Inspection visit
Inspection
8 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0658
Ensure services provided by the nursing facility meet professional standards of quality.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to ensure a resident's medications were administered timely in
accordance with the prescriber's order and the facility's Medication Pass Guidelines. This applies to 1 of 1
resident (R21) reviewed for medication administration in a sample of 15.
Residents Affected - Few
The findings include:
R21's admission record showed that R21 was admitted to the facility on [DATE], with multiple diagnoses
including Chronic obstructive pulmonary disease, vascular dementia, anxiety disorder, essential
hypertension, chronic kidney disease and overactive bladder.
R21's MDS (Minimum Data Service) dated June 30, 2023, showed R21 is cognitively intact and requires
supervision with most of her ADL's (Activities of Daily Living).
On October 4, 2023, at 11:30 AM, V21 (R21's Power of Attorney) stated that she had concerns regarding
facility staffing. V21 stated that on September 23, 2023, and September 24, 2023, R21 received her
medication scheduled for 8:00 AM after 11:00 AM.
R21's Medication administration audit report for September 23, 2023, showed scheduled 8:00 AM
medications were not administered until 11:14 AM on September 23, 2023. The medications administered
late included Gabapentin 600 mg (milligrams) and diphenhydramine 25 mg. 2 capsules, ordered to be given
three times per day (08:00AM, 2:00PM and 8:00PM). Also administered late were (Brand Name)
moisturizing mouth solution, probiotic capsule, triamcinolone cream and alprazolam 0.25 mg. were ordered
to be given twice a day (08:00 AM, 8:00PM) were given at 11:15 AM. Fluticasone-Umecliden-Vilant aerosol
powder inhaler and Seroquel 12.5mg scheduled to be given at 2:00 PM were administered late at 5:59 PM
on September 23, 2023. On September 24, 2023, the medications were administered late, at 10:44 AM
included Gabapentin 600 mg (milligrams) and diphenhydramine 25 mg. 2 capsules, ordered to be given
three times per day (08:00 AM, 2:00 PM and 8:00 PM).
R21's order summary report showed Gabapentin 600 mg was ordered to be given three times a day for low
back pain on August 15, 2023. Diphenhydramine 50 mg was ordered to be given three times a day for
allergy symptoms on August 15, 2023. Fluticasone -Umecliden-Vilant aerosol powder breath activated
(inhaler) 1 puff orally every afternoon for respiratory symptoms was ordered on June 9, 2022. RisaQuad
(probiotic product) was ordered to be given two times a day for bowel management on April 29, 2022.
Seroquel 12.5 mg. was ordered to be given in the afternoon for vascular dementia with behavioral
disturbance on July 28, 2023.
On October 4, 2023, at 1:18 PM, V4 (Infection Preventionist Nurse) stated V19 (Licensed Practical
(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 11
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
10/05/2023
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)
F 0658
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Nurse) was the nurse who worked the A wing and half of the B wing on September 23 and 24, 2023 during
the 6 AM to 6 PM shift.
On October 4, 2023, at 1:30 PM, V19 stated she has been a nurse since 2003 and she worked on first shift
on September 23 and 24, 2023 and was assigned to A wing and half of B wing. V19 further stated she had
a discharge on A wing on Saturday September 23, 2023, that delayed her medication pass on the B wing
and she administered R21 medications late for both Saturday and Sunday. V19 stated it is safer to have a
nurse on each wing as A wing residents take a lot of time and families have many requests that take staff
time to address. This causes a delay in being able to give care and medications timely to the residents on
the B wing assignment.
The facility's Medication Pass Guidelines dated April of 2019, showed 5. Medication Timing .All medications
should be given in the correct time window or a reason for late/early administration should be documented
on the MAR/eMAR.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 2 of 11
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
10/05/2023
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)
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to assist residents identified as needing
assistance with personal hygiene. This applies to 5 of 5 residents (R14, R26, R36, R245 and R249)
reviewed for ADLs (activities of daily living) in the sample of 15.
