Health inspection·December 24, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some mobility related to intellectual disability, generalized weakness, and recurrent falls. The care plan specified that R67 required staff assistance for grooming, hygiene, and oral care. On December 21, 2025, at 10:45 a.m., R67 was in the small lounge area. He was noted to have an unkempt, long beard and mustache, long hair protruding from his ears, and long fingernails with sharp edges and black/brown debris underneath. On December 21, 2025, at 12:05 p.m., R67 was in the dining room visiting with V16 (his family member). R67 remained poorly groomed. V16 stated that R67 required oral care. Upon request, R67 smiled and revealed visible thick dental plaque and brown debris between the teeth. V3 (Assistant Director of Nursing) was notified of concerns related to R67's unmet ADL needs. 3. The EMR shows diagnoses for R47 including cellulitis of the left lower limb, lack of coordination, muscle weakness, morbid obesity, chronic kidney disease, and chronic obstructive pulmonary disease. The MDS dated [DATE], shows R47's cognition is moderately impaired and she is dependent on staff for ADLs, including hygiene and grooming. The care plan dated November 18, 2025, identified the need for staff assistance with personal hygiene due to activity intolerance, lymphedema, bilateral lower-extremity cellulitis, and morbid obesity. On December 21, 2025, at 11:30 a.m., R47 was in her room with long fingernails that had sharp edges and black debris underneath. R47 stated she wanted her nails trimmed. V8 was notified of this request. 4. The EMR shows R12 had a diagnosis of cerebral infarction with residual hemiparesis and hemiplegia. The care plan dated February 22, 2025, shows R12 required maximum assistance for ADLs, including hygiene. On December 21, 2025, at 11:11 a.m., R12 was in bed with long fingernails, sharp edges, and black debris underneath. On December 22, 2025, at 12:15 P.M., R12 was in the therapy room and continued to have long, unkempt nails. R12 was also noted to have a significant amount of white flakes visible from his hair onto his shirt. V3 (Assistant Director of Nursing) was present during this observation. 5. R40's face sheet included multiple diagnoses including unspecified dementia, unspecified severity, with other behavioral disturbance, unilateral primary osteoarthritis, left hip, other abnormalities of gait and mobility, muscle weakness (generalized), other lack of coordination. R40's Annual MDS dated [DATE], shows R40 has moderately impaired in cognition and required substantial maximal assistance in toileting, showers and upper body dressing and was dependent on staff for lower body dressing. On December 21, 2025, at 1:03 PM, R40 stated she had not been cleaned up all day and she is soaking (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 2 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some wet. There was a strong smell of urine near the resident who was lying in bed. On December 21, 2025, at 1:14 PM, V25 (Certified Nursing Assistant/CNA) stated that she was going to give resident shower now. V24 (CNA) and V25 came into R40's room to get her ready for a shower, but first they changed R40's incontinence brief. R40's incontinence brief and the two green incontinence pads underneath R40 were soaked from front to back with yellow urine. V25 stated she was assigned to care for R40 and was helping with lunch on the other side and that is why she did not come earlier to check on R40. V25 stated that the last time she had changed R40 was this morning around 7:00 AM. R40's care plan revised August 13, 2025, included that the resident requires assistance with all ADLs, presents with frequent incontinence of both bowel & bladder. Interventions included to assist resident with shower/bathing per schedule, staff to check her for incontinence episode every 2 hours and also needs assistance to wash, rinse and dry perineum and that resident needs assistance to change clothing as needed after incontinence episodes. On December 23, 2025 at 4:10 PM, V2 (Director of Nursing) stated CNAs should provide incontinence care as needed and should be checking residents for incontinence minimally every 2 hours. The facility's Incontinence and Perineal Care plan Revised June 30, 2025 showed the following: It is the policy of the facility to provide perineal care to ensure cleanliness and comfort to the resident, to prevent infection and skin irritation, and to observe the residents skin condition. Procedures:1 Do rounds at least every 2 hours to check for incontinence during shift. 6. R6's EMR (Electronic Medical Record) shows R6 was admitted to the facility on [DATE], with multiple diagnoses including end stage renal disease, dependence on renal dialysis, anemia in chronic kidney disease, diabetes, glaucoma, heart failure, and muscle weakness. R6's MDS (Minimum Data Set) dated November 3, 2025, shows R6 is cognitively intact and needs set-up/clean up assistance with oral hygiene and partial/moderate assistance with personal hygiene. R6's MDS also shows R6's vision is severely impaired. R6's care plan dated May 16, 2025, shows R6 requires assistance with all ADLs (Activities of Daily Living). On December 21, 2025, at 11:20 AM, R6 was lying in bed. R6 had a beard that was coarse, long and very thick. R6's hair was long, and it was curling at the base of the neck. R6 stated he wanted a haircut, and his beard shaved. R6 continued to say he has been asking staff to shave off his beard and give him a haircut since October 2025. On December 22, 2025, at 8:58 AM. R6 still had his long, thick beard and long hair. R6 stated the last time his beard was shaved was five to six months ago. R6 continued to say he needs help from staff to shave and cut his hair. On December 22, 2025, at 9:25 AM, V2 (Director of Nursing, DON) stated R6 should be shaved. R6 stated to V2 he would like to receive a haircut, and his beard shaved off. R6 stated he has been waiting for a shave and a haircut since October 2025. R6 continued to say he has asked several nurses many times for a shave and a haircut. 