The Center at Advocate

In the surveyor’s words

From the most serious findings on record at The Center at Advocate, in the surveyor’s own words.

• Immediate jeopardy, isolatedF740Jun 10, 2024

  Based on record review and interview, the facility failed to provide behavioral health services for four Resident's (#192, #91 #64, and #73) with a history of suicidal ideation (SI) and/or depression, out of a total universe of 67 residents. Specifically, 1. Resident #192 expressed suicidal ideation and the facility failed to provide the appropriate services, which resulted in staff finding Resident #192 with a tightly tied plastic bag around his/her head during an attempted suicide, 2. the facility failed to provide behavioral health services timely for Resident #91, 3. […]

• Immediate jeopardy, isolatedF742Jun 10, 2024

  Based on record review and interview, the facility failed to provide the appropriate treatment and services for one Resident (#192), with a known history of mental disorders, suicidal ideation, and adjustment difficulty. Specifically, the facility failed to develop, implement, and update the plan of care, resulting in an attempted suicide after the vocalization of suicidal ideation. Findings include: Review of the facility policy titled Suicide Prevention, dated 8/1/23, indicated the following: - Suicidal Ideation is defined as self-reported thoughts about engaging in suicide-related behaviors. - All staff members will immediately report any suicidal ideation to the resident's charge nurse and facility social worker. […]

• Immediate jeopardy, isolatedF835Jun 10, 2024

  Based on observations and interviews the facility failed to ensure it was administered in a manner that enabled the facility to use its resources effectively to attain the highest practicable physical, mental, and psychosocial well-being of each resident. Specifically, the facility administration failed to ensure the appropriate behavioral health services were in place for one Resident (#192) who attempted suicide after verbalizing suicidal ideation. Findings Include: During the survey process it was identified that the Administration's failure to ensure adequate behavioral health services were provided for residents with mental health disorders. […]

• Actual harm, isolatedF689Apr 23, 2025

  Based on records reviewed and interviews for one of five sampled residents (Resident #1), who was totally dependent on staff for bed mobility, which included turning, repositioning and incontinence care, the Facility failed to ensure his/her was provided with the necessary level of staff supervision and/or assistance, when on 03/02/25, Resident #1 was positioned onto his/her side during care, the staff member left the room to get supplies, leaving him/her unattended and when staff member returned he/she was found on the floor after falling out of bed. […]

• Actual harm, isolatedF688Jun 10, 2024

  Based on observations, record review, policy review and interviews, the facility failed to 1) prevent a worsening of range of motion with new contracture development for one Resident (#125) and 2) failed to implement interventions for contracture management for one Resident (#16) out of a total sample of 38 residents. Findings include: Review of the facility policy titled, Prevention of Decline in Range of Motion, dated 2/2024 indicated the following: -Residents who enter the facility without limited range of motion will not experience a reduction in range of motion unless the resident's clinical condition demonstrated that a reduction in range of motion is unavoidable. […]