Inspection·October 30, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their fall focus program for one resident who was identified as moderate risk for falls, by not ensuring the resident's entire bathroom floor was dry prior to assisting him with care. This affected one of three residents (R1) reviewed for safety during care. This failure resulted in R1 sustaining a witnessed fall resulting in an impacted intertrochanteric fracture of the proximal right femur (right hip fracture).Findings include:R1 was admitted to the facility on [DATE] with a diagnosis of down syndrome, severe intellectual disabilities, mood disorder and osteoarthritis. R1's brief interview for mental status score dated 9/26/25 documents a score of 8/15 which indicates mildly impaired. R1's functional abilities dated 9/26/25 documents supervision or touching assistance for personal hygiene, shower transfer, putting on/taking off footwear, upper and lower body dressing. Under shower/ bathe self documents: R1 requires partial/moderate assistance.R1's fall assessment dated [DATE] documents moderate risk for falls. Under gait analysis documents: unable to independently come to standing position, exhibits loss of balance while standing, decrease muscle coordination and strays off straight path of walking.R1's incident report dated 10/13/25 documents: Resident was taking a shower had a slip and hurt his buttocks area. The fall was witnessed no injury to head. Resident reports pain to right leg. Under predisposing environmental factors wet floor is marked.On 10/28/25 at 2:06pm, V4 (CNA/Certified Nurses Assistant) said she was passing by R1's room and heard the water. V4 said she entered the room and observed R1 undressed in his bathroom with wet towels. R1 was soaking the towels in the sink with water and then going to shower and squeezing the water onto himself because the shower head was turned off and only had a small amount of water coming from the shower head. V4 said she tried to convince R1 to come out of the bathroom, but he was refusing. V4 said there was water all over the floor. V4 said the floor was still wet with puddles where R1 was standing but had dried the other half of the floor. V4 said, V5 (CNA) heard them and came into the room to assist. V4 said R1 started listening to V5 and V4 was able to dry off R1 and assisted him to get dressed with cueing. R1 had a shirt, pants, shoes on and was reaching to put on his sweater that V5 was holding. V5 and V4 were walking out of the bathroom to try to get R1 to come out to put his sweater on when R1 slipped and fell to his buttocks. On 10/29/25 at 12:21pm, V5 (CNA) said on day of incident he was in the hallway and heard R1. He went into R1's room to assist. R1 was already out of the shower and had pants and shoes on. The floor was wet because R1 had a cup that he was filling with water at the bathroom sink and bringing to the shower to bathe. R1 needed to get his shirt on and was assisted by staff V4 who was in the room as well. R1 was not being resistive with care at that time. V5 said he had R1's sweater and when R1 went to grab it he slipped and started to fall. V5 said he tried to stop him from falling but R1's weight took him down and the position he was in due to the toilet being in the way.R1's right femur x-ray report dated 10/13/25 documents: an impacted intertrochanteric fracture of the proximal right femur with (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: 145946 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 145946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Hillside,the 4600 North Frontage Road Hillside, IL 60162 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)