Residents Affected - Some
The findings include:
1. R14 had multiple diagnoses including dementia without behavioral disturbance, late onset of Alzheimer's
disease and bullous disorder (rare skin condition causing large, fluid filled blisters) based on the face sheet.
R14's quarterly MDS (minimum data set) dated July 25, 2023 showed that the resident was severely
impaired with cognition and required extensive assistance from the staff with personal hygiene.
On October 2, 2023 at 2:05 PM, R14 was sitting in her wheelchair inside her room. R14 was alert but
non-verbal. R14's fingernails were long with black and thick yellow substances underneath. V2 (Director of
Nursing) stated that R14's family does not want the resident's fingernails shorten, however V2
acknowledged that R14's fingernails should be cleaned by the staff.
On October 3, 2023 at 10:28 PM, R14 was sitting in her high back reclining chair. R14 was alert but
non-verbal. In the presence of V6 (Licensed Practical Nurse/LPN) and V5 (family/POA [Power of Attorney]),
multiple of R14's fingernails were observed with black substances underneath. V5 stated that she told the
facility staff about the long and dirty fingernails of R14, but the staff does not trim and/or clean the
resident's fingernails. V5 stated that the last time she trimmed and cleaned R14's fingernails was on the
first of September 2023. According to V5, R14 had a history of resisting care but because of the
progression of dementia, R14 had been calmer and compliant with care. V6 was present during the entire
interview of V5.
R14's active care plan initiated on April 14, 2017 showed that the resident had ADL self-care performance
deficit related to dementia. The same care plan showed multiple interventions including, Assist with ADL
tasks as needed, Assist with personal hygiene as needed and Provide needed level of assistance and
support to complete Activities of Daily Living.
2. R26 had multiple diagnoses which included dementia without behavioral disturbance and Alzheimer's
disease, based on the face sheet.
R26's annual MDS dated [DATE] showed that the resident was moderately impaired with cognition and
required extensive assistance from the staff with personal hygiene.
On October 2, 2023 at 11:12 AM, R26 was in bed, alert and verbally responsive. R26 had accumulation of
long chin hair and her fingernails had black substances underneath. R26 was asked if she wanted the staff
to remove her facial hair and clean her fingernails. R26 replied, okay. V3 (Registered Nurse) was present
during the observation and interview of R26.
On October 3, 2023 at 11:40 AM, R26 was in bed, alert and verbally responsive. R26 had accumulation of
long chin hair and her fingernails had black substances underneath. In the presence of V6 (LPN), R26 was
again asked if she wanted the staff to remove her facial hair and clean her fingernails.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 3 of 11
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
10/05/2023
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)
F 0677
R26 replied, yes.
Level of Harm - Minimal harm
or potential for actual harm
R26's active care plan initiated on November 20, 2021 showed that the resident had ADL self-care deficit.
The same care plan showed multiple interventions including, Assist with ADL task as needed and Provide
needed level of assistance and support to complete Activities of Daily Living.
Residents Affected - Some
On October 4, 2023 at 12:09 PM, V2 (Director of Nursing) stated that it is part of the nursing care and
service to provide assistance to all residents needing assistance with shaving/removal of unwanted facial
hair and cleaning and trimming of fingernails to ensure and maintain good hygiene and grooming.
3. R36's face sheet showed multiple diagnoses including unspecified dementia, unspecified severity,
without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, unspecified
abnormalities of gait and mobility, weakness, history of falling. R36's Annual MDS dated [DATE] showed
that R36 was severely impaired in cognition and required extensive one person assistance with personal
hygiene.
On October 2, 2023 at 11:30 AM, R36 was seated in the television room and noted to have long nails with
some of them jagged with chipped nail polish. R36 was able to respond clearly to queries. R36 remarked I
need my nails done and cut. I need them to cut it. R36 also had several long facial hairs on her chin. R36
stated I have to have them remove it.
On October 3, 2023 at 1:55 PM, R36's nails were still long and jagged and R36 stated that her facial hair
was removed but they did not have time to do my nails. R36's request about her nails was relayed to V12
(Certified Nursing Assistant).
