Inspection·May 12, 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 ensure that residents do not have access to alcohol and other illicit drugs while at the facility. This failure affected one resident (R1) and has the potential to affect four other residents (R2, R5, R6, and R11) reviewed for adequate supervision and access so alcohol/illicit drugs at the facility. As a result, R1 got drunk and consented to sexual activity that she claimed happened while under the influence of alcohol and illicit drugs. R1 reported that the sexual activity caused emotional harm to her(R1) and R1 was sent to the hospital. Findings include: R1's records show the following: Progress notes dated 4/25/25 at 11:00pm written by V7(RN/Registered Nurse) states in part that R1 was suspected to be intoxicated. V7 notified the Nurse Practitioner who gave an order to hold all R1's medications for the night. Progress notes dated 4/28/25 at 6:35pm written by V3(Social Services Director) states in part that R1 was tested for drugs because R1 admitted to using drugs recently. Test results showed that R1 had cocaine and marijuana in her system. On 5/1/25 at 12:05pm, R1 stated (R2) is a friend. He's nice and respectful. We smoke and drink together. On this Friday night, we were drinking and I got very drunk and went to my room to lay down. In the middle of the night, I felt somebody penetrated me; I felt there was a chain on the neck of the person. The next day when I woke up at 5am, I was naked. I did not give consent to have sex with anyone. When I asked the nurse, the nurse told me that I was intoxicated and throwing things around in my room. So, I did not tell her that I thought someone raped me. So, on Monday, I told the staff that supervise us during smoking, and also told the nurse (V5/LPN/Licensed Practical Nurse). So, they called the ambulance, but I went to my sister's house on a pass and told my sister. My sister called here and spoke with the nurse, and the nurse told me to come back to the facility. I returned about 3pm when my pass was over. I was sent to the hospital and did all the tests and came back here. Inquired from R1 if R1 had been drinking and smoking anything outside of the official smoking time that is supervised by staff. R1 responded that she(R1) and other residents usually drink and smoke pot (Marijuana) together. On 5/1/25 at 11:45am, R2(male resident/alleged sexual abuser) stated I was chilling and (R1) came into my room around 10:00PM. She and I were getting intimate together in my room. We then went into the bathroom and smoked a blunt and she gave me oral sex. It was just the two of us in the bathroom. (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 5 Event ID: 145995 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 145995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Archer Heights Healthcare 4437 South Cicero Chicago, IL 60632 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)