Inspection·September 13, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Abnormalities of Gait and Mobility.R1's MDS (Minimum Data Set), dated 6/30/25, documents R1 is severely cognitively impaired.R1's Care Plan, dated 6/27/25 documents, Cognition/Disorientation: (R1) experiences disorientation to place, time. My memory is similarly impaired. I have problems with decision making, insight, logic, reasoning, social skills, judgment. This problem is related to my cognitive deficits.R1's Progress Notes, dated 8/22/25 and signed by V7/RN (Registered Nurse) documents, (V7) called (V11/R1's Physician Assistant) and reported that (R1) is not being cooperative to reenter the facility.R1's BIMS (Brief Interview of Mental Status) Assessments dated 8/22/25 and 9/4/25 documents R1 is cognitively impaired.R1's Elopement Evaluation, dated 8/22/25, documents R1 is at risk of Elopement. This same evaluation documents Focus: Risk for Wandering/Elopement Identified. Goal: (R1) will not leave facility unattended. Goal: (R1's) safety will be maintained.R1's Community Survival Skills, dated 8/22/25, documents, The resident sufficiently alert, oriented, and knowledgeable allowing him/her to be considered for independent outside pass privileges? No. This same form documents R1 requires supervision to be out in the community.R1's Care Plan, dated 9/3/25, documents Focus: Risk for Wandering/Elopement Identified (Date initiated 8/22/25). Interventions: 8/22/25 Wander guard to right ankle. 8/22/25 15-minute checks initiated, 9/3/24 (R1) was moved to memory care unit, 9/3/25 Engage (R1) in purposeful activity, 9/3/25 Provide clear, simple instructions, Provide reorientation to surroundings, environment.R1's 15-Minute Checks, dated 8/22/25 through 9/4/25, does not document any safety concerns under safety concerns located on the top right corner of the 15-minute checks.R1's Illinois Department of Public health First and Final Report, dated 9/4/25, documents on 9/3/25 R1 left the building through his room window. A phone call was made to the facility at 7:34 PM by Local Police Department. Staff located R1 at 7:41 PM.R1's Police Report, dated 9/3/25, documents at 7:28 PM V4/R1's Family Member notified the police department advising that R1 had taken off from the local nursing facility. At 7:34 PM the police department attempted to call the facility with no answer. At 7:38 PM the police department spoke with V7/RN. V7 advised they would look for R1. In the background while V7 had set the phone down the police officer could hear employees stating they could not locate R1. On 9/3/25 at 7:55 PM the police department called the facility and spoke with V7. V7 advised the police department they (facility staff) had located R1 a block away from the facility.R1's Progress Note, dated 9/3/25 and signed by V7/RN, documents, (V7) received a call from (Local Police Department) at 7:33 PM to report that (R1) may have left facility through (R1's) window. Per Local Police Officer, (R1) is on the phone with (V4/R1's Family Member). (V7) and another CNA (Certified Nursing Assistant) identified as (V5), went to (R1's) room and observed that (R1) was not in the room or personal bathroom. (V7) did observed window opened about 14 inches and screen was missing. (V5) went through window to search for (R1) and this nurse informed the other staff on the floor to begin a search in the building. This nurse called (V12/Sister Facility Administrator) at 7:38 PM to report that (R1) had possibly left from facility exiting through windows. (V7) went out the back door and searched in the parking lot. (V7) met up with (V5) and got into (V7's) car and began to search for (R1). (V7) went around the corner and one-half block from facility and observed (R1) walking with a steady gait carrying a plastic bag with a small number of belongings at 7:41 PM. (V7) parked vehicle and approached (R1). (R1) was observed by (V7) that (R1) was on the phone with (V4) when (V7) approached (R1). (R1) agreed to get into vehicle and (R1) was returned to the facility.On 9/8/25 at 10:32 AM R1 was on the memory care unit lying in his bed. R1 was unable to answer questions appropriately but did state he was able to continually work on sliding his window over little by little and hit the window stopper until it would move. R1 stated he would do it a little every day until he knew it was wide enough to get through. R1 denies knowing where he went when he got out the window, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145012 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Knox County 280 East Losey Street Galesburg, IL 61401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few speaking to V4/R1's Family Member, or how he got back to the facility on 9/3/25.On 9/8/25 at 3:05 PM this surveyor and V1/Administrator watched the video surveillance on the hallway R1 resided the night R1 left the facility unattended through his window on 9/3/25. At 7:04 PM a male with a meal tray cart (identified as V10/Cook) was observed slightly opening R1's room and grabbing R1's meal tray. At 7:36 PM two females (identified as V5/CNA and V6/CNA) were observed running down the hallway towards R1's room. Once they arrived to R1's room, they both look into (R1's) room and immediately started running back up the hallway. At 