R36's restorative care plan dated July 24, 2023 included that R36 has an ADL (activities of daily living) Self
Care Performance Deficit related to Syncope, Dementia, Chronic Obstructive Pulmonary Disease,
Depression, weakness. Intervention included to assist with ADL tasks as needed.
4. R245's face sheet showed multiple diagnoses including unspecified dementia, unspecified severity,
without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, anxiety disorder,
urinary tract infection, history of falling. R245's 5-day MDS dated [DATE] showed that R245 was severely
impaired in cognition and required limited one person assistance in personal hygiene.
On October 2, 2023 at 10:37 AM, R245 was seated at the nurses station and noted to have blackish
substance underneath his finger nails. R245 did not respond clearly with queries.
On October 3, 2023 at 11:37 AM, R245 was again seated at the nurses station and his finger nail showed
blackish substance underneath. This was relayed to V11 (Resident Assistant).
R245's restorative care plan revised October 26, 2022 included that R245 has an ADL Self Care
Performance Deficit related to elbow infective bursitis, right elbow cellulitis, Dementia, weakness.
Intervention included to assist with ADL tasks as needed.
5. R249's face sheet showed multiple diagnoses including hemiplegia, unspecified affecting left
nondominant side, transient cerebral ischemic attack, Alzheimer's disease, dementia in other diseases
classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood
disturbance, and anxiety, cognitive communication deficit. R249's admission MDS dated [DATE]
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 4 of 11
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
10/05/2023
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)
F 0677
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
included that R249 was severely impaired in cognition and required extensive one person assistance with
personal hygiene.
On October 2, 2023 at 11:45 AM, R249 was in the lounge area watching television. R249 had multiple long
facial hairs on her chin area. R249 stated that she needs help with grooming. R249 was able to respond
clearly to queries.
R249's restorative care plan revised August 18, 2023 included that R249 has potential for ADL fluctuations
secondary to hemiplegia/hemiparesis. Intervention for the same included to assist resident with ADLs as
needed.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 5 of 11
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
10/05/2023
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)
F 0805
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual
needs.
Based on observation, interview and record review, the facility failed to serve roasted potatoes suitable for
mechanical soft diets and failed follow menu spread sheet for serving vegetables and pulled pork. This
applies to 7 of 7 residents (R8, R23, R27, R35, R36, R39, R245) reviewed for dining in the sample of 15.
The findings include:
Physician Order Sheet and facility Diet Order listing showed that R8, R23, R27, R27, R35, R36 and R245
are on mechanical soft diets.
On October 2, 2023, at 12:39 PM, V8 (Cook) was at the steam table plating the lunch meal. V8 stated that
the residents receive the same item of roasted potatoes for regular and mechanical soft diets. R8, R23,
R27, R35, R36, R39, R245 who were on mechanical soft diets received roasted potatoes with skin on
them. R35 only had 2 teeth in front and did not touch her potatoes. R8 also received coleslaw instead of
cooked vegetables. On inquiry, whether the residents can have skin of potatoes for mechanical soft diet, V7
(Dietary Manger) stated that they followed the recipe for roasted potatoes. V7 was asked to provide policy
and procedure for the same. V7 came back at a later time and agreed that potato skin and coleslaw should
have been avoided for mechanical soft diets.
Facility Spring/Summer menu spreadsheet for October 2, 2023 (Cycle Day 9) showed to serve braised
cabbage instead of confetti coleslaw for mechanical soft diets.
Facility Standards of Professional practice for Regular ground/mechanical soft diets included as follows:
Breads and starches to avoid: Potato skins, potato chips, tortilla chips, pretzels, French bread, hard taco
shells. Vegetables: Avoid: Hard raw vegetables.
On October 4, 2023, at 12:29 PM, at lunch meal service R8, R23, R27, R35, R36, R39, R245 received
pulled pork served in a bun. The pulled pork was noted to have strands of pork in varying sizes and length.
