Bella Terra Streamwood

In the surveyor’s words

From the most serious findings on record at Bella Terra Streamwood, in the surveyor’s own words.

• Actual harm, isolatedF689Mar 20, 2025

  Based on interview and record review, the facility failed to supervise a resident at high risk for falls during patient care by leaving the resident alone for staff to obtain supplies and then finding the resident on the ground. The facility failed to train staff on identifying residents at risk for falls. The facility also failed to implement measures to prevent falls from happening. These failures affect 1 (R9) of 4 residents reviewed for falls in the sample of 45. These failures resulted in R9 being emergently transferred to the hospital and admitted with a left femur fracture that required surgical intervention. […]

• Actual harm, isolatedF689Oct 14, 2022

  Based on interviews and record reviews, this facility failed to provide safe transfer assistance to prevent an avoidable fall incident for 1 of 3 (R1) residents reviewed for safe transfers. This failure resulted in R1 being involved in a fall incident while being assisted by staff to the toilet. This fall resulted in R1 sustaining a left distal fibula fracture with subluxation of the left ankle. Findings include: On 10/7/22 at 12:55pm, V7 (Director of Rehabilitation) stated that skilled therapy was working with R1 on bed mobility and transfers. V7 stated that R1 would fatigue very fast during therapy. V7 stated that R1 required two person assist with ADLs (Activities of Daily Living) because R1's level of assistance needed fluctuated between moderate and extensive assistance. […]

• Actual harm, isolatedF689Aug 12, 2022

  Based on interview and record review the facility 1) failed to supervise a resident who is a high risk for falls. This failure resulted in R3, sustaining a subdural hematoma (brain bleed) and laceration at the back of her head requiring staples. Based on interview, observation and record review the facility 2) failed to put interventions in place for a resident who is a high risk for falls. This failure resulted in R4 sustaining a lumbar fracture requiring hospitalization . This applies to 2 of 4 residents (R3 and R4) reviewed for falls in the sample of 6. The findings include: 1. R3's Physician Order Sheet dated 8/22 show R3 has diagnoses that include dementia of Alzheimer type and [CONDITION(S)]. […]

• Actual harm, isolatedF689Jul 3, 2021

  These failures resulted in two deficient practice statements. 1. Based on observation, interview, and record review, the facility failed to follow their care plan interventions to monitor and supervise a cognitively impaired resident with a history of falls. These failures affect one (R2) of four residents reviewed for falls and resulted in R2 having an unwitnessed fall, then not being monitored according to the plan of care. R2 was subsequently found unresponsive and pronounced dead at the facility. 2. Based on observation, interview, and record review, the facility failed to provide required assistance with bed mobility during incontinence care for one (R1) of four residents in the sample. […]

• No harm, potential for more than minimal, patternF550Jun 15, 2023

  Based on observation, interviews and record reviews, the facility failed to ensure that call lights are answered in a timely manner per policy. This deficiency affects four (R1, R12, R13 and R14) of four residents reviewed for accommodation of needs. Findings include: 1.) R1 was admitted on [DATE] with diagnoses of Displaced Fracture of Base of Neck of Right Femur, Subsequent Encounter for Closed Fracture with Routine Healing; Difficulty in Walking, Not Elsewhere Classified; Unsteadiness on Feet; Need for Assistance with Personal Care and End Stage Renal Disease. R1's MDS (Minimum Data Set) dated 05/25/23 under Section C indicated that her BIMS (Brief Interview for Mental Status) score is 15 which means intact cognition. R1 was discharged to home on 06/02/23. […]