Health inspection·November 14, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to update and follow all physician orders after resident's outpatient appointment.This applies to 1 resident (R1) reviewed for quality of care.The findings include:R1's Facesheet shows the following diagnoses: Iron Deficiency Anemia, Malignant Neoplasm of Female Breast, Secondary Malignant Neoplasm of Bone, and Secondary Malignant Neoplasm of Bone Marrow.On 9/30/25 at 11:32 AM, V4 (Oncology NP/Nurse Practitioner) said he is very familiar with R1, and saw her in the office with V9 (Oncology Doctor) on 8/21/25. V4 said on 8/21/25, V9 gave the written order to the facility to stop R1's Ribociclib chemotherapy medication until 8/28/25. V4 said Ribociclib is taken every day for 3 weeks and then the patient has 1 week off and R1 was to be off the Ribociclib from 8/21/25 through 8/28/25. V4 said Ribociclib causes bone marrow suppression, so the one week off the medication is important to give the bone marrow time to recover. V4 said he thinks R1's anemia is more related to her cancer as opposed to the Ribociclib chemotherapy. V4 said R1's chemotherapy isn't helping her anemia, but it is not the main cause. V4 said it is hard to say if R1's anemia is a direct cause of the Ribociclib being given during her ordered off week, 8/21/25-8/27/25, or if R1's anemia and need for blood transfusion was coincidental because R1 has a history of anemia.R1's Physician Order Sheet signed by V9 and dated 8/21/25 shows 4 orders:1. CBC Weekly,2. Letvozole to be given daily,3. 2nd cycle of Ribociclib at 400mg to begin 8/28/25. To continue for 21 days, and4. Patient to be evaluated by radiation oncology.R1's MAR (Medication Administration Record) for the month of August shows she received Ribociclib 400mg oral tablet on 8/22, 8/23, 8/24, and 8/25.On 9/30/25 at 12:49 Pm, V2 (DON/Director of Nursing) said it is the nurse's responsibility when resident returns from an appointment with physician orders, to enter those orders into the computer and carry them out. V2 said V7 (LPN/Licensed Practical Nurse) was the nurse assigned to take care of R1 on 8/21/25. On 9/30/25 at 1:20PM, V7 (LPN) said she did not enter order for R1's Ribociclib per the physician's order and verified that she did write a nurse's note on 8/21/25 at 5:52 PM stating R1's daughter dropped off Ribociclib medication to be started on 8/28/25. V7 reviewed R1's Physician Order Sheet signed by V9 (Oncology Doctor) dated 8/21/25. V7 then reviewed R1's orders and confirmed the only order she entered from R1's Oncology Appointment was for weekly CBC. V7 said she did not enter any of the other orders from R1's Oncologist, including the order for Ribociclib.On 9/30/25 at 1:56 PM, V8 (RN/Registered Nurse) said she took care of R1 on 8/26/25. V8's nurse's note written on 8/26/25 at 8:11 AM states Ribociclib 400mg to be resumed on 8/28/25. V8 said she remembers writing that note and it was prompted because she tried to administer Ribociclib to R1 that morning, and R1 told her she could not take it until 8/28/25. V8 said per R1's Physician Order Sheet signed by V9 on 8/21/25, R1's Ribociclib should have been held from 8/21/25 through 8/27/25 and the 2nd cycle should have started on 8/28/25.The facility's policy titled, Physician Orders for Medications or Treatments dated 06/2022 states, A. Policy:.Each medication order is documented in the resident's medical record with the date and signature of the person receiving he order.C. Procedure:.2. The nurse will Residents Affected - Few Page 1 of 2 146153 146153 11/14/2025 Alden Estates of Shorewood 710 W Black Road Shorewood, IL 60404

F 0684 follow facility-specific procedures to submit orders to pharmacy appropriately, which may include transcribing any telephone or transfer sheet orders to the POS. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 146153 Page 2 of 2