V7, who was in the area stated that the regular and mechanical soft diets received the same pulled pork.
Facility Spring/Summer menu spreadsheet for October 4, 2023 (Cycle Day 11) showed pureed pulled pork
for mechanical soft diets. V7 stated that it must have been a typo and she will check with the menu
specialist.
On October 4, 2023 at 1:38 PM, V7 stated that the menu specialist stated that the mechanical soft diets
were supposed to receive ground pulled pork instead of regular consistency of the same and that the typo
of serving pureed pork will be corrected. V7 added that the menu specialist also confirmed that the
mechanical soft diets should not receive potato skin.
Policy and Procedure titled Mechanical Soft Prep (last revised August 18) included as follows:
Policy: Mechanical soft food will be served as ordered. Mechanical soft food will be palatable, attractive, and
prepared in a safe manner.
Purpose: To provide residents with the consistency needed to tolerate food.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 6 of 11
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
10/05/2023
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)
F 0805
Procedure:
Level of Harm - Minimal harm
or potential for actual harm
1. The food used for the general diet will be used for the mechanical soft diet. Foods that are difficult to
chew are replaced with foods that have been altered into a form that can be easily chewed.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 7 of 11
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
10/05/2023
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)
F 0814
Dispose of garbage and refuse properly.
Level of Harm - Potential for
minimal harm
Based on observation, interview and record review, the facility failed to maintain dumpster area free from
debris. This has potential to affect 54 residents that reside in the facility.
Residents Affected - Many
The findings include:
The Facility Data Sheet dated October 2, 2023, showed that the facility census was 54.
On 10/04/23 at 11:37 AM, the facility dumpster area was toured in the presence of V7 (Dietary Manager).
The gates leading to the dumpster were open. The dumper was situated in an area close to a wooded area
easily accessible by rodents and other critters. The dumpster lid covers were open and was full of bagged
garbage. There was also an open barrel near the dumpster filled with miscellaneous waste that was open to
air and covered with flies. At the back of the dumpster there were several bagged garbage (with clear
plastic covers) on the floor. The contents of the bags were visible through the plastic and showed
incontinent briefs and other garbage. V7 stated that they may be trash collected by housekeeping from the
residents' rooms. There were also other used paper products and debris on the floor. V7 stated that the
dumpster holds garbage collected from the kitchen and resident areas by dietary and housekeeping staff.
On 10/04/23 at 12:05 PM, V15 (Building Manager) stated that the dumpster maintenance is spilt between
him and V16 (House Keeping Manager). V15 stated The waste management has skipped us a couple of
times. They did not pick up [trash] on the last two weekends. They are supposed to come in at 8:00 AM
every day from Monday through Friday. V15 stated that the dumpster lids have been torn and the hinges on
the gate to the dumpster is not working properly and therefore are unable to be closed properly. V15 stated
that he has contacted the contracted provider several times but has not received an adequate response.
V15 stated that the contacts were made via personal email. V15 did not provide records of the same.
Facility policy and procedure titled Grounds and Exterior Inspection (revised August 15) included as follows:
Policy: Building Manager will inspect the exterior of the building and grounds daily.
Procedure: Weather permitting, the Building Manager will walk the outside perimeter of the building(s)
during every schedule workday to check for concerns including, but not limited to:
4) garbage collection issues
7) trash and debris
The Building Manager and Housekeeping Supervisor will work together to maintain the exterior free of
trash and debris and maintain exits and sidewalks free of snow and ice accumulation.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 8 of 11
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
10/05/2023
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 6. On October
3, 2023 at 4:04 PM, after preparing and administering a medication to R29, V6 (Licensed Practical Nurse)
wheeled R29's wheelchair to the unit TV (television) lounge and then wheeled R14's reclining wheelchair
out of the unit TV lounge to the unit nursing station. After wheeling and positioning R14's reclining
wheelchair close to the medication cart (by the unit nursing station), V6 started preparing R14's
medications. V6 took a bottle of Vitamin D3 tablets, opened the bottle cap and poured several tablets of the
said medication inside the bottle cap. Since V6 needed only one tablet of the Vitamin D3, V6 used her finger
to hold on to the one tablet (while still inside the bottle cap) and returned the rest of the tablets back inside
the bottle. V6 then crushed the medication, mixed it with apple sauce and administered the Vitamin D3 with
other medications to R14. During the above-mentioned procedure, V6 did not perform hand hygiene (hand
washing and/or gloving) after handling the wheelchairs of R29 and R14, and before preparing R14's
medication.
