Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to protect resident's right to be free from physical abuse. This
failure affected one (R1) out of three residents reviewed for abuse.
Findings include:
On 04/22/25 at 11:30 AM, R1 stated R2 tried to choke him when R1 was in the 1st floor dining room doing
activities. R1 stated, R2 came up from behind R1 and grabbed R1 around the neck with R2's arm. R1
stated he was not expecting it, so he was surprised when R2 did that. R1 stated one of the staff got R1 off
R2 and R2 was removed from the room. R1 does not remember if R2 said anything as he was trying to
choke R1. R1 stated R2 did not look angry and I don't know why he did that.
On 04/22/25 at 11:10 AM, observed R2 sitting in his bedroom looking at an opened bible on his bedside
table. V21 (Business Office Manager) acted as translator because R2's primary language is Spanish. R2
stated via V21 that God, told me to choke him (R1) so I did and God told me to do this because he (R1)
was going to try to choke me first. R2 stated via V21 that R1 never touched or threatened R2 and the only
reason R2 tried to choke R1 was because God told R1 to do it.
On 04/23/25 at 11:10 AM, via phone interview V3 (Former Activity Aide) stated he was running the activity
group in the morning in the 1st floor dining room on the day R2 tried to choke R1. V3 stated that on that day
R2 walked into the 1st floor dining room and came up from behind R1 and got R1 in a head lock using his
arms. V3 stated he could see that R2 was trying to choke R1. V3 stated he had to pull R2's arm off from
around R1's neck. V3 stated once he separated them, R2 told V3 that God told R2 to kill somebody, not
specifically R1, just somebody. V3 stated he was the only staff in the room when this happened, and he
does not remember the names of the other residents in the room at the time.
On 04/23/25 at 12:22 PM, V21 (Business Office Manager) stated on 02/04/25, the former administrator
called her downstairs to translate for R2 after the altercation had occurred between R1 and R2. V21 stated
R2 told her that he (R2) was trying to kill R1 because God told him to. V21 stated R2 said he put his arm
around R1's neck to choke him. V21 stated R2 said R2 did that because R1 was going to hurt R2, so God
told R2 to hurt R1 first. V21 stated R2 said he was trying to kill R1, not just hurt R1. V21 stated R2's story
on 02/04/25 was the same he told us yesterday (04/22/25), no changes.
On 04/22/25 at 10:51 AM, V5 (Licensed Practical Nurse) stated on 02/04/25, she was notified that there
had been an altercation between R1 and R2 and she assessed each of them. V5 stated R1 told her, R2
grabbed me from behind. V5 stated R1 denied being in pain anywhere and there were no signs or
(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 5
Event ID:
146191
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
146191
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mado Healthcare - Uptown
4621 North Racine Avenue
Chicago, IL 60640
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 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
symptoms of any injury. V5 stated R1 told her I don't know, muchacha, I don't know, muchacha and R2 was
calm, not agitated. V5 stated R2 does have a history of schizophrenia and does hallucinate saying things
like God told me I need to drink water or God told me
On 04/23/25 at 11:45 AM, V1 (Administrator) stated he is the abuse coordinator at the facility and has been
working at the facility for two months. V1 stated the main goal is to prevent abuse and to keep the residents
free from abuse. V1 stated the residents living at the facility are a vulnerable population and it is the
staff/facilities responsibility to advocate for the residents and keep them safe from abuse. V1 stated R2
choking R1 is physical abuse. V1 stated he does not think the action was intentional, but it was willful on
R2's part because R2 was responding to the inner voice inside his head telling R2 to take the action of
trying to choke R1.
R2's nursing progress note dated 02/04/25 entered by V5 documented, Writer was notified at about 11am
that resident was aggressive and meet criteria for psychiatric evaluation. Resident is to be sent to St Mary's
Hospital for psychiatric evaluation and indicated that R2's son, primary care provider, and psychiatric nurse
practitioner were notified.
R2's Petition for Involuntary/Judicial admission dated 02/04/25, 11:30 AM documented in part, client is
presenting below baseline. Displaying socially intrusive and aggressive behavior directed toward people in
immediate environment secondary to psychosis. Client choked a co-peer believing God told him to. In need
of immediate hospitalization for psych evaluation and to prevent harm to others.
Facility reported incident written witness statement received 02/04/25 at 11:00 AM documented in part, I,
(V3) witnessed R2 choking R1 around the neck in a choke hold yelling, God told me to kill him. The written
statement also the incident happened in the dining room during morning group at 10:15.