7:46 PM two females (identified as V5 and V7) were observed walking (R1) back into the facility's back door. (R1) was observed to have pants, shoes, and a t-shirt on. V1/Administrator confirmed at this time that R1 was on 15-minute checks and that no staff was observed on the camera going in R1's room and checking on R1 every 15 minutes. V1 stated staff should have been implementing R1's 15-minute checks and staff should have physically gone into R1's room and checked on R1 when performing the 15-minute checks. On 9/9/25 at 1:50 PM this surveyor, V1/Administrator, V2/Interim Director of Nursing, and V20/Regional Director of operations watched the video surveillance on the hallway R1 resided the night R1 left the facility unattended on 9/3/25 between 6:00 PM and 7:00 PM. From 6:00 PM to 6:28 PM R1's door is slightly cracked open. At 6:29 PM R1 is observed opening his door and standing slightly in the doorway. At that time V6/CNA is observed walking down the hallway and goes into a different resident's room, next to R1's room. At 6:31 PM V5/CNA is observed going into R1's room to deliver R1's meal tray and then immediately leaves R1's room. From 6:32 PM to 7:00 PM no other staff is observed checking on R1. During this time V1/Administrator and V2/Interim Director of Nursing both verify that R1 was not physically being checked on every 15-minutes as implemented and should have been.On 9/9/25 at 6:38 PM V17/Prior Administrator-in-Training stated she was the administrator in the building when R1 attempted to elope from the facility on 8/22/25. V17 stated, After (R1) attempted to elope, (R1) was determined to be a risk for elopement, so I placed a wander guard on (R1) and implemented 15-minute checks. (R1) was ambulatory and when he attempted to elope on 8/22/25, staff could not get him to come back into the facility. (R1) walked at least five blocks across main roads and railroad tracks (with staff present) and then finally agreed to get back into the facility van and come back to the facility with us. (R1) is not safe to be out in the community by himself. On 9/8/25 at 11:59 AM V7/RN (Registered Nurse) stated, The past two weeks prior to (R1) getting out of the facility on 9/3/25, he was verbalizing that he wanted to go home, or he wanted to get out. (R1) never stated how he was going to get out and rarely ever left his room. I didn't start work on the night of 9/3/25 until around 6:00 PM. While I was getting report between 6:00 PM and 6:15 PM, (V4/R1's Family Member) had called the facility and told me (R1) was wanting to leave and said he was going to get out through his window. I then told (V5/CNA and V6/CNA) to keep an eye on him and check on him periodically through the night. I didn't go down and look at the window myself to see if he could get out at that point. The windows never open very far so I didn't figure there was any way he could get out through his window. Around 7:30 PM the police department called the facility. I was doing my medication pass and had gone to answer the phone. The police department told me that (V4) had called them and stated (R1) had left the building. I then yelled to (V5) and (V6) to go check on him. (V5) ran down to (R1's) room and noticed (R1) was not in the room. (V5) jumped out the window to go look for (R1) and I told staff to start looking for (R1), and then I went outside to look for (R1). I was in the back parking lot looking for (R1) when I saw (V5). We both jumped in my car to go look for (R1). There are railroad tracks, and he was half a block from the tracks when we found (R1). We found (R1) approximately a block away from the facility. (R1) agreed to get in the car and allowed me to drive him back to the facility. We arrived back to the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145012 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Knox County 280 East Losey Street Galesburg, IL 61401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few around 7:45 PM. On 9/10/25 at 12:25 PM V22/LPN (Licensed Practical Nurse) stated, (V4/R1's Family Member) called on 9/3/25 while I was giving report to (V7/RN). It would have been approximately between 6:00 PM and 6:15 PM. (V4/R1's Family Member) told me (R1) and (V4) had been arguing and that (R1) had told (V4) he was going to escape out of his window tonight. I assured (V4) that we would keep an eye on (R1), I then reported what (V4) had stated to (V7). I did not go down to (R1's) room and assess (R1) or his window. I would have never thought (R1) would have been able to get through his window. The windows usually only open four inches. On 9/8/25 at 1:33 PM V4/R1's Family Member stated, (R1) had called me between 5:00 PM and 6:00 PM the night of 9/3/25 and told me he wanted to leave the facility and that he was almost able to get through his window. I got off the phone and called the facility and spoke to some nurse and told them what (R1) had stated. They told me they would check on (R1). Later, that night around 7:30 PM (R1) had called me and stated he had got out his window and was walking down the street. We then got disconnected so I attempted to call the facility and could not get anyone to answer so I called the local police department and let them know. I was told by the facility (R1) was found around a block away. On 