Health inspection·March 28, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 promptly answer resident call lights. Residents Affected - Few This applies to 3 of 16 residents (R3, R6, R7) reviewed for call lights in a sample of 17. Findings include: 1. The admission Record documents R3 as a [AGE] year old admitted to the facility on [DATE], with diagnoses to include left femur fracture, anxiety, history of falls and diverticulosis. A Progress Note, dated 3/25/2024, documents R3 as alert and oriented and able to make needs known to staff. On 3/26/2024 at 10:12 AM, R3's call light was already activated. V7 (Nurse Manager) entered R3's room to respond to the call light, and R3 stated she needed assistance to the bathroom to have a bowel movement. V7 informed R3 she would notify her Certified Nursing Assistant (CNA) to assist her to the bathroom and left the room. At 10:13 AM, R3 stated her call light was on for approximately 10-15 minutes prior to V7 entering her room. R3 stated, I have issues with them answering my light. At 10:15 AM, V8 (Guest Services) entered R3's room, and also left after asking R3 what she needed. At 10:18 AM, V8 approached V10 (Nurse) who was passing medications 3 rooms away from R1's room and informed V10 that R3 needed assistance to the bathroom. V10 told V8 that R3's CNA was assisting another resident in the shower and I will help her when I am done. At 10:21 AM, V8 was again in and out of R3's room, and R3 still had not been assisted to the bathroom. At 10:25 AM, V8 and V7 entered R3's room again; V7 left and V8 stayed stating, I am not a CNA and I cannot change you. V8 told R3 she would stay with her until she receives help. R3 responded with, See this is what they say. They will say they will come back and they don't for at least 30 minutes. At 10:31 AM, V9 (CNA) entered room to assist R3 to the toilet. At 10:33 AM, V9 completed a gait belt stand pivot transfer to the wheelchair and wheeled R3 into the bathroom. At 10:34 AM, V12 (CNA) entered R3's room to assist V9; R1 was transferred to the toilet. R3 had been incontinent of bowel, but urinated while she was on the toilet. R3's Response History, dated 3/25-27/2024, shows R3 has been both continent and incontinent of her bowels since admission. On 3/27/2024 at 1:48 PM, V2 (Assistant Administrator) confirmed R3's call light and toileting needs should have been attended to sooner than they were during the observed incident of 3/26/2024. 2. R6's Minimum Data Set (MDS), dated [DATE], documents R6 as cognitively intact. (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: 145899 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 145899 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Warren Barr Orland Park 14601 South John Humphrey Dr Orland Park, IL 60462 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)