R1's admission record indicates admission date on 01/03/25 with diagnosis including but not limited to
Chronic Obstructive Pulmonary Disease, Chronic Sinusitis, Dysarthria and Anarthria, Schizophrenia,
Osteoarthritis of Knee, Insomnia, Slurred Speech, Essential (Primary) Hypertension. R1's MDS ([NAME]
Data Set) dated 01/21/25 indicates intact cognition. R1 has care plan in place stating R1 is at risk for
abuse/neglect.
R2's admission record indicates admission date on 11/24/21 with diagnosis including but not limited to
Chronic Obstructive Pulmonary Disease, Unspecified Dementia, Unspecified Severity, with Other
Behavioral Disturbance, Mild Cognitive Impairment of Uncertain or Unknown Etiology, Essential (Primary)
Hypertension, Unspecified Schizophrenia, Schizoaffective Disorder, Bipolar Type, Alcohol Dependence, In
Remission. R2's MDS dated [DATE] indicates intact cognition. R2 has care plans in place for audio
hallucination/preoccupation with religion, felony history for aggravated stalking and risk for abuse/neglect.
Facility provided document titled, Illinois Long-Term Care Ombudsman Program Residents' Rights for
People in Long Term Care Facilities dated 11/18 documents in part, your rights to safety: You must not be
abused, neglected, or exploited by anyone- financially, physically, verbally, mentally, financially or sexually.
Facility provided document titled, Abuse Policy dated 01/04/24 which documents in part, that each resident
will be free from Abuse Abuse can include verbal, mental, sexual, or physical abuse . Additionally, resident
will be protected from abuse, neglect, and harm while they are residing at the facility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146191
If continuation sheet
Page 2 of 5
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
146191
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mado Healthcare - Uptown
4621 North Racine Avenue
Chicago, IL 60640
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 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview and record review, the facility failed to (a) assess and document pressure ulcer
characteristics and measurement on a weekly basis and (b) ensure that the orders provided by wound
nurse practitioner (NP) were performed to 1 (R3) out of 3 residents reviewed for Improper nursing care.
Residents Affected - Few
The findings include:
R3's admission record showed initial admission date on 5/19/2021 with diagnoses not limited to Acute
respiratory failure with hypoxia, Pressure ulcer of right heel stage 3, Morbid (severe) obesity due to excess
calories, Chronic respiratory failure with hypoxia, Pressure ulcer of right buttock stage 2, Unspecified
diastolic (congestive) heart failure, Acute embolism and thrombosis of unspecified deep veins of right lower
extremity, Unspecified urinary incontinence, Type 2 diabetes mellitus, Schizoaffective disorder, Chronic
obstructive pulmonary disease. R3 was discharged from the facility on 4/15/2025.
On 4/22/25 at 10:25AM V5 (LPN / Licensed Practical Nurse) stated wound treatment is done by nurse on
duty, had regularly worked and provided treatment to R3's wounds (Sacrum and Right heel). She said R3
had wound on sacrum area and treatment was Santyl and Foam dressing. V5 said R3 's wound to right
heel, treatment was Xeroform.
On 4/22/25 at 11:22am V10 (MDS coordinator, LPN) stated R3 had 2 pressure ulcers, 1 Stage 2 to sacral /
right buttock and 1 Stage 3 to Right heel and were present upon readmission.
On 4/22/25 At 1:04PM V8 (Wound NP) stated has been servicing the facility for 2 years and seeing wounds
in the facility. Stated he has been following R3's wounds. Surveyor reviewed R3's EHR (Electronic health
record) with V8 and said R3 had pressure ulcers, Stage 2 to sacrum and Stage 3 to right heel. Reviewed
V8's wound documentation dated 4/8/25 and said treatment for sacrum and right heel was Hydrofera. V8
stated is it important to follow treatment order to promote wound healing and prevent complication like
worsening or deterioration of wound. V8 stated the purpose of Hydrofera treatment is to keep the wound
moist and promote healing. He said Santyl is a chemical debriding agent. V8 said Santyl to Right buttock /
Sacrum should have been discontinued and changed to Hydrofera. He said R3's wound visit was on 3/1/25
then 3/26/25 and 4/8/25. V8 stated no wound visit on 3/8/25, 3/15/25, 3/22/25 and 4/1/25. He said it is
important to assess wound and document at least weekly to monitor if treatment is appropriate and if need
to be changed, it will also monitor progress of the wound and if the wound is not improving treatment
should be changed.
