Inspection·May 30, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the physician of a change in condition for a resident. Residents Affected - Few This applies to 1 of 1 resident (R1) who was reviewed for a change in condition. Findings include: On 05/28/2025 at 8:35 AM, V10 (R1's family member) stated that on the evening of 05/22/2025, R1 experienced a change in condition and the facility did not notify the physician before a nurse increased oxygen from 2 liters to 4 liters via nasal cannula. On 05/28/2025 at 1:30 PM, V4 LPN (Agency-License Practical Nurse) stated that she worked with R1 for the first time and took the report from the morning nurse. She was not aware that she had not notified the provider. V4 said the staff involved in assessing R1 said being lethargic is R1's baseline. When R1 was excessively sweating and his oxygen saturation was at 89 percent around 9:00 PM, V10 arrived and requested that R1 be transferred to the hospital. V4 said she called 911 and transferred R1 to the hospital. On 05/28/2025 at 6:00 PM, V3 (LPN) said she worked from 7:00 AM to 7:00 PM, and the incident happened during the turnover of shift. V3 said she assessed R1 along with V4, and took vital signs, which were per his baseline, and then endorsed to V4 since her shift had ended. On 05/22/2025 at 3:11 PM, V7 NP (Nurse Practitioner) stated that she was on call for the facility and did not receive any calls regarding R1's change in condition and transfer to the hospital. On 05/22/2025 at 12:09 PM, V2 (Director of Nursing) stated that it's a standard policy guideline to notify physicians of changes in conditions and any new orders. On 05/22/2025 at 5:28 PM, V8 (R1's NP) stated that they did not hear anything about R1's condition and that the facility should have followed the notification protocol, despite R1's vital signs being at baseline, or R1's previous hospital admissions for failing lungs condition and lethargy. R1's EMR (Electronic Medical Records) shows R1 was a [AGE] year-old male admitted to the facility on [DATE], and R1's diagnoses include acute and chronic respiratory failure with low oxygen and high carbon dioxide, chronic obstructive pulmonary diseases, multiple cardiac diseases, stage five chronic kidney/end-stage renal disease, anemia, hemiplegia, and hemiparesis, and dependence on supplement oxygen. R1's Minimum Data Set indicated that R1's cognition was intact. (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: 146008 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 146008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden of Waterford 2021 Randi Drive Aurora, IL 60505 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)