Inspection Reports for CENTRAL BAPTIST VILLAGE (Assisted Living)
4747 N Canfield Ave, IL, 60706
Back to Facility ProfileDeficiencies per Year
4
3
2
1
0
Moderate
Inspection Report
Complaint Investigation
Deficiencies: 1
Feb 18, 2025
Visit Reason
The inspection was conducted as a complaint investigation regarding the facility's failure to notify a physician about a resident's concern of redness and pain on the buttock to ensure adequate assessment and treatment.
Findings
The facility failed to notify the physician of one resident's concern of redness and pain on the buttock, despite documentation of the resident's complaints and observations of redness. Staff stated that since the resident self-administers medication, physician notification was not made, but the Power of Attorney and physician should have been notified. Staff will be in-serviced on this requirement.
Complaint Details
Complaint IL185243/2590716 was substantiated with citation 295.4000 related to failure to notify physician of resident's concern of redness and pain.
Severity Breakdown
Type 3 Violation: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failed to notify physician of one resident's concern of redness and pain on the buttock to ensure adequate assessment and appropriate treatment. | Type 3 Violation |
Report Facts
Residents reviewed: 3
Resident age: 97
Dates of documented observations: 5
Date of survey completion: Feb 18, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E2 | Director of Resident Services | Provided documentation and interview regarding resident care and notification procedures |
| E4 | Registered Nurse | Entered progress notes and interview regarding resident's complaint and physician notification |
Inspection Report
Plan of Correction
Deficiencies: 1
Feb 18, 2025
Visit Reason
Complaint investigation regarding failure to notify a physician of a resident's concern of redness and pain on the buttock to ensure adequate assessment and treatment.
Findings
The facility failed to notify the physician of one resident's concern of redness and pain on the buttock, despite the resident self-administering medication. This was substantiated as a Type 3 violation of Section 295.4000 Physician's Assessment.
Complaint Details
Complaint Investigation IL185243/2590716 - Substantiated, 295.4000 cited.
Severity Breakdown
Type 3 Violation: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to notify physician of resident's concern of redness and pain on the buttock to ensure adequate assessment and treatment. | Type 3 Violation |
Report Facts
Deficiency count: 1
Resident age: 97
Date of survey: Feb 18, 2025
Date of completion: Feb 28, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jolanta Jerzyk | Presenter of the in-service training on notification of physician and POA. | |
| E2 | Director of Resident Services | Monitors documentation and compliance with physician notification. |
| E4 | Registered Nurse | Assessed resident and noted unsteady condition; advised resident to call physician. |
Inspection Report
Plan of Correction
Deficiencies: 3
6021978 View POC 003 Combined SOC's
Visit Reason
The document is a Plan of Correction submitted by Central Baptist Village in response to alleged deficiencies related to employee health records and tuberculosis (TB) testing compliance.
Findings
The Plan of Correction addresses deficiencies including incomplete TB testing and physical examinations for employees, with corrective actions and quality assurance plans to ensure compliance with state regulations.
Deficiencies (3)
| Description |
|---|
| Employee E4 had a positive Quantiferon TB Gold Plus Test but the x-ray evidence was not accepted due to incomplete documentation. |
| Employee E8 did not have a physical examination completed until after the required timeframe. |
| Resident R5 admitted without an initial TB test completed; test was completed during survey with negative result. |
Report Facts
Date of Completion: 2025.07
Employee hire date: 2025.05
TB Test collection date: 2025.01
Employee hire date: 2025.03
Physical exam completion date: 2025.06
Resident admission date: 2024.09
Resident TB test completion date: 2023.08
Resident TB test during survey: 2025.06
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David P Ciaverella | MD | Reading physician for chest x-ray dated 1/13/2025 |
| Pankti Dhruv Reid | Authorizing provider | Authorizing provider for chest x-ray |
| Barbara Czyz | Administered TB test on 06/24/2025 | |
| Jobelle Gramata | Employee medical exam dated 6/18/2025 |
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