders.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145850
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
FAQ · About this visit
Common questions about this visit
What happened during the April 7, 2025 survey of CITY VIEW MULTICARE CENTER?
This was a inspection survey of CITY VIEW MULTICARE CENTER on April 7, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at CITY VIEW MULTICARE CENTER on April 7, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.