Inspection·May 9, 2025

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 ensure that no medication should be left at resident's bedside without physician order. The facility also failed to follow its policy in resident self-administration of medication. This deficiency affects all four (R71, R103, R116 and R177) residents in the sample of 35 reviewed for Medication Safety. Residents Affected - Some Findings include: On 5/6/25 at 12:43PM, Observed V17 LPN (Licensed Practical Nurse) preparing medication for R116. V17 said that R116's eye drop medication is at bedside. V17 said that R116 is alert and oriented x 3. V17 said that she usually keeps the eye drops and take it by herself. Observed Refresh eye drop 1 vial (individual dosage) and 1 bottle of Calcium chewable extra strength 750mg on top of R116's bedside tray table. R116 said that her family bought these medications, and she keeps at bedside because the nurses are forgetting to give her medications. She took her eye drops and calcium this morning around 9am because the nurse did not give her medications. V17 LPN is at the bedside and did not response to R116. V17 administered prepared medication including the refresh eye medication at bedside. On 5/6/25 at 12:55PM, V17 LPN said that R116 does not have physician order to keep medications at bedside. On 5/6/25 at 12:58PM, V28 Wound care nurse opened the treatment cart and gave the Voltaren gel house stock to V17 LPN that they use for residents on 4th floor. V17 said that they use the Voltaren house stock and shared it with residents on the 4th floor. Surveyor and V17 went to R177's room to administer Voltaren cream medication but R177 refused. Observed 2 bottle of artificial tears and 3 opened albuterol sulfate inhalers, I box of unopened albuterol sulfate inhaler, 1 Vicks vapor rub. R177 said that she has been keeping these medications at bedside. R177 said that she uses all these medications as needed. R177 said that she uses the Vicks frequently at night. On 5/6/25 at 1:02PM, V9 Nurse Supervisor said that they can keep medication at bedside if there is an order from physician. V17 LPN said that R177 has no physician order to keep medications at bedside. On 5/6/25 at 2:13pm Informed above concerns with V2 DON. V2 said that medication cannot be left at bedside without physician order. If resident wants to self-administer her medications, the IDT (Interdisciplinary team) team will assess resident for self-medication administration and will develop care plan. V2 said that the Voltaren cream house stock should not be shared by residents on the 4th floor. Each resident should have each own medication cream. (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 12 Event ID: 145931 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 145931 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Warren Barr Lieberman 9700 Gross Point Road Skokie, IL 60076 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)