Inspection·November 18, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 consistently administer bilevel positive airway pressure (BIPAP) therapy as ordered by a physician for one resident (R2) out of three residents reviewed for respiratory care in a total sample of seven residents. Findings include:R2's current face sheet documents R2 is a [AGE] year-old individual admitted to the facility on [DATE] and has diagnoses not limited to: obstructive sleep apnea (adult) (pediatric), chronic obstructive pulmonary disease, unspecified, morbid (severe) obesity due to excess calories, sleep related hypoventilation in conditions classified elsewhere.R2's MDS/Minimum Data Set, dated [DATE] documents that R2 has a BIMS/Brief Interview for Mental Status score of 15/15, indicating that R2 has intact cognitive function. R2's active physician order set documents in part Bipap (bilevel positive airway pressure) at 15 cm (centimeters) H2O (water) On at Night and off while awake. No additional details were documented in the scheduled portion of the order. R2's physician note dated 8/26/2025 10:01 PM documents bipap trial at night, on nasal canula oxygen at the rate of 2 liters / min, keep head end of the patient elevated. Patient and staff educated on overall plan of care and warning signs and symptoms reviewed with patient. R2's physician note dated 9/3/2025 7:31PM documents in part obstructive sleep apnea, bipap trial at night.R2's physician note dated 9/8/2025 7:51PM documents in part bipap trial at night.R2's care plan documents R2 is at risk for acute cardiac distress, SOB (shortness of breath), and risk R/T (related to) COPD (chronic obstructive pulmonary disease), CHF (congestive heart failure), OSA (Obstructive Sleep Apnea). Respiratory risks will be minimized with nursing and medical interventions thru next review. There is no documentation of BIPAP therapy documented in R2's care plan interventions.R2's medication administration records and treatment administration records dated August 2025 and September 2025 did not document R2's Bilevel Positive Airway Pressure (BIPAP) is scheduled nor administered. R2's progress notes since admission reviewed and no consistent documentation that R2's BIPAP was administered as ordered by the physician.On 09/17/2025 at 10:55 AM, R2 was lying on her bed with R2's head of the bed elevated. R2 noted with oxygen via nasal cannula at 2 liters/minute. R2 stated that she has been in the facility for about three weeks to four weeks. This surveyor observed R2's (BIPAP), a non-invasive ventilation therapy used to assist patients with breathing difficulties, on R2's bedside table. R2 stated that she is not able to put on the BIPAP by herself and needs assistance. R2 stated that no one was putting it on R2 since R2 had been here until recently. R2 said that when she inquired about her BIPAP the nurse's response was I can't bother with this, it is too hard. R2 said that she cannot recall the nurse's name who said this to R2. On 09/17/2025 at 11:35 AM, V2 (Director of Nursing) said I saw R2 maybe a couple of weeks ago pertaining to R2's BIPAP. V2 stated that R2 reported that she was not getting the BIPAP therapy. On 09/18/2025 at 10:45 AM, V2 (Director of Nursing) stated that the administration of BIPAP should be documented in the electronic medication administration record (EMAR) or in the resident's progress notes. V2 stated that R2's BIPAP order does document when it should be administered which is at night and off in the morning time. V2 stated that she did see some notes that it was administered, V2 stated but she did not see the notes consistently. V2 stated that the order is not in the EMAR with scheduled details and where the nurses can sign off when administered. V2 stated that the importance of a BIPAP machine is to ensure that the resident is getting adequate oxygenation and to prevent them from going into pulmonary distress or respiratory distress, to keep the lungs open. On 09/18/2025 at 10:14 AM V14 (Registered Nurse) stated that she regularly works with R2. V14 stated that the importance of a BIPAP machine is for their breathing and is commonly ordered for conditions such as COPD (chronic obstructive pulmonary disease) and sleep apnea. V14 stated that Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145938 If continuation sheet Page 2 of 3 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 11/18/2025 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)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the nurses would know to administer the BIPAP if the order is in the MAR (medication administration record) or the TAR (treatment administration record), or sometimes by reviewing R2's physician order set. V14 stated that the administration of the BIPAP would need to be documented in the MAR, TAR, or the resident's progress notes. V14 stated that if it is a standard order, it would be documented in the MAR. V14 stated that if it is not documented then it is not done. Facility document not dated documents in part physician orders (following physician orders). It is the policy of the facility to follow the orders of the physician. The facility will have orders to provide essential care to the resident, consistent with the resident's mental and physical status upon admission. Facility provided document not dated documents in part resident rights. You have the right to safety and good care. Your facility must provide services to keep your physical and mental health, and sense of satisfaction. Event ID: Facility ID: 145938 If continuation sheet Page 3 of 3