Inspection·April 30, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Based on interview and record review the facility failed to notify a resident and a resident's primary care physician (PCP) of missed medication doses for 1 of 4 residents (R1) reviewed for notification in the sample of 4. The findings include: R1's admission Record showed R1 is an eighty-two-year-old male resident originally admitted to the facility with diagnoses which include: peripheral vascular disease and a history of pulmonary embolism (blood clot in lungs). R1's March 2025 Medication Administration Record (MAR) showed from March 24 through March 27,2025, R1 did not receive their Warfarin (blood thinner) doses. The MAR showed no order for Warfarin in R1's record for March 24th through March 27th. The MAR showed R1 had an order placed on 3/28/25 with a new order for Warfarin 3mg to give 1 tablet at bedtime related to personal history of pulmonary embolism. On 4/30/25 at 10:05 AM, R1 stated they knew they were on a blood thinner. R1 stated he did not remember anyone telling him he missed any of his medication doses. On 4/30/25 at 10:20 AM, V4 R1's PCP (Primary Care Physician) stated he did not receive a call or text for a Warfarin order on 3/28/25. V4 stated they were reviewing their records during the interview. V4 stated he gave an order for 3mg of Warfarin on 3/24/25, and a new order for 3.5mg on 3/31/25. V4 stated he had not been notified R1 had missed any doses of their Warfarin between 3/24/25 and 3/31/25. V4 stated if he were contacted about any missed doses, he would have ordered labs to be drawn, and a new order based on the lab results. On 4/30/25 at 11:30 AM, V8 R1's Emergency Contact (Family) stated the facility has contacted them in the past when R1 has gone to the hospital and when R1 was put on isolation. V8 stated they have not been notified R1 had any missed medication doses. R1's progress notes dated 3/28/25 at 7:47 PM showed V9 placed an order was for Warfarin 3mg. This progress note has no reference regarding notifying R1's physician at that time for not being admistered the physician ordered medication doses. On 4/30/25 at 12:40 PM, V2 Director of Nursing stated, the physician should have been notified about the missed medication doses when it was realized R1 did not receive them. 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: 146186 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 146186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Estates Cts of Huntley 12140 Regency Parkway Huntley, IL 60142 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)