Health inspection·May 8, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on interview and record review, the facility failed to update a resident care plan as exacerbation of neurological symptoms began to occur. This failure affected 1 (R3) resident reviewed for care plan in the total sample of 5 residents. Findings include: On 05/05/2025 at 2:20pm, V2 (Director of Nursing) stated R3 was doing spastic movement of her upper extremities, flexion and extension. R3 never had this jerking movement before. It was as if she was trying to get out of her chair. It was just severe so we put her on 1:1 supervision. If you (staff) were with her, there is no spastic movement but as soon as you (staff) leave, R3 would have spastic movements of both her upper and lower extremities. I really think her cerebral palsy is exacerbating. There is a change on her baseline signs and symptoms. The exacerbation of R3's symptoms should be care planned. It is a problem that we need to focus on, we have to create a goal and add interventions. R3's careplan for cerebral palsy and spastic movement was not updated with new interventions. R3's careplan should be revised to include new interventions. I (V2) will update it today. R3's admission Record documented that R3's diagnoses (include but not limited to) cerebral palsy, metabolic encephalopathy, and reduced mobility. R3's (02/14/2025) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: no entry. C0700. Short-Term memory Ok: 1 Memory problem. C0800. Long-Term Memory Ok: 1. Memory Problem. C1000. Cognitive Skills for daily decision making: 3 severely impaired. Section I0020. Indicate primary medical condition. 07. Other neurological conditions. I0020B. primary Medical Condition. Cerebral Palsy. R3's care plan (date initiated: 05/05/2023) documented, in part The resident has an alteration in musculoskeletal status r/t (related to) hx (history) of muscle wasting and atrophy, spasticity and involuntary/impaired movements of the limbs and trunk d/t (due to) Cerebral Palsy. Date Initiated: 05/05/2023. Revision on: 05/05/2025. Revision by: V2 (Director of Nursing). Give medication as prescribed. Date Initiated: 05/05/2025. Created on: 05/05/2025. Created by: V2 (Director of Nursing). Neurology/Psychiatrist referral PRN. Date Initiated: 05/05/2025. Created on: 05/05/2025. Created by: V2 (Director of Nursing). Of note, revision was made on day one of survey. The (10/20/2024) Care plans, comprehensive Person Centered documented, in part Policy Statement: A comprehensive, person-centered careplan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Policy Interpretation and implementation. 8. The comprehensive, person-centered care plan Page 1 of 2 146167 146167 05/08/2025 Foster Health & Rehab Center 2840 West Foster Avenue Chicago, IL 60625

F 0657 will: g. Incorporate identified problem areas. 13. Assessments of the resident are ongoing and care plan are revised as information about the residents and the resident's condition change. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 146167 Page 2 of 2