Inspection·April 14, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to follow a resident's plan of care interventions for fall prevention and failed to provide the resident with a working call light for a resident high risk for falls in one (R1) of three residents reviewed for falls. Findings include: R1 is a [AGE] year-old female with a diagnosis including Schizophrenia, Chronic respiratory failure, Epilepsy, Nondisplaced fracture of seventh cervical vertebra, Subdural hematoma, Drug induced secondary parkinsonism and Type 2 diabetes. R1 was first admitted to the facility on [DATE]. R1 has a BIMS (Brief Interview for Mental Status) of 10/15. R1 uses a wheelchair for mobility. R1 is assessed as a high risk for falls (latest 3/25 fall assessment scored 21). R1 is care planned for including history of multiple falls. R1 is physician ordered to wear cervical collar until follow up appointment for further orders. R1 was placed on 1:1 supervision on 3/20/24. On 4/12/24 at 11AM R1 was observed in R1's room by herself. R1 was sitting up on the edge of bed trying to get up to transfer to her wheelchair. R1's wheelchair was 5 feet from R1's reach next to the wall opposite the side of bed. R1 almost fell to the floor. R1 had to be prompted by surveyor to remain sitting in her bed. R1 stated she had to go to the bathroom real bad. R1 attempted to stand several times and had to be prompted to stay sitting in bed. Help was called from surveyor. R1 did not have a soft helmet on. R1 did not have 1:1 supervision at time of observation. V3 (Licensed Practical Nurse/LPN) was called from office room across from R1's room. V3 had to retrieve R1's wheelchair and place it next to the bed and lock the wheels. V3 assisted R1 from a sitting position to the wheelchair. V3 then transported R1 to the women's bathroom in the corridor. R1's bed is located against the wall. The nurse call box was observed missing the cord and not usable. The square metal conduit leading to the nurse call box was observed pulled apart exposing sharp metal. This sharp metal edge was directly next to the middle of the mattress. On 4/12/24 at 11:05AM V3 (LPN) stated, I did not know that R1 needed assistance. I don't know what happened to the cord for the nurse call. I don't know where the CNA (Certified Nursing Assistant) is. On 4/12/24 V2 (Director of Nursing/DON) was asked to provide the interventions in place to prevent falls of R1. The following list was provided by V2: 2/23/24 Re orient the resident to her surroundings and ensure that the resident has on proper footwear. (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 4 Event ID: 146149 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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)