Aspyre of Bronzeville

In the surveyor’s words

From the most serious findings on record at Aspyre of Bronzeville, in the surveyor’s own words.

• Immediate jeopardy, widespreadF584Oct 4, 2023

  Based on observation, interview and record review, the facility failed to provide a safe and home like environment by not maintaining comfortable and safe temperature levels in the entire premises of the facility and the facility failed to follow their policy to take and record temperature levels every hour during an event of extremely hot weather. These failures resulted in an immediate jeopardy to the health and safety of all 132 residents residing in the facility who were subjected to hazardous temperatures above 80F (Fahrenheit) on 8/23/23 requiring evacuation and transfer of all 132 residents to different facilities. On 8/23/23, R1 sustained nausea, vomiting and weakness secondary to heat. […]

• Immediate jeopardy, isolatedF684Oct 4, 2023

  Based on observation and interview the facility failed to maintain safe and comfortable temperatures in the facility, failed to monitor residents for heat exhaustion, failed to provide adequate hydration during hazardous temperature, and failed to assess and supervise one resident (R21) with a change in condition related to heat exhaustion. These failures affected R21 who was sent to the hospital exhibiting heat related signs and symptoms and has the potential to affect all 132 residents. This was identified as an Immediate Jeopardy which began on [DATE] at 9:35 am per ([DATE]) facility temperature log which documents a temperature of 81.2F (Fahrenheit) in resident room. […]

• Immediate jeopardy, isolatedF689Feb 9, 2023

  Based on interviews and record review, the facility failed to monitor and supervise a resident (R2), who was placed on facility's 24-hour safety monitoring, who has a history of illegal substance abuse and suicidal ideation. This failure resulted in R2 eloping from the facility and presenting at a county hospital reporting hallucinations and suicidal ideation with a plan to jump into the lake. This was identified as an immediate jeopardy which began on 1/10/2023 when R2 eloped from the facility. V1(Administrator) was notified of the Immediate Jeopardy on 2/07/23 at 10:17am. The facility presented a removal plan on 2/07/23 at 12:45pm. On 2/07/23 at 2:08pm, regional office acknowledged receipt of removal plan and began review at 2:40pm on 2/07/23. […]

• Actual harm, patternF689May 27, 2022

  Based on interview and record review, the facility failed to ensure the safety of residents by not monitoring and preventing residents (R3, R6, R11, R12, R14) from receiving and using illegal drugs. This failure resulted in R3, R6, and R12 overdosing on illegal drugs, requiring transfer to local hospital for treatment. Findings include: 1. R12's medical record (Face Sheet, MDS-Minimum Data Set) notes in part, R12 is a cognitively intact [AGE] year-old with the following diagnoses including but not limited to: [CONDITION(S)] disorder and Nicotine Dependence. PAS/MH (Preadmission Screen/Mental Health 02/04/2022) notes in part, R12 has a history of alcohol, cocaine, heroin and marijuana use. […]

• Actual harm, patternF684Oct 15, 2021

  Based on observation, interview and record review, the facility failed to provide sufficient nursing staff to ensure residents received essential medications to treat their medical conditions as ordered by their physician. There was no nurse to pass medications on the third floor on one portion of a resident hallway and as a result, 13 residents (R18, R122, R58, R74, R32, R86, R5, R59, R61, R63, R106, R14, R95) did not receive their scheduled medications on 10/12/2021 on the day shift (7:00 AM - 3:00 PM). These failures have the potential to cause serious negative medical outcomes for all 13 residents Findings include: On 10/12/21 at 10:45 AM surveyor observed and interviewed residents on the third floor. […]