Health inspection·June 7, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review, the facility failed to follow their policy of transferring a resident via a mechanical lift. This failure affected 1 (R1) resident reviewed for supervision in the total sample of 3 residents. Findings include: The 06/06/2025 List of Residents on Sit to stand and/or Mechanical Lift transfer include R1. On 06/06/2025, at 11:18 AM, inside R1's room, V12 (Certified Nursing Assistant/CNA) and V13 (Registered Nurse) transferred R1 from the wheelchair to the toilet seat with the use of the sit to stand lift. After sitting R1 on the toilet seat, V13 washed her hands and informed V12 to call her when R1 is done using the toilet. On 06/06/2025, at 11:30 AM, V12 transferred R1 from the toilet seat to R1's wheelchair with the use of the sit to stand lift all by herself. On 06/06/2025, at 11:32 AM, V13 went inside R1's room. V13 asked V12 Why did you not call me? On 06/06/2025, at 11:33 AM, V12 stated we need two-person assist for transfer via the sit to stand lift. I did not wait for her (V13) to assist me because she (R1) is already getting agitated. On 06/06/2025, at 11:55 AM, V13 stated I was in the dining room talking to the sisters. I did not hear her (V12) calling me. The sit to stand lift transfer should be with two-person assist for the safety of the resident. She (R1) has a cognitive deficit. On 06/06/2025, at 2:03 PM, V5 (Director - Quality Management) stated if the intervention is Sit to Stand lift with transfer, the expectation is to implement the intervention for all transfers. The importance of implementing the intervention is to promote safety to residents and staff. On 06/06/2025, at 3:16 PM, V10 (Restorative Nurse) stated when transferring a resident via a Sit to Stand lift, the expectation is to have two staff transferring the resident because it is a machine and that is the regulation and for the safety of the resident and the staff. R1's (undated) Profile Face Sheet documented that R1's diagnoses (include but not limited to) dementia with other behavioral disturbance, hypothyroidism, type 2 DM, and late onset Alzheimer's disease. (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: 145960 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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)