9/8/25 at 11:01 AM V5/CNA stated she was working on the unit where R1 resided when R1 got out of the building on 9/3/25. V5 stated, I do remember (V7/RN) stating (V4/R1's Family Member) had called and told (V7) (R1) was saying he was going to escape out his window and to check on (R1) periodically. It was around 6:15 PM. I did not go down there immediately to check on (R1) but do know I had checked on (R1) at some time, I just don't remember the time. I did not frequently check on (R1) because his room is at the end of the hallway, and I didn't figure there was any way for (R1) to escape since (R1) would have to walk past the nurse's station or try to go through an exit (which he had a wander guard on). I did not look at (R1's) window though to see if he could get through it and should have. I worked with (V6/CNA) that night on that hallway. I was the one in charge of the 15-minute checks. I was not sure why (R1) was on the 15-minute checks. It does not say anywhere. If I had known, I would have kept a better eye on him. I do physically go down and check on (R1) when I am completing the 15-minute checks, but I may not get down there every 15 minutes. I did not know (R1) had attempted to get out of the facility prior to 9/3/25 or that he was a high-risk wanderer. I have never been trained on how to access a resident's care plan or if I even have access. V5 stated the night R1 got out his window on 9/3/25 V5 was sitting at the nurse's station charting. V7 had told V5 she received a phone call that R1 had escaped from the building. V5 reported she immediately ran down to R1's room, noticed R1's window was wide open and R1 was not in his room. V5 stated she immediately told V7 and V5 jumped through the window in an attempt to locate R1. V5 reported she did not notice anything broken on the window. V5 noticed V7 out in the parking lot and got in the car with V7 to go locate R1. V5 stated, I got in (V7's) car in the back parking lot. We took a right out of the parking lot. Then at the stop sign we took another right, then a left at the following stop sign. (R1) was observed to be right at the corner of that block by the stop sign about a half block from the railroad tracks. (R1) was cooperative and did get back in the car with us. On 9/8/25 12:30 PM V6/CNA stated she had no means to check on R1 that night and that she did not know anything about him. V6 denies V7/RN telling her to keep an eye on R1 or that R1 was wanting to escape on 9/3/25. V6 stated, I don't remember the last time I saw (R1) that night. I honestly didn't even know who (R1) was. On 9/8/25 at 2:05 PM V10/Cook stated, I didn't witness anything on 9/3/25 regarding (R1). They just said he was out of the building, and they were looking for him. I don't recall how (R1) got out his window. I would have picked up (R1's) room tray after 7:00 PM, but I don't even know if (R1) was in there. (R1) leaves his door cracked open and I just grabbed (R1's) tray. I didn't put my eyes on (R1). V10 stated no one interviewed him the night of 9/3/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145012 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Knox County 280 East Losey Street Galesburg, IL 61401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to ask if he had observed R1 that night or not.On 9/8/25 at 11:26 AM V3/Maintenance Director reports when he came into work on 9/4/25, V3 was told about R1 escaping out his window without staff knowledge. V3 stated, I went down to (R1's) room to observe his window. There are locks located on the bottom of the window seals, they only allow the windows to be open four inches. When I got down to his room, a visible scratch was observed along the bottom of the window seal, and the lock was observed to be next to the other four-inch lock. It looked like (R1) had been working on moving the bottom lock over for a while. I had to physically loosen the set screws and slide it back down to the original position and then set the screws again. I did put a new lock on it with the pointed screws. V3 stated it would have taken R1 a while to get the bottom lock to slide over, R1 would have had to use excessive force, and it was not something that could have happened quickly. V3 reported the only other way to get the bottom window locks to move is by utilizing a special tool to undo the locks. On 9/8/25 at 2:54 PM V1/Administrator stated she would have expected someone (a staff member) to immediately go down and assess R1's window at that time and then move R1 closer to the nurse's station to be monitored closely, after receiving a phone call that R1 was wanting to leave the facility and escape through his window. V1 stated, (R1) most definitely should have been checked on more than 15 minutes at that time if staff were aware he was voicing he was going to get out the window. The immediate jeopardy started on 9/3/25 when V7/RN and V22/LPN were made aware byV4/R1's Family Member of R1 voicing he was going to escape out his window and failed to immediately assess R1's window or immediately provide additional supervision. V1/Administrator and V20/Regional Director of Operations were notified of the Immediate Jeopardy on 9/10/25 at 11:35 AM. On 9/13/25 the surveyor confirmed through interview and record review that the facility took the following actions