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F0558
D

Failure to Accommodate Resident’s Needs and Preferences Regarding Roommate Behaviors

Round Lake Beach, Illinois Survey Completed on 08-27-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to reasonably accommodate a resident’s needs and preferences regarding her roommate’s behaviors. During an initial tour, one resident in a wheelchair reported she was having problems with her roommate, stating the roommate became jealous when she had visitors and made inappropriate comments, leading her to say she did not want to return to her room. Later the same day, the resident again expressed discomfort, stating that although the facility had discussed moving rooms, she felt she should not have to move because she liked her room and felt uncomfortable when her roommate exhibited behaviors toward her. Further observations showed the roommate lying in bed crying while the resident sat next to her, holding her hand. When CNAs entered to transfer and provide care to the resident, the roommate repeatedly called out for the resident, asking her not to leave, while crying. The resident attempted to rest in her bed, but the roommate continued calling out, and the CNAs did not intervene or redirect the roommate. The resident’s spouse reported to management that the roommate’s behaviors were affecting his wife, including multiple upset phone calls about the roommate issues. The DON acknowledged that the spouse reported the roommate was “driving” the resident “insane” and that a room change had been discussed but not implemented due to concerns the roommate might follow her. Social services also stated that the roommate hovered over the resident, causing her to become upset, and that the spouse wanted more boundaries and limits to protect his wife.

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