Health inspection·May 2, 2024

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that PRN (as needed) antianxiety medication orders had clinician documented rationale for use beyond 14 days, failed to identify and monitor target symptoms/behaviors and failed to implement non- pharmacological interventions prior to PRN medication use. This applies to 1 of 5 residents (R13) reviewed for unnecessary medications in the sample of 12. The findings include: R13's EMR (Electronic Medical Record) showed R13, [AGE] years old, was admitted to the facility on [DATE], with multiple diagnoses including Alzheimer's disease with late onset, personal history of other diseases of the nervous system and sense organs, anemia, primary hypertension, anxiety disorder, arthritis, history of left hip replacement and history of surgical repair of the right ankle. R13's MDS (Minimum Data Set) dated April 4, 2024, showed R13's cognition was severely impaired and was dependent on staff assistance for all ADLs (Activities of Daily Living) including bed mobility, eating, toileting, bathing, dressing, and transfer, and R13 could not sit unsupported requiring the use of a high back wheelchair with built in supports. R13's care plan initiated on September 30, 2022, for use of anti-anxiety medication showed the intervention to monitor/record target behavior of restlessness, anxiety, disrobing, inappropriate response to verbal communication and violence/aggression toward staff and others etc. and document behavior per facility protocol. Interventions included to administer anti-anxiety medication as ordered by the Physician. There were no non-pharmacological interventions to address anxiety, restlessness or agitation in the care plan. R13's pharmacy recommendation dated February 15, 2024, showed R13 was prescribed Lorazepam (anti-anxiety medication) 1 mg (milligram) every 4 hours PRN, greater than 14 days, without a stop date. R13's March 2024 MAR (Medication Administration Record) showed Lorazepam 1 mg, every 4 hours PRN order initiated on February 16, 2024, had a stop date of March 1, 2024. R13 was prescribed Lorazepam 1 mg. every 4 hours PRN on March 7, 2024, through March 21, 2024, without a note written by the prescriber documenting rationale for use. R13 was administered Lorazepam 1 mg on March 9, 2024, at 7:16 PM and March 13, 2024, at 7:43 AM, with No documented for behavior observed prior to administration. R13 was prescribed Lorazepam 1mg. every 4 hours PRN on March 22, 2024, with a stop date of April 5, 2024, without a note written by the prescriber documenting rationale for continued use. R13 was (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: 146155 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 146155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Place Christian Community 1150 Euclid Avenue Elmhurst, IL 60126 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)