Health inspection·May 18, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and records review, the facility failed to assist one resident (R1) of three reviewed in a sample of three with communication and access to services inside and outside the facility. This failure resulted in R1 not getting his social security card. Findings include: R1's current face sheet documents R1's medical conditions to include but not limited to: type 2 diabetes mellitus with diabetic chronic kidney disease, chronic kidney disease, stage 3 unspecified, acquired absence of right/left leg below knee, unspecified combined systolic (congestive) and diastolic (congestive) heart failure. MDS (Minimum Data Set) section C -Cognitive Function dated [DATE], documents R1's Brief Interview for Mental Status (BIMS) as 15/15 indicating R1 has intact cognitive function. On 05/17/2025, at 10:06 AM, R1 was observed laying in bed awake. R1 was alert, oriented to person, place, time, and situation. R1 stated he applied for his Social Security (SS) card about four weeks ago, but he has not yet received it. R1 stated he wanted to go to social security administration offices and follow up on his SS card. R1 called the senior citizen bus company for transportation to take him to SS offices but the facility told him he cannot go alone and that the facility would assist him. R1 stated to date no one in the facility has assisted him in following up with his SS card. R1 stated he needs his SS card to apply for housing and financial assistance. On 05/17/2025, at 12:40 PM, V7 (Business Office Manager) stated if R1 has applied for his social security card, the facility has not received it yet. V7 stated V9 (Psychiatric Rehabilitation Services Coordinator (PRSC) come to the admissions office a few weeks ago in April (Cannot remember date) and was talking to V10 (Admissions Director). V10 mentioned that R1 wanted to go to social security office to get a social security card. V7 stated V10 told V9 that R1 did not have to go to the Social Security office to apply for his social security card because he can do it at the facility through the phone. V7 stated she did not follow up after that conversations and does not know if R1 was assisted with applying for or following up on his social security card. V7 stated a social security card is used for identification purposes for various things. If R1 was asking for assistance getting it, he should have been assisted by the facility. V7 stated when a resident comes to the facility all their identification including a social security card is uploaded in their electronic medical record. V7 stated R1 does not have a social security card uploaded in his electronic medical record and if R1 was assisted with getting his card, it could have been uploaded into his medical records. V7 state she, V9 and V10 could have assisted R1 in following up on his SS card. Page 1 of 2 146164 146164 05/18/2025 Community Care Nursing Center 4314 South Wabash Avenue Chicago, IL 60653

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 05/17/2025, V10 (Admissions Director) via V9's phone stated a few weeks ago (Cannot remember the date) she was informed by V9 (Psychiatric Rehabilitation Services Coordinator -PRSC) that R1 wanted to go to social security office to get a Social Security card. V10 stated she told V9 that R1 did not have to go to the social security office to apply for the card and he (R1) can come down to her (V10's) office. V10 can help R1 call Social Security and apply by phone. V10 stated R1 did not come down to the office and she did not follow up with R1. On 05/17/2025, at 1:38 PM, V9 (Psychiatric Rehabilitation Services Coordinator -PRSC) stated she does not remember the exact day, but it might have been between 28 and 30th of April when R1 told her he needed to apply for a social security card. V9 stated the social services department assists residents with getting documents such social security cards and Identification cards (IDs). V9 stated she does not know why R1 needed his social security card, and she did not document her conversation with R1. V9 further stated R1 has not been assisted with applying for his social security card and she was planning on taking R1 to the social security office with another resident but did not provide a date when R1's visit to social security office was scheduled. V9 she had documented on her personal notes on paper to assist R1 but not in his progress notes in in electronic health record. V9 was unable to show in her note book any note referring to her conversation with R1 and any documentation she had scheduled an appointment to take him (R1) to social security office. During the interview as surveyor was talking to V9, she (V9) was observed trying to write R1's initials in her notebook to show she had spoken to him. V9 was using a blue pen to write R1's initial in her notebook and her notes that were already written were in black ink. On 05/17/2025, at 3:05 PM, V1 (Administrator) stated he was not aware R1 needed to apply for new social security card. V1 stated if R1 had asked staff for assistance getting his social security card, staff should have assisted R1 either to apply by phone or to go to social security offices because the facility has a bus to transport residents to appointments. V1 stated V7, V9 and V10 should have assisted R1 with getting his SS card. V1 stated V9 had scheduled to take R1 to the social security office with another resident but V1 was not able to provide any documentation between R1 and V9 discussion or R1's appointment to SS office. Review of R1's progress notes do not document R1's appointment to SS office for SS card needs Facility Policy titled Resident Rights dated 3/31 documents: -The facility will meet with resident to attempt to resolve any issues in a timely matter. -The resident will be provided resources to assist them in exercising their rights. 146164 Page 2 of 2