On 4/22/25 At 2:36pm V2 (DON / Director of Nursing) stated it is important to carry out and follow wound
NP's order for wound treatment. She said wound NP's order should be placed in POS (Physician order
sheet) and TAR (Treatment administration record). V2 said purpose of wound treatment is to promote
healing of the wound. She said if wound treatment is not followed, potentially can lead to wound
deterioration / complications. V2 said it is important to assess and document wound at least weekly to
monitor the progress of the wound.
MDS (Minimum Data Set) dated 3/4/25 showed R3's cognition was intact. She needed Substantial /
maximal assistance with oral hygiene, upper body dressing; Dependent with toileting and personal hygiene,
shower / bathe self, lower body dressing, chair / bed and toilet transfer. R3 was always incontinent of
bladder and frequently incontinent of bowel. MDS showed R3 had 1 Stage 2 and 1 Stage 3
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146191
If continuation sheet
Page 3 of 5
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
146191
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mado Healthcare - Uptown
4621 North Racine Avenue
Chicago, IL 60640
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 0686
pressure ulcers that were present upon admission.
Level of Harm - Minimal harm
or potential for actual harm
V8 (Wound NP/Nurse Practitioner) follow up wound documentation dated 4/8/25 showed in part:
-
Residents Affected - Few
Sacrum pressure ulcer Stage 2 orders: cleanse wound using normal saline solution, pat dry using gauze.
Apply Hydrofera on wound bed. Apply ABD pad on wound and secure with tape.
Right heel pressure ulcer Stage 3 orders: cleanse wound using normal saline solution, pat dry using gauze.
Apply Hydrofera on wound bed. Apply Hydrofera on wound bed. Apply rolled gauze and secure with tape.
R3's order summary report dated 4/22/25 with order not limited to:
Santyl External Ointment 250 UNIT/GM (Collagenase) Apply to Sacrum topically one time a day related to
pressure ulcer of right buttock Stage 2. Cleanse sacrum with NS, apply Santyl ointment, cover with gauze,
secure with ABD pad.
Xeroform Petrolat Patch 2 (Bismuth Tribromophenate-Petrolatum) Apply to Right heel topically one time a
day related to pressure ulcer of right heel, stage 3. Apply to right heel topically every day shift for wound
treatment on the right heel post saline cleansing then cover with gauze dressing and wrap with kerlix until
healed.
R3's TAR (Treatment Administration Record) schedule for April 2025 showed in part:
Santyl External Ointment 250 UNIT/GM (Collagenase) Apply to Sacrum topically one time a day related to
pressure ulcer of right buttock Stage 2. Cleanse sacrum with NS, apply Santyl ointment, cover with gauze,
secure with ABD pad. Start date 3/26/25. Discontinue date 4/16/25.
Xeroform Petrolat Patch 2 (Bismuth Tribromophenate-Petrolatum) Apply to Right heel topically one time a
day related to pressure ulcer of right heel, stage 3. Apply to right heel topically every day shift for wound
treatment on the right heel post saline cleansing then cover with gauze dressing and wrap with kerlix until
healed. Start date 3/6/25. Discontinue date 4/16/25.
Care plan dated 3/18/2025 showed in part: R3 has alteration in skin integrity related to Breakdown (right
buttock wound, right heel wound). Conduct wound assessment and observation per facility protocol
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146191
If continuation sheet
Page 4 of 5
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
146191
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mado Healthcare - Uptown
4621 North Racine Avenue
Chicago, IL 60640
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 0686
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Facility was not able to provide R3's weekly wound assessment / documentation on 3/8/25, 3/15/25,
3/22/25, and 4/1/25.
Facility's skin management guidelines policy dated 3/2016 documented in part: Document findings, wound
characteristics, stage (if applicable), wound measurements in centimeters (cm), pain associated with
wound on the weekly wound documentation form. Notify the physician, obtain treatment orders and
document orders on TAR (Treatment administration record).
Facility's wound care / prevention policy dated 1/2025 showed in part: Ensure that the orders provided by
physician are performed as ordered.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146191
If continuation sheet
Page 5 of 5
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Back to topCitations
2 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.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
FAQ · About this visit
Common questions about this visit
What happened during the April 25, 2025 survey of MADO HEALTHCARE - UPTOWN?
This was a inspection survey of MADO HEALTHCARE - UPTOWN on April 25, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at MADO HEALTHCARE - UPTOWN on April 25, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate pressure ulcer care and prevent new ulcers from developing."
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
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