Inspection·February 2, 2026

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 Based on interview and record review the facility failed to safely transfer 1 of 3 (R1) residents reviewed for accidents in a sample of 7. This failure resulted in R1 falling out of a whole-body lift machine onto the floor and sustaining a right hip fracture, a fracture of the distal right femur and a fracture of the right tibia.This past noncompliance occurred on 1/24/2026.Findings included:R1's admission Record documents R1 was admitted to this facility on 5/20/2025 with diagnoses of dependence on dialysis, end stage renal disease, morbid obesity and chronic obstructive pulmonary disease among others.R1's MDS (minimum data set) dated 11/15/25, documents R1 needs two staff assistance for all transferring activities and the staff utilize a full body lifting machine for lifting R1. R1's MDS documents R1 has a BIMS (Brief Interview for Mental Status) of a 15 indicating R1 has no cognitive impairment.R1's care plan documents a focus area of: R1 has impaired physical mobility related to decreased strength, limited weight bearing tolerance and dependence on mechanical lift for transfers. Date initiated as 1/24/26.A facility document titled Long Term Care Facility-Serious Injury Incident Report for R1 dated 1/24/2026 documented the following in part: At approximately 0900 hours (9:00 am) two CNAs (Certified Nurse Assistants) went into the resident's room to get her out of bed using the mechanical lift. They attached the sling to the lift and raised the resident up over her bed and weighed her. After obtaining the weight on the resident they went to place her in her wheelchair. According to both CNAs, the bottom right strap slipped off the hook on the mechanical lift and the resident slid out of the sling onto the ground. R1 was transported to the hospital. Hospital called and notified the facility that R1 has suffered a hip fracture, femur and upper tibia fractures.On 1/28/2026 at 1:25pm, V5 (CNA) said on 1/24/26 around 8:45am, she and V6 were transferring R1 into her wheelchair from bed using the (mechanical) lift and a bariatric sized sling. V5 said she operated the machine while R6 maneuvered the wheelchair. V5 said while the lift machine was moving with R1 up in the air, R1's sling hook on the bottom, slipped off and R1 fell to the ground. V5 said she ran and got help while R6 stayed with R1. V5 stated R1 was transported to the local hospital emergency room (ER) via EMS (Emergency Medical Services). V5 said after R1 was sent to the ER, they looked over R1's sling and found nothing wrong with it. V5 said it was in perfect working order. On 1/29/26 at 11:00am, V6 (CNA) said on 1/24/2026 around 8:45am, R1 was ready to get out of bed after breakfast because her family was coming to spend the day with her from out of town. V6 said she and V5 (CNA) prepared R1 for transfer by placing R1's bariatric lift sling underneath R1 and hooking the sling straps to the lifting machine. V6 said she hooked the bottom straps while V5 hooked the top straps. V6 said V5 began to lift R1 up into the air with the lifting machine, while V6 got R1's wheelchair ready for R1 to be lowered down into the wheelchair. V5 said while they were moving the lift machine with R1 up in the air, the bottom right strap of R1's lift sling slid off the machine causing R1 to fall to the floor. V5 said she must not have gotten the strap on the machine correctly. V5 said the nurse immediately came and R1 was sent to the local emergency room for treatment of (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: 146096 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 146096 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Haven of Ridgeview 413 Ridge Lane Oblong, IL 62449 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)