Residents Affected - Some
On October 4, 2023 at 12:07 PM, V2 (Director of Nursing) stated that it is not the standard of practice at the
facility to touch medications with bare hands/fingers. V2 also stated that it was not the standard of practice
at the facility to return the medications back inside the bottle especially if the medications were potentially
contaminated to ensure infection control.
On October 4, 2023 at 12:15 PM, V6 acknowledged that she held R14's medication with her bare
hand/finger without performing hand hygiene and/or putting on gloves, after handling the wheelchairs of the
two residents.
Review of the facility's pharmacy medication pass guidelines dated 2005-2019 showed to practice hand
hygiene (hand wash with soap and water or use of commercially prepared alcohol gel) under multiple
circumstances including, before starting the medication pass and after physical contact with resident during
medication pass. The same medication pass guidelines showed in-part under infection control, Follow all
facility infection control policies and procedures, including proper hand hygiene and Do not touch
medications directly; if this happens, discard medication and administer new.
Based on observation, interview, and record review, the facility failed to follow standard infection control
practices with regards to hand hygiene and gloving during incontinence care, wound care, and medication
administration. In addition, the facility failed to provide clean barrier during blood glucose monitoring. This
applies to 6 of 15 residents (R1, R4, R7, R14, R29, R33) reviewed for infection control in the sample of 15.
The findings include:
1. On October 3, 2023, at 10:13 AM, V17 (Certified Nursing Assistant/CNA) assisted R7 to the bathroom.
V17 assisted R7 to transfer from wheelchair to the toilet. When R7 finished using the toilet, V17 put the
shoes on R7, assisted R7 to stand up and proceeded to provide peri-care, then she pulled the incontinence
brief and pants back up to R7, while wearing the same soiled gloves all throughout the care.
2. On October 3, 2023, at 10:29 AM, V17 (CNA) and V22 (Resident Assistant/RA) rendered incontinence
care to R33. V17 cleaned R33's perineum from front to back, she (V17) applied clean incontinence brief,
and barrier cream, and repositioned R33. V17 changed her gloves without hand hygiene all throughout the
care.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 9 of 11
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
10/05/2023
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
3. On October 4, 2023, at 11:48 AM, V18 (Nurse) provided wound care to R29 who had a pressure ulcer on
the left heel. V18 removed R29's socks, touched R29's bare foot to check the wound, then proceeded to
remove soiled dressing, then she cleaned the wound while wearing same gloves. After cleaning the wound,
V18 changed her gloves without hand hygiene, she applied (Brand name of topical ointment) on the wound
and covered it with bordered gauze. V18 assisted R29 back to the wheelchair, she picked up the garbage,
removed her gloves and left the room without hand hygiene.
On October 4, 2023, at 4:55 PM, V2 (Director of Nursing/DON) stated that during wound care when staff
remove the soiled dressing, they should change their gloves and do hand hygiene. During peri-care, the
staff must perform hand hygiene and change gloves in between task to prevent contamination and potential
infection.
Facility's Non-Sterile Dressing Change Policy and Procedure dated 3/2021 indicates:
Guidelines:
1. non-sterile dressings protect open wounds and absorb drainage.
2. Designated staff member will use non-sterile dressing technique for all dressing changed unless
otherwise indicated by the physician or nurse practitioner/NP or manufacturer guidelines. Clean aseptic
technique should be used.
