Inspection·June 6, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, facility failed to follow their policy to ensure a call light was within reach for one (R4) out of three residents reviewed for call lights in a total sample of 9. Residents Affected - Few Findings include: R4's MDS (Minimum Data Set) section C (Cognitive Patterns) dated May 28, 2025, documents R4's Brief Interview for Mental Status (BIMS) as 15/15 indicating R4 has intact cognitive functional abilities. MDS Section GG-Functional abilities documents R4 requires Substantial/maximal assistance with eating, oral hygiene, toileting hygiene, shower/bathe self, upper body dressing, Lower body dressing, putting on/taking off footwear, personal hygiene, roll left and right, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, toilet transfer, tub/shower transfer, walk 10 feet, walk 50 feet with two turns, walk 150 feet, and R4 is a two person assist. On 06/04/2025, at 12:03 PM, R4 was observed trying to sit up in bed, alert, oriented to person, place, time, and situation. R4 was observed trying to get himself into a sitting position and was observed looking for something. R4 stated he was looking for his call light to get staff's attention to get him up and out of bed. R4 was tired of staying in bed and his back was hurting him. R4 stated he could not find his call light. R4 was observed with left hand contractures. On 06/06/2025, at 12:10 PM, V11 (Certified Nursing Assistance-CNA) and surveyor observed R4's call light hanging on top of R4's overhead light far from R4's reach. R4 stated he could not reach the call light. V11 stated R4 would not be able to reach the call light where it was placed. Therefore, he would not be able to use it to get staff's attention for his needs. V11 stated if call lights are not within reach, residents are unable to make their needs known. R4 could have fallen and hurt himself trying to adjust himself or reach for the call light. On 06/04/2025, at 12:24 PM, V3 (Assistant Director of Nursing-ADON) stated call lights should be within residents' reach for residents to use in case of an emergency or to get their needs met. If residents cannot reach the call light in an emergency their needs will not be met and the resident could experience negative outcomes such as falls. On 06/05/2025, at 9:34 AM, V2 (Director of Nursing-DON) stated resident's call lights should be within reach so that the resident can use it to reach staff in case of an emergency or if the resident needs help from staff. V2 stated if the call light is not within resident reach, the resident will not be able to reach staff. (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: 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 06/06/2025 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)