Health inspection·October 21, 2024

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to perform background check searches on the six offender Website links on the State Health Care Worker registry, and failed to ensure the initiation date of background checking were done prior to a new employee starting a work schedule. These failures have the potential to affect all the residents at the facility. Residents Affected - Many Findings include: The (undated and untitled) facility provided document indicated V9 (Housekeeping/Laundry/Maintenance Supervisor) was hired on 09/26/24, V19 (Certified Nursing Assistant - CNA) was hired on 09/23/24, V20 (CNA) was hired on 09/23/24, and V22 (Certified Nursing Assistant) was hired on 10/09/24. The (undated and untitled) facility provided document indicated V9 works all floors and started working 09/30/24, V19 and V20 work on 2nd floor and started working on 10/05/24, and V22 works on 2nd floor and started working on 10/09/24. On 10/16/2024 at 10:01am, V4 (Business Office Manager) stated, It is required of the State Health Care Facilities to run the Health Care Worker Registries prior to hire to ensure who we bring into the facility to work are properly screened for the safety of our residents and other staff; to prevent potential abuse. On 10/16/2024 from 10:13am - 10:37am, during the review of V9, V19, V20, and V22 personnel files, V4 stated, I checked their Illinois Sex Offender, Department of Corrections Sex Offender, Department of Corrections Inmate Search, Department of Corrections Wanted Fugitive, and Health and Human Services Office of Inspector General registries yesterday (10/15/24) because I know you will look for these. I am under the impression once they are eligible at the State Health Care Worker Registry, it is okay to hire them without checking the other 6 registries. This surveyor also pointed out to V4 that dates were missing for the initiation of the background checking. V4 stated, There is really no assurance when I checked their background because there is no date indicated on the sheets. On 10/16/2024 at 2:52pm, V1 (Administrator) stated, The main purpose of checking the State Health Care Worker Registry and to do searches on the other six registry links is to make sure the staff we hire do not have a background, like we cannot hire people who have records. Because if you hire a sex offenders or thieves, these people can put residents and staff in jeopardy. It is for the safety of the residents and staff. I expect (V4) to run backgrounds before the staff starts working to make sure that we are hiring appropriate people to work in nursing home. Review of V9's personnel file has no date for the initiation of that background checking. Of note, the Illinois Sex Offender, National Sex Offender registries, and Health and Human Services Office of (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 2 Event ID: 146198 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 146198 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE All American Vlge Nrsg & Rhb 5448 North Broadway Street 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)