Health inspection·September 3, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report and investigate mental abuse for one (R2) of three residents reviewed for mental abuse. Findings include: On 08/29/2024 at 10:51AM, R2 stated on the day of the altercation he was standing in the medication line to receive his medication. R2 stated the nurse (identified as V7/LPN) gave R2 his medication and noticed a pill was missing so R2 let V7 know. R2 stated V7 works at the facility periodically and V7 forgets his pill often. R2 stated this particular time after R2 reminded V7 to give him his pill, V7 told R2, I'm going to beat the $h!+ out of you. R2 stated he reported this to V5 (Psychiatric Rehabilitation Service Coordinator/PRSC) the next day. R2 stated he reported to V5 that V7 was being ignorant with him, giving him a hard time, and that V7 threatened to beat the $h!+ out of R2. On 08/29/2024 at 11:10AM, V5 (PRSC) stated R2 reported to her that V7 (Licensed Practical Nurse/LPN) yelled at him, V7 does not give R2 his medication, and R2 does not like getting his medication from V7. V5 stated R2 reported this to her last week sometime and she has been out of the facility for the last four days and just returned back to work today. V5 stated R2 did not report anything else to her but she cannot be certain of this. V5 stated the day R2 reported to her, V5 was located on the third floor of the facility at the end of the hallway by the stairs. V5 stated she was about to leave the facility and was on her way home for the day. V5 stated it is a possibility that R2 reported to her that V7 threatened R2 but V5 stated the only thing she remembers is R2 telling her that V7 yells at R2 and doesn't give R2 all of his medication. V5 reported this to her supervisor (identified as V6/Psychiatric Rehabilitation Service Director/PRSD). V5 stated she only reported to V6 what she remembered hearing, which is, that R2 does not feel comfortable receiving his medication from V7. V5 stated since she was leaving the facility for the day, it's possible that she did not comprehend what R2 was reporting to her. V5 stated she was in-serviced on abuse about 1.5 weeks ago and is able to verbalize different forms of abuse and who to report abuse to. V5 stated the importance of reporting abuse is to keep the residents safe and to protect them. V5 stated her conversation with R2 was very quick and it is a possibility that R2 reported abuse to her but V5 was not paying attention. V5 stated if abuse allegations are not addressed then R2 is at risk for experiencing more emotional abuse which could cause trauma and mental abuse because R2 was still in the presence of the V7 (LPN) and had to receive his medications from V7. V5 stated she has seen R1 receive his medication from V7 without any concerns. V5 stated she has never heard any complaints of V7 mistreating or abusing any of the residents in the facility. On 08/29/2024 at 1:03PM, V6 (PRSD) stated he has never had a conversation with V5 (PRSC) about (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: 145864 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 145864 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Forest Edge 8001 South Western Avenue Chicago, IL 60620 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)