Inspection·June 13, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow its policy when they did not provide a notice of discharge to the resident's representative, before the discharge, which included explanation and rights to appeal, when the facility did not allow a resident to return after the ten-day bed hold lapsed, which constituted a facility discharge. This applies to 1 of 3 residents (R1) reviewed for bed holds. The findings include: R1's Electronic Health Record (EHR) showed R1 was originally admitted on [DATE], and was recently sent to the hospital on [DATE], where she is. The EHR showed R1 had multiple diagnoses including cerebral infarction, Alzheimer's disease, hypertension, type 2 diabetes, dysphagia, hemiplegia left dominant side, dementia, and vascular dementia. R1's Minimum Data Set (MDS), discharge - return anticipated, dated [DATE] showed R1 could not complete the mental assessment, but was considered severely impaired for daily decision making. R1's Care Plan dated [DATE] showed: R1 will not be discharging from the facility, as determined by the inter-disciplinary team, physician, resident and/or legal representative. R1 has impaired cognitive functioning related to diagnosis of dementia. Assist with decision making including family or responsible party as needed. On [DATE], V2 (Director of Nursing/DON) stated, on [DATE], V2 informed V12 (R1's Guardian) that R1's 10-day bed hold lapsed, and another resident was going to be admitted to R1's room. V2 stated, she informed V12 that R1 is considered long term and there are no other beds available, and R1 would need to go on the waiting list if she wanted to return to the facility. V2 stated, R1 was discharged on the 11th day, [DATE]st, per policy. During interviews, V1 (Administrator) stated, R1's room was held for 10 days, from [DATE]-[DATE], and on [DATE], V1 made V12 aware that the bed hold period expired. V1 stated, she made V12 aware that R1 would not be able to return to the facility, because R1's room was going to a new admission, and since R1 is considered long term, and there were no more long-term beds available, she would have to go on the waiting list. V1 stated, there was no semi-private long-term beds available, and the last semi-private female bed was considered a short-term bed, but a new admit was taking that bed on [DATE]th. V1 stated, R1 had electronic monitoring and a resident in a semi-private room would have to (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 4 Event ID: 146182 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 146182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Courts of Waterford 1991 Randi Drive Aurora, IL 60504 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)