Procedure:
10. Remove soiled dressing and place in a trash bag after observing soiled dressing and peri-wound for
any drainage, checking for amount, color, consistency, and odor.
11. Remove gloves, perform hand hygiene, and apply new gloves.
13. Clean wound with normal saline or prescribe cleanser.
15. Upon completion, removes gloves, perform hand hygiene, and apply new gloves.
17. Apply prescribed topical agent to the wound bed.
18. Apply wound dressing.
21. Discard gloves and all supplies in trash bag and remove equipment.
22. Perform hand hygiene.
Facility's Hand Washing and Hand Hygiene dated June 4, 2020, shows,
Purpose: Appropriate hand hygiene is essential in preventing the spread of infectious organisms in
healthcare settings.
Guidelines:
1. Hand hygiene must be performed after touching blood, body fluids, secretions, excretions, and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 10 of 11
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
10/05/2023
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)
F 0880
contaminated items. Specific examples include but are not limited to:
Level of Harm - Minimal harm
or potential for actual harm
f. After removing gloves.
Residents Affected - Some
g. After touching any item or surface that may have been contaminated with blood and body fluids,
excretions, and secretions.
4. R4's admission Record showed R4 was admitted to the facility on [DATE], with multiple diagnoses
including Alzheimer's disease, type 2 diabetes, hypertension, and muscle weakness.
R4's MDS (Minimum Data Set) dated June 29, 2023, showed R4 was severely cognitively impaired and
required extensive assistance with bed mobility, toilet use, personal hygiene, and eating and is dependent
on staff for transfer.
On October 3, 2023, at 11:04 AM, V9 and V10 (both CNAs) provided incontinence care to R4. R4 was lying
in bed and V10 cleansed the front of R4. V9 assisted to turn R4 to her right side and V10 cleansed the
perineal area from the back. V9 commented there was brown smear on the wipe after cleaning. R4 urinated
again while on her right side and V9 turned R4 to her back. V10 cleansed R4 front of the perineum again
without changing gloves.
On October 3, 2023, at 2:36 PM, V4 (Infection Preventionist/IP Nurse) stated the expectation for staff while
providing incontinence care would be to change gloves between wiping stool and cleansing the front of the
perineum.
5. R1's admission Record showed R1 was admitted to the facility on [DATE]. R1's MDS (Minimum Data Set)
showed R1 had multiple diagnoses including type 2 diabetes, dementia, anemia, hypothyroidism,
polyosteoarthritis, and asthma.
R1's MDS (Minimum Data Set) dated August 4, 2023, showed R1 had severe cognitive impairment and
required extensive assistance with bed mobility, dressing, personal hygiene, and toilet use and dependent
on staff for transfer and uses a wheelchair for mobility.
On October 2, 2023, at 12:02 PM, R1 was seated in her wheelchair at a dining table with 3 other residents.
The table was set with clean linen tablecloth and napkins, plates, and utensils. V3 (Registered Nurse/RN)
performed blood glucose test on R1 while she was at the dining table, held R1's finger over the clean
utensils, pricked the finger with lancet, drawing blood and placing the blood on the glucose monitor strip
without a barrier. V4 (IP Nurse) also witnessed V3 perform the blood glucose test at the dining table. V4 told
V3 you are not allowed to do that.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146182
If continuation sheet
Page 11 of 11
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
8 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
F805 - Food and drink
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
F814 - Food Safety Requirements
Dispose of garbage and refuse properly.
F880 - Infection Control
Provide and implement an infection prevention and control program.
- 0321GeneralS&S Epotential for harm
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- 0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
- 0531GeneralS&S Epotential for harm
Have elevators that firefighters can control in the event of a fire.
FAQ · About this visit
Common questions about this visit
What happened during the October 5, 2023 survey of ALDEN COURTS OF WATERFORD?
This was a inspection survey of ALDEN COURTS OF WATERFORD on October 5, 2023. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ALDEN COURTS OF WATERFORD on October 5, 2023?
Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure services provided by the nursing facility meet professional standards of quality."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.