Inspection·September 22, 2024

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to safely transfer a resident during toileting when a gait belt was not used, and required assistance was not provided. This failure resulted in R1 sustaining an acute comminuted fracture of the left femur due to a fall incident occurred during direct care. This applies to 1 of 3 residents (R1) reviewed for falls in the sample of 3. The findings include: The EMR (Electronic Medical Record) showed R1, a 92-year -old with diagnoses includes dementia, depression, osteopenia, osteoarthritis, stroke, history of breast cancer and pulmonary embolism. R1's surgical history includes right knee replacement. R1 was Covid positive on August 4,2024. R1 was originally admitted to the MMC (Memory Care Center) in the facility on October 11, 2019. R1 was transferred to the skilled section in the facility on September 3, 2024. due to declining condition, multiple falls, and weakness. The incident report log showed R1 had 2 falls for 2 weeks period. The incident report dated September 7, 2024 at 4:40 P.M., showed R1 ended up on the bathroom floor when R1 was getting off the toilet and slid down. The incident report dated September 16, 2024 at 2:00 P.M., showed during toilet assistance by V3 (CNA/Certified Nurse Assistant), R1's was assisted to the floor because R1's knees buckled up during the toilet/transfer assistance. This incident showed R1 had complained of pain to the left lower extremity after the fall. An x-ray was done on same day, with result of acute comminuted impacted supracondylar fracture of the left femur. The progress notes dated 9/16/2024 showed R1 was sent out to the hospital and was admitted due to fracture. On September 20,2024 at 12:14 P.M., V2 (Director of Nursing) said R1's fall on September 7, 2024 was because R1 was left alone in the bathroom as the CNA provided privacy to R1. V2 added R1's fall on September 16,2024 happened when V3 assisted R1 to the toilet, then R1 got weak, and legs buckled up. V2 said V3 assisted R1 to the floor. V2 added R1 then complained of left knee pain after the fall and x-ray was done. V2 said x-ray showed an acute fracture of R1's left femur. On September 20/2024 at 11:15 A.M., V4 (Registered Nurse) said he was the assigned nurse when R1 had a fall on September 16, 2024. V4 said he had also taken care of R1 when R1 was at the MMC. V4 said R1 was transferred to the skilled unit on September 3, 2024 due to R1's decline in level of functioning, was weak due to post Covid infection (August 4,2024). V4 said R1 had been falling at the MMC almost every other day and was then moved to skilled unit for closer supervision and assistance. V4 (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 09/22/2024 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)