to remove the Immediate Jeopardy: R1's care plan was reviewed and update to reflect current wandering and elopement risk by V23/MDS Coordinator on 9/4/25.V20/Director of Operations reviewed all resident's MDS sections E and associated CAA (Care Area Assessment) on 9/4/25 and all concerns identified were addressed or updated on 9/4/25.V24/Social Service re-evaluated residents at risk for wandering/elopement, including R1, using the elopement risk assessment tool in PCC (Point Click Care) on 9/4/25.V1/Administrator in serviced all nursing staff on wandering, elopement, and resident safety on 9/4/25 and continued in-serving staff on leave by their next shift. R1 assessed for Memory Care Unit and moved to a room on Memory Care for safety. R1's window faces an interior courtyard. V1/Administrator, V2/Interim Director of Nursing, V20/Director of Operations, V24/Social Service Director, V20/Regional Director of Operations assessed all residents to determine if other residents should be placed in the memory care unit on 9/4/25.R1's room with the damaged window was repaired on 9/4/25 by V3/Maintenance Director.V7/RN completed a head-to-toe assessment on R1 upon his retorn to his room on 9/3/25.On 9/4/25 V25/Chief Nursing Officer audited all residents care plans and diagnosis to determine if any other resident needed to be placed in the locked dementia unit, needed a wander guard, or needed more frequent checks. On 9/4/24 V3/Maintenance director verified all window safety measure in place to ensure that window cannot be opened to a measurement where a resident can climb out the window. V3/Maintenance Director was in serviced by V20/Regional Director of Operation regarding the placement of these window safety measures, and to perform daily checks that the window safety measures are still in place and working properly. On 9/4/25 V1/Administrator in-serviced all staff regarding window safety measures and to alert maintenance or management if they identify a window safety component to be broken, out of place or missing. On 9/4/25 V1/Administrator in-serviced regarding safety and supervision policies and procedures, including but not limited to following resident care plan interventions pertaining to Wandering and Elopement (example: more frequent checks). On 9/4/25 V1/Administrator in-serviced all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145012 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Knox County 280 East Losey Street Galesburg, IL 61401 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete staff regarding the facility's Elopement Policies and Procedures. On 9/4/25 all staff involved regarding if a resident should be placed in the locked memory care unit, have a wander guard, or need more frequent checks, were in serviced by V20/Regional Director of Operation regarding the assessing the resident collaboratively to make the determination, and relaying to the staff why the determination was made.V20/Regional Director of Operations reviewed the Elopement and Wandering Residents Policy and Procedure with Interdisciplinary Team and V26/Medical Director on 9/4/25.V24/Social Service Director audited new admissions for elopement risk and ensure appropriate interventions were in place on 9/11/25.On 9/4/25 V23/MDS Coordinator audited all completed MDS's to ensure the care plan reflects needs/concerns identified in the CAA's.On 9/4/25 V20/Director of Operations updated all new hire packets with education regarding wandering, elopement, resident safety, and window safety. There have been no new hires since 9/4/25.On 9/4/25 V20/Regional Director of Operations held a QAPI meeting to review and interpret all audit findings, review all procedures, review investigation, review root cause analysis and all facts surrounding the incident IDT team and V26/Medical Director.On 9/4/25 V1/Administrator in-serviced all staff regarding following resident care plan pertaining to resident safety and supervision (Example: conducting 15-minute checks and looking for Elopement and Wandering behaviors). V1/Administrator and V20/Regional Director of Operations conducted an Audit on 9/5/25 and 9/12/25 regarding all policies and procedures pertaining to wandering and elopement, including resident care plans pertaining to wandering and elopement, weekly. Will continue weekly for weeks and then monthly for three months. On 9/11/25 V1 in-serviced all clinical staff on where to find/access the resident care plans. (Staff will not be allowed to return to work until education is completed. On 9/11/25 V1 provided education to clinical staff on the PCC dashboard identifying residents at risk, the intervention, and the reason for the intervention. (Staff will not be allowed to return to work until education is completed. On 9/11/25 V1 provided education to clinical staff on the need for safety interventions (Such as 15-minute checks-requiring actual visualization of resident identified with need for additional safety measures in place). Staff will not be allowed to return to work until education is completed. On 9/4/24 V20/Director of Operations reviewed/modified current policies to ensure appropriate procedures are in place to prevent harm/potential harm with IDT team and V26/Medical Director. Event ID: Facility ID: 145012 If continuation sheet Page 6 of 6