Health inspection·July 3, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many surveyor that facility follows that is from IDPH (Illinois Department of Public Health). When asked what the humidity is, so we can figure the heat index V1 stated, I am going to go find a relative humidity thermometer and buy one, so we know. I do not know what the humidity is by that gun readings. V1, Administrator, was asked if maintenance staff scanning temperatures aiming at air conditioners was the correct practice. V1, Administrator, stated, I am not sure. I can find out.On 7/1/2025 at 3:10 PM, V1, Administrator, stated, The (brand) thermometer I found today can't be reading right, as it is saying this room is 64.5 F. It can't be, but the 77 Wb (wet bulb) looks right, and the humidity level is reading 49%. I am just going to send the maintenance guy to buy a new one that reads both, as he did calibrate this gun and it is still reading 64.5 F, and I know it is not that cold in here. I looked up on the internet and everything I read stated that scanning for temperatures of the rooms should be aimed directly through the room, or aiming at window/wall across room in the middle to get correct temperatures. If you aim at the air conditioner or floor, you will get a cooler reading as cool air falls and heat rises.On 7/3/2025 at 8:54 AM, V1, Administrator, stated, I now have new thermometers that read both the humidity and the temperatures. I read the manual and know how to work the thermometer. We have to make sure the tip is open and turn it on and it reads both humidity and temperature. Temperatures have been reading fine. The east side of the building where the sun rises reads a little high, but that is because that is where the sun comes up. My nurses took temperatures on all residents. I will scan you those documents.On 7/3/2025, at 9:45 AM, V1, Administrator, stated, I told the Maintenance Director and (V6, Assistant Maintenance Director) and had them educate their team on how to calibrate, read, and scan for room temperatures. I ensured that they know to scan directly across the middle of the room to get accurate temperatures. I did this on Tuesday (7/1/2025) this week.On 7/3/2025 at 9:52 AM, Surveyor accompanied V6 to take temperatures in the building. V6 stated, (V1, Administrator) told us how to scan for temperatures, and I also in serviced all of my staff on Tuesday (7/1/2025) as well. We are to scan directly across the room in the middle for correct temperatures. Two areas noted to be above 81 degrees F when using Section 300. Table D heat index table/apparent temperature in administrative code. These areas were (room#) and the hallway outside of (room #). Temperature in (room #) read 84.0 degrees F with humidity of 53.7% which indicates about 89 degrees F. The hallway outside of (room#) read 83.8 degrees F with humidity of 53.3%, which indicates on table about 88 degrees F.On 7/3/2025, at 10:48 AM, V1, stated, Regarding (room#) being above temperature; one resident that resides in that room, (R4), keeps turning off the air conditioner. I have (R4) care planned for this. I have a total of 9 residents that are turning the air off for a myriad of reasons. One is just to play his game boy. For these residents, we are doing checks on them every 2-3 hours checking the room making sure air is on, plugged in, reeducating residents and this on top of the 3 daily temperature checks from maintenance staff. I spoke to both other roommates in (room #) and they do not want to move out of this room. If I am being honest, (R4) is going to keep doing it, but she cries a lot and does better with roommates, so I don't want to put her in a private room either. We will continuously monitor (R4) and her room for temperature. Both of her roommates have passes to go out, and go out all the time. (R4) does not have a pass. For the hallway that reads above temperature, the large swamp cooler is in that hallway already, but I will put another one on that hallway, as I have an extra one. V1, Administrator, stated she will provide surveyor with a copy of care plan for R4 regarding turning off air conditioner, and rescan temperatures taken 7/1/2025 and 7/3/2025 with surveyor present, with the added apparent temperatures added by surveyor figured by heat index table. I will also personally ensure that everyone in maintenance department has an in-service by me personally showing them how to use the relative humidity thermometers I (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 07/03/2025 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete just bought. (room#) has a brand new PTAC (packaged terminal air conditioner) that was just installed on 6/30/2025, and she has a portable chiller in the room as well, as she keeps turning off the air conditioner.Extreme Heat Policy, with effective date of 2/4/2022 and last reviewed date of 2/4/2024, documents:Policy: Should the temperatures in the facility rise above the upper limits for relative humidity and the temperature set forth in the Administrative Cod, the following measures will be carried out.Maintenance Department FunctionsMonitor air temperature in various locations of the facility to determine cooler rooms within the facility.Monitor all exhaust/ventilation systems and assure their working conditions.Maintain all air conditioning systems/Clean all air conditioning filters.Assure that water lines to the facility are working appropriately.Check emergency equipment and assure that they are in working condition.Administration functionsAssure that adequate equipment and supplies are on hand. Event ID: Facility ID: 145850 If continuation sheet Page 3 of 3