Health inspection·November 20, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide necessary assistance for one dependent resident (R149) in accordance with care plan by failing to complete weekly shower/skin assessment as ordered. This failure affected one (R149) of six residents reviewed for Activities of Daily Living (ADL) care. R149 developed a hematoma to her right great toe at the facility, complaint of pain where it was noted R149's wound was infected, and an x-ray revealed a fracture to the right great toe. R149 was treated with oral antibiotics for seven days.Findings include:R149 is a [AGE] year-old female who has resided at the facility since 8/28/2025, past medical history includes, but not limited to hypertensive heart disease, other dysphagia, other reduced mobility, type 2 diabetes, anemia, hemiplegia, and hemiparesis following cerebral infarction affecting the right dominant side, etc.On 11/17/2025 at 10:30AM, R149 was in her bed, awake and alert but could not answer any questions, resident was able to nod yes and no to some questions. The nurse was outside the door preparing medication for resident, surveyor requested her assistance to assess resident's right great toe, which was noted with no dressing, dry and with some whitish discoloration close to the nail bed. Surveyor asked resident if she still gets dressing to her toe and she shook her head no.Wound care note dated 10/1/2025 documented a facility acquired hematoma to right great toe measuring 2.50 X 2.0 X unknown (L X W X D). Area 5.00cm, volume unknown. Tissue typeblood filled blisters 100%.R149 was assessed as being dependent on staff for all activities of daily living (ADL) needs and always incontinent of bowel and bladder, Behavior assessment indicated that resident does not exhibit any behaviors. Active physician order documented the following: Right great toe: cleanse with normal saline, pat dry and paint with betadine and cover with dry dressing daily and as needed for wound care. Weekly showers/skin assessment, acknowledgement of shower and skin assessment completed. If new skin issue, notify physician, notify family and complete skin assessment form.Care plan initiated 10/1/2025 documented that resident has arterial wound to right great toe, is at risk for delayed wound healing and is at risk for further alteration in skin integrity related to anemia, diabetes, hypertension, and peripheral arterial disease. Interventions include monitor skin during care and report changes, ongoing assessment of wound to evaluate signs of deterioration or improvement, treatment as ordered by physician, etc.Urgent care record dated 10/25/2025, history of present illness documented in part: [AGE] year-old female parented(sic) with right great toe injury discovered 25 days ago by family when they removed resident's socks. Currently patient reports pain to right great toe at the site of injury, pain is worse with touch.X-ray of foot 3 or more view indicated under impression of acute nondisplaced intra- articular fracture of the distal phalanx of the right toe.Diagnosis was listed as cellulitis of right toe, nondisplaced fracture of distal phalanx of right toe, type 2 diabetes. Medication orders: prescribed clindamycin HCL300mg capsule, take 1 capsule by mouth every 6 hours for seven days.Shower sheets for the months of September, October and November indicated that R149 was not receiving showers as Residents Affected - Few (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 3 Event ID: 145967 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 145967 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Country Club Hill 18200 South Cicero Avenue Country Club Hills, IL 60478 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)