Inspection·May 19, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to keep a resident free from staff to resident verbal abuse. Residents Affected - Few This affected 1 of 3 residents (R1) reviewed for verbal abuse. This failure resulted in R1 being yelled and cursed at by V2 (certified nurse aide) Findings Include: R1 is a [AGE] year-old with the following diagnosis: schizophrenia, schizoaffective disorder, and moderate intellectual disabilities. R1 admitted to the facility on [DATE] and discharged on 5/4/23. The Resident Abuse Investigation Form dated 5/2/23 documents V2 (Former CNA) was yelling at R1 stating 'Why are you throwing milk down the hall?' V3 (PRSC) heard V2 state, 'You don't throw fucking milk in here.' V3 immediately separated R1 from V2. V2 was asked to go to the lobby, and the incident was reported to V4 (DON) immediately. No injuries were noted to R1. R1 denied being yelled at. R1 denied V2 using profanity toward R1. V2 acknowledged yelling down the hallway, asking R1 why did R1 throw the milk however, V2 denied using profanity. V2 reported being frustrated that V2 was behind in morning tasks and felt overwhelmed with the back and forth. On 5/17/23 at 11:41AM, V2 stated, R1 was being aggressive and threw and open carton of milk in the hallway. I finished with another resident and approached R1. I went to ask R1 why R1 did that; to try to get an understanding. I did get upset and told R1 that R1 shouldn't do that again. We both cussed at each other. I said, If you do that again a resident would kick your ass. I don't recall saying the F-word. The only cuss word I said was ass to R1. They told me I was discharged for misconduct as far as behavior. Verbal abuse would be a degrading statement or an insensitive comment. After I walked away from R1, the DON asked me to come into her office. I told V4 what happened, and I said some things I shouldn't have said in the heat of the moment. On 5/17/23 at 12:38PM, V3 stated, I heard V2 yell out 'What are you throwing stuff for? V2 said, 'You don't throw fucking milk in here.' V2 voice was raised. I could hear V2 clear down the hall. I went and told the DON what happened. I did not hear R1 cussing at V2. V2 was the only one speaking when I was coming down the hall. This would be verbal because it is profanity and demoralizing. That is not how we show respect to each other ever. On 5/17/23 at 12:52PM, V4 stated, I was told that V2 had cussed at R1. I don't remember the exact words, but I believe it was over a carton of milk that was thrown. This would be verbal because it was words that were said to a resident that were not appropriate. (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: 145947 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 145947 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Midlothian 3249 West 147th Street Midlothian, IL 60445 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)