Health inspection·January 13, 2026

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews, the facility failed to implement their abuse prohibition policy by failing to conduct a thorough investigation for an injury of unknown origin. This failure affects one of three residents (R1) reviewed for injuries of unknown origin. As a result, R1 was noted with swelling to the right lower forearm and grimacing in pain and was transported to the local hospital and R1 was found to have sustained a right comminuted distal radial fracture with displacement, a comminuted and impacted distal ulnar fracture with displacement, and a hematoma to the right side of the head.Findings includes:R1's hospital record, dated 9/22/25, notes R1 was brought in by EMS (emergency medical services) crew. Per EMS report, R1 had fall yesterday. This morning R1 had images which showed distal radius and ulna fracture. R1 states that she remembers falling yesterday. On physical exam by emergency room physician, a small hematoma was noted to R1's right lateral head; swelling noted to right wrist with obvious deformity. The emergency room diagnoses: fall and closed fracture of distal ends of right radius and ulna. The hospital's orthopedic surgeon was consulted and noted unclear, unwitnessed mechanism of injury given R1 is bedbound and has been for the last 3-4 years. Also noted is an injury to R1's head, deformity to wrist with dorsal prominence, and moderate swelling around wrist. R1's fracture was closed reduced and right arm placed in a splint.R1's hospital x-rays, dated 9/22/25, shows mildly comminuted (severe break where the bone shatters into three or more pieces, often from high-impact trauma, car accident or fall) fracture of the distal radial diaphysis with 1/4 shaft width radial displacement of the distal fracture fragment; mildly comminuted and impacted fracture of the distal ulnar metaphysis with 1/4 shaft width ulnar displacement of the distal fracture fragment; partially imaged osteoarthritis in knuckles and finger joints; and regional soft tissue swelling.There is no documentation found in R1's hospital record noting right arm injury due to pathological fracture.The facility's investigation into this incident only has statements from V3 RN (registered nurse), V4 RA (restorative aide), and V5 CNA (certified nursing assistant.) The facility did not present any further statements from other staff that worked on R1's nursing unit the days preceding the incident. The facility's investigation, dated 9/22/25, notes R1's right arm injury was due to a pathological fracture. The facility is unable to present any hospital documentation noting R1 had osteoporosis in right arm.On 1/8/26 at 9:45 AM, V1 (administrator) stated that R1 injured right arm when R1 hit arm on side rail. V1 stated that an investigation was done regarding this incident. V1 stated that all the nurses and CNAs (certified nurse aides) on R1's nursing unit were interviewed; all denied R1 falling.On 1/8/26 at 10:55 AM, V2 DON (director of nursing) stated she was present in facility at the time of R1's injury on 9/22/25. V2 stated that she was notified by staff and immediately went to R1's room to assess R1. V2 stated that R1 was not able to state what happened. V2 stated that she interviewed R1's roommates and was informed by one of them that R1 was rolling top sheet up and arm hit side rail. V2 stated that due to R1's comorbidities V2 believed right arm fracture was pathological. V2 stated that V2 called the hospital and asked if injury and R1's comorbidities 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 2 Event ID: 145969 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 145969 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Forest Park 8200 West Roosevelt Road Forest Park, IL 60130 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)