Health inspection·January 29, 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 observation, interview, and record review the facility failed to ensure a resident was transferred safely and, in a manner, to prevent resident injury. These failures resulted in a resident (R1) sustaining a leg laceration during a resident transfer. The resident was sent to a local hospital where she required fourteen sutures to repair her leg laceration. These failures apply to 1 of 3 residents (R1) reviewed for safety and supervision in the sample of 3. The findings include: A facility incident report and progress notes dated 1/20/25 showed R1 was found by staff to have a large, bleeding laceration to her right lateral lower leg, immediately after being transferred from her wheelchair to bed by V5 Certified Nursing Assistant (CNA). The incident report showed, Per CNA (V5) when transferring resident, her right leg scraped on the enabler piece of the resident's bed frame. The progress notes showed R1 was assessed by V4 Registered Nurse (RN) and found to have a 10 cm (centimeter) x 1 cm laceration to her leg. 911 was called. R1 was transported emergently to a local hospital for an evaluation and treatment. R1's hospital discharge notes dated 1/20/25 showed R1 was treated for a large laceration to her right lower leg that required fourteen sutures to repair. R1 was discharged back to the facility on 1/20/25. R1's progress note dated 1/21/25 showed R1 was provided with a new bed. R1's progress note dated 1/23/25 showed R1 was started on antibiotics due to developing redness to the wound on her right lower leg. R1's admission record showed R1 was admission care plan dated 1/13/25 showed R1 was admitted to the facility with diagnoses of spinal stenosis, history of falling, muscle weakness, unsteadiness on feet, and dementia. R1 was cognitively impaired. R1's transfer assessment dated [DATE] showed R1 required the assistance of 1-2 staff members for transfers. On 1/29/25 at 9:38 AM, R1 was seated in a wheelchair with a large gauze dressing noted to her right lower leg. R1 stated she didn't remember what happened to her right leg, but she remembers her leg was bleeding. R1 was unable to state when the incident happened or who was with her at the time of the incident. This surveyor's interview with R1 was limited due to R1's impaired cognition. (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: 146007 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 146007 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Moorings of Arlington Heights 761 Old Barn Lane Arlington Hts, IL 60005 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)