Health inspection·January 24, 2024

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 interview and record review, the facility failed to follow their abuse policy and immediately remove the alleged staff from resident care. This affected one of three (R1) residents reviewed for abuse policy. Residents Affected - Few Findings Include: On 1/23/24 at 11:45AM, R1 stated that R1 went to the third floor looking for someone who can assist him to look for his nurse. R1 went to the back by the med room and knocked, a male voice from the inside answer saying he is not the nurse but will look for my nurse. I just want to make sure, so I know who I was talking to, so I opened the med room door and found V7 (Registered Nurse/RN) inside. V7 stood up from a chair, kneed me with his right knee to my left knee and put his hands on my shoulder and pushed me away from the med room. I told him, take your hands off me. Stated that there were no other staff or residents witnessed the incident. V7 then went back inside the med room and R1 went back to his floor. I checked the 2nd floor med room. R1 reported the incident to V1 (Administrator) via phone around 4 or 5am, and same morning V1 came and talked to R1 in person, they also called the Police Department to report the incident. On 1/24/24 at 8:30AM, interview with V7 (RN) reported that V7 was made aware of the abuse allegation when V7 was already home on 1/3/24, after V7 completed his shift. V7 stated that he received a call from V1 (Administrator) informing him of the abuse allegation and that V7 will be suspended pending the investigation. V7 was scheduled to work on 1/2/24 (11-7 shift, night nurse). Timecard reviewed and showed that V7 clocked in to work that shift at 10:57PM and clocked out at 7:28AM. V7 was not on the schedule 1/3/24 and 1/4/24 due to the investigation. On 1/24/24 at 10:30AM, V1 stated that he was made aware by R1 about the abuse allegation probably around 5am on 1/3/24 via phone. The nurse called V1 and gave the phone to R1. V1 spoke to R1 and R1 reported an alleged abuse from V7. When asked if V7 was escorted out of the facility once the allegation was reported to V1, and V1 stated that V7 was not escorted out of the facility, that the third floor would not have had a nurse. It would have been maybe only an hour or so that V7 stayed in the facility. V1 stated that V1 is not in the facility 24/7 and did the best that V1 could with the situation. V1 stated that V1 was not in the facility to escort V7 out at that time. V1 wanted to make sure that other residents are being taking care of, and to have a nurse on the 3rd floor. V1 stated if there is a crime made, we have 24 hours to report it to the regulatory agency. I don't know what else to tell you. We have abuse policy, but I cannot tell you at this time what was exactly said in our abuse policy. (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: 145999 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 145999 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Niles 6601 West Touhy Avenue Niles, IL 60714 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)