Health inspection·November 14, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to immediately notify the physician and obtain an order to transport a resident with an acute change in mental status and respiratory status to the hospital. This affected one of three residents (R1) reviewed for acute change in condition. This failure resulted in R1 experiencing an acute change in condition at on 10.13.24 at approximately 7:00am, and the facility staff not notifying the physician or calling EMS until 10:44am. R1 was admitted to the hospital with a diagnosis of aspiration pneumonia and sepsis secondary to pneumonia. Residents Affected - Few Findings include: R1's EMS (Emergency Medical Services) run sheet, dated [DATE], notes EMS 911 was notified at 10:44AM for an unresponsive resident. Emergency crew was dispatched and arrived at R1's bedside at 10:54AM. R1 remained unresponsive to verbal and painful stimuli throughout transport to the hospital. R1's heart rhythm showed atrial fibrillation with rapid ventricular response. R1's lung sounds with rhonchi (gurgling) throughout right and left lungs. R1's hospital medical record, dated [DATE], notes per facility staff, R1 was eating at 8:30AM and was alert and oriented x 2, R1's baseline. R1 wears oxygen at 2 liters per nasal cannula, oxygen saturation was 85% on oxygen. R1 only responded to painful stimuli. R1 presented to the emergency room with a chief complaint of unresponsiveness and respiratory distress. EMS crew reports that they found R1 with vomit on clothes and mouth, unresponsive, and in respiratory distress. Initial work up in the emergency room revealed opacification throughout the entire right lung with some opacification in the left lung most concerning for aspiration. On initial assessment by the intensive care team, R1 is minimally responsive with audible gurgling with breathing. Per heart monitor, R1 in atrial fibrillation with rapid ventricular response, heart rate 120s-130s. R1 with elevated troponin level (protein found in the heart muscle which leaks into the bloodstream when the heart muscle is damaged resulting in increased level) due to demand ischemia (when the heart's need for oxygen is greater the body's ability to supply it. Initially R1's troponin level was 202 (normal range is less than 52); worsened to 240. CT (computed tomography) scan noted anasarca (severe buildup of fluid in the tissues of several parts of the body). On re-evaluation, R1's gurgling significantly worse, R1 even less responsive than previous with minimal movement to painful stimuli and evident respiratory distress. The intensive care physician expressed concern to R1's family that R1 is unlikely to survive this event and that antibiotics are likely futile given the severity of R1's illness and current medical condition. R1's code status was changed to DNR (Do Not Resuscitate) and R1 was placed in hospice on comfort measures only. R1 expired on [DATE]. R1's medical record, dated [DATE] at 10:55am, V4, RN, noted V14 alerted by staff that R1 was experiencing a change in condition. Further assessment revealed R1 was lethargic unresponsive to verbal (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: 146132 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 146132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at Homewood 19000 South Halsted Homewood, IL 60430 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)