Inspection·April 16, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure that residents' rooms (R10, R11 and R12) were free from urine on the floor and urine odors. Findings include: R10 is a [AGE] year old with diagnosis including but not limited to: Encounter for attention to other artificial openings of urinary tract, personal history of malignant neoplasm of bladder, anxiety disorder, dementia and obstructive and reflux uropathy. R11 is a [AGE] year old with diagnosis including but not limited to: Essential hypertension, schizophrenia, weakness, bipolar disorder and unspecified fracture of right femur. R12 is [AGE] year old with diagnosis including but not limited to: overactive bladder, bilateral inguinal hernia, weakness, chronic obstructive pulmonary disease and bipolar. During investigation on 4/10/25 at 12:58 PM, Surveyor noted a strong odor of urine outside of residents (R10, R11 and R12) room. Surveyor observed R10 sitting in bed with urine leaking from his urostomy site and a puddle of yellow fluid on the floor next to his (R10's) bed. Surveyor inquired about the odor in the room. On 4/10/25 at 1:00 PM, V5 (LPN/ Licensed Practical Nurse) said, that she smelled a strong odor of urine in the room and would get housekeeping to clean the urine from the floor. On 4/14/25 at 12:32 PM, Surveyor noted a strong urine odor outside of R10's bedroom. R10 was observed sitting in his bed with a puddle of yellow fluid on the floor next to his (R10's) bed. On 4/14/25 at 12:36 PM, V15 (Registered Nurse) said that he would inform housekeeping of the urine on the floor near R10's bed. On 4/16/2025 at 10:37 AM, V13 (Housekeeping Director) said, The housekeepers' duties includes cleaning and mopping the residents' rooms daily. If there is urine on the floors, we are supposed to get it up. A CNA (Certified Nurse Assistant) or a Nurse should report to us if there is a urine spill in the floor. The nursing staff can also get the spill up if the housekeeper is on lunch and notify us (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 4 Event ID: 145938 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 145938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Hyde Park Rehabilitation and Nursing C 6125 South Kenwood Chicago, IL 60637 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)