Health inspection·March 19, 2025

F 0839 Employ staff that are licensed, certified, or registered in accordance with state laws. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Interview and Record Review, the facility failed to hire and maintain a current and active license for a Registered Nurse (RN) and allowed that RN to work unlicensed upon hire. Residents Affected - Some The Findings Include: On [DATE] at 11:50 AM, While doing the background check review, one of the facility's RNs (V4) was found to have an expired license and has been working at facility since hired on [DATE]. On [DATE] at 11:52 AM, V1, Administrator, stated I did the background checks on (V4, RN), and I never noticed that her license was expired. I just called (V4) who told me that she thought she renewed her license, but she doesn't have a receipt to prove it. (V4) was calling the Illinois Department of Financial and Professional Regulation (IDFPR) to discuss this with them and will let me know of the outcome. On [DATE] at 12:35 PM, V6, Business Office Manager, stated There are three of them who do the background checks for new employees, V1, herself, and V7, Medical Records. On [DATE] at 12:37 PM, V7 stated We run fingerprints on date of hire or before, but since it takes a while to get them back, we usually accept the acknowledgment email from state indicating they received it, and that the employee is eligible to work with nothing flagged so far. On [DATE] at 12:45 PM, V1 stated I am the one who did (V4's) background check and I printed them out, and never saw the expiration date on her RN license. (V4) has been taken off the schedule. (V4) called the state who told her they never received a check to pay for the license renewal, therefore, it was not renewed and (V4) will have to send a letter indicating what happened and the board will review the issue and get back with her. On [DATE] at 1:45 PM, V1 stated The facility is staffed with two Nurses and five CNAs for Days and Evenings, then one to one and half Nurses and three CNAs for Nights. (V4) only works on Hall-Two with rooms 14 through 36. V4 was hired on [DATE] with a IDFPR License check completed upon hire. This License check indicated that V4's RN License expired on [DATE], prior to V4 being hired by the facility. The Facility's Nursing Schedules from [DATE], through [DATE], were reviewed with V4, RN, working 35 shifts as an RN on the floor. V4 cared for R2, R3, R4, and R5 during her shifts. Page 1 of 2 145921 145921 03/19/2025 Hitz Memorial Home 201 Belle Street Alhambra, IL 62001

F 0839 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some R2's, R3's, R4's, and R5's Medication Administration Record (MAR), dated [DATE], documents V4 administered medications to each resident on the shifts that she has worked at the facility. The Facility's Policy and Procedure Abuse and Neglect, undated, documents Employee Screening and Training: Before new employees are permitted to work with residents, references provided by the prospective employee will be verified as well as appropriate board registrations and certifications regarding the prospective employee's background. Licensed Staff: The facility will not employ or otherwise engage a licensed professional who has a disciplinary action in effect against his or her professional license by a state licensure body as a result of a finding of abuse, neglect, and exploitation, mistreatment of residents or misappropriation of resident property. A criminal background check will be conducted on all prospective employees as provided by the facility's policy on criminal background checks. 145921 Page 2 of 2