7. R105's EMR shows R105 was admitted to the facility on [DATE], with multiple diagnoses including obesity and hypertensive heart disease with heart failure. R105's MDS dated [DATE], shows R105 is cognitively intact and needs supervision/touching assistance with oral hygiene and partial/moderate assistance with personal hygiene. R105's care plan dated May 22, 2025, shows R105 requires assistance with all ADLs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 3 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On December 21, 2025, at 12:08 PM, R105 was sitting up in bed. R105 had hair on her upper lip and chin, which were approximately 0.5 inches long. The hair on her chin was curled. R105's hair looked disheveled, and she stated she does have knots in her hair. R105 stated her facial hair really bothers her and she wanted it removed. R105 further stated she wanted her hair and teeth brushed daily. R105 stated for the past two months she had asked several staff members multiple times to remove her facial hair. R105 stated her hair, and teeth were brushed only on shower days, usually once or twice per week, and she could not recall the last time her hair and teeth were brushed. R105 stated she required staff assistance with these tasks. On December 22, 2025, at 8:52 AM, R105's hair was still disheveled with knots, and R105 still had hair on her upper lip and chin. The hair on her chin was curled. On December 22, 2025, at 9:37 AM, V2 stated R105 should have her hair washed and have her facial hair removed. R105 stated to V2 she also wants her teeth and hair brushed. 8. R99's EMR shows R99 was admitted to the facility on [DATE], with multiple diagnoses including congestive heart failure and malignant neoplasm of uterus. R99's MDS dated [DATE], shows R99 is cognitively intact, and needs set up/clean up assistance with oral hygiene and substantial/maximal assistance with personal hygiene. R99's care plan dated June 9, 2025, shows R99 requires assistance with all ADLs. On December 21, 2025, at 12:13 PM, R99 was sitting up in bed. R99 had disheveled hair with knots. R99 stated she would like her hair and teeth brushed daily. R99 stated she can feel the knots in her hair. R99 stated she gets her hair and teeth brushed once or twice a week on shower days. R99 continued to say she would like her hair and teeth brushed more frequently. R99 stated her hair was brushed last week when she had to go to a doctor's appointment. R99 stated it has been several days since that appointment, and she has not had her hair and teeth brushed. R99 added she needs help from staff to brush her hair and teeth. On December 22, 2025, at 8:53 AM, R99 still had disheveled hair. On December 22, 2025, at 9:42 AM, V2 stated R99 should have her hair washed and brushed. V2 stated residents should have their hair and teeth brushed daily. On December 22, 2025, at 9:51 AM, V2 continued to say she expects her staff to check with residents about their grooming needs every morning and she expects the residents to get daily oral care. The facility's policy titled General Care revised on June 30, 2025, shows under policy statement, the facility will provide care for every resident to meet their needs. The policy further shows under procedure, the facility will assist the resident to meet his/her ADL needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 4 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to obtain a treatment order, assess, and treat a resident with skin alteration. The facility also failed to follow the physician's treatment order for a resident with moisture-associated skin dermatitis.This applies to 2 of 2 residents (R48, 123) reviewed skin alteration in a sample of 27.The Findings include:1.According to the face sheet, R48 had multiple diagnoses including, Alzheimer's disease, other lack of coordination, and polyarthritis. Residents Affected - Few R48's Quarterly MDS (Minimum Data Set) dated October 17, 2025, showed R48 had moderate cognitive impairment and required substantial to maximum assistance with toileting hygiene, personal hygiene, lower body dressing, and was dependent on staff for showers or bathing. R48's (ADL) Activity of Daily Living Care Plan initiated on August 12, 2025, showed R48 required assistance with all areas of ADL, and interventions include staff to assisting R48 with showering or bathing per schedule. On December 22, 2025, at 10:29 AM, R48's left front knee had a dressing dated December 15, 2025. The dressing was dirty and saturated with old, serosanguinous (mixture of bodily fluids and bloody drainage from the outside and underneath when V28 (Nurse) removed the gauze dressing. R48 had a small piece of Vaseline gauze dressing beneath the gauze dressing, and there was some redness and a skin tear to the left front knee when the dressing was removed. V28 took a measurement and said the skin tear and redness area on R48's knee was 1.5 cm X 1.5 cm. R48 said she had a skin tear some days ago while in physical therapy from rubbing her knees close together. V28 said she was R48's nurse on December 22, 2025, and December 21, 2025, during the day shift and was not aware that R48 had a left knee skin tear or that there was a dressing on R48's knee since December 15, 20025. V28 also said there was no order for treating R48's left knee skin care, and no TAR (Treatment Administration Record) flowsheet to document R48's left knee skin tear wound care, and it was not communicated in the nurses' shift-to-shift report. The facility's Incident Report, documented by V26 (Nurse) dated December 15, 2025, showed the resident sustained a skin tear on her left knee (front) while with a restorative aide in the therapy room. The same Incident Report documented that R48's physician was notified and an order to cleanse the skin tear, apply dry dressing and change it every three days was obtained. The facility's Skin Alteration Nursing Evaluation documented by V26 on December 15, 2025, showed R48 sustained a skin tear to the front area of her left knee, and there was bloody drainage present. On December 22, 2025, R48's current (POS) Physician Order Sheet did not show a wound treatment order for the left knee skin tear. On December 22, 2025, at 11:20 AM, R48's Physician, Wound Nurse Practitioner, and Nurses' Progress Note documentations were reviewed for December 1, 2025, to December 22, 2025, and there were no documentations regarding R48's left knee skin tear wound assessment, treatment, or condition. Review of R48's Treatment Administration Record for December 2025 showed there was no Treatment Order Flowsheet documentation of R48's left knee (front) skin tear sustained on December 15, 2025. On December 22, 2025, V3 (Assistant Director of Nursing/ADON) stated that R48 should not have had a saturated dressing which was last changed seven days prior. V3 also said the nurses should inspect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 5 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the R48's knee every shift, and the facility should have had a wound treatment order and TAR for documentation to prevent further worsening of the wound and infection control. 2. The EMR (Electronic Medical Record) showed R123 was admitted to the facility on [DATE], and discharged home on October 17, 2025. R123's documented diagnoses included a displaced fracture of the greater trochanter of the left femur, protein-calorie malnutrition, chronic obstructive pulmonary disease (COPD), nicotine dependence, dermatitis, and malignant neoplasm of the bronchus. Review of the POS (Physician Order Sheet) for October 2025 showed a physician's order dated July 2, 2025, directing staff to cleanse the buttocks with mild soap and water and apply Zinc Oxide Ointment every shift. R123's Skin assessments dated June 5, June 12, June 20, and June 25, 2025, documented that R123 had incontinence-associated dermatitis to the buttocks, measuring 3.0 cm x 3.0 cm. Review of R123's Electronic Treatment Administration Record (ETAR) and POS for the months of July, August, September, and October 2025 showed that Zinc Oxide Ointment continued to be ordered and applied as a preventative measure for skin impairment. However, review of the ETAR for these months revealed multiple instances of missing nurse signatures indicating that the Zinc Oxide treatment had not been administered as ordered. On December 22, 2025, at 2:45 p.m., V22, (Certified Nursing Assistant/CNA), stated that R123 occasionally experienced skin irritation to the buttocks. On December 23, 2025, at 2:59 p.m., V4, (Wound Care Certified Nurse), stated that R123 developed moisture-associated dermatitis to the buttocks on June 12, 2025, which was identified as incontinence-associated dermatitis. V4 further stated that Zinc Oxide Ointment remained in use after the dermatitis healed as a preventative measure to reduce the risk of recurrence. V4 also confirmed that nurses are required to sign the ETAR to show the treatment was done. On December 23, 2025, at 2:42 p.m., V2, (Director of Nursing, DON), stated that it is the facility's policy for nurses to sign the ETAR to document treatments were administered as ordered. V2 explained that if the ETAR was not signed, the treatment was considered not completed. Review of the facility's Skin Care Regimen and Treatment Policy dated July 3, 2025, showed the facility is required to ensure prompt identification, documentation, and appropriate treatment of residents with skin breakdown. The policy further requires nurses to document all assessments and treatments in the EMR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 6 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to assess and provide G Tube (gastrostomy tube) site care to residents on enteral tube feeding.This applies to 4 of 4 residents (R12, R28, R50, R101) reviewed for G Tube care in a sample of 27.The Findings include:1. According to the face sheet, R28 had multiple diagnoses, including Parkinsonism, nutritional deficiencies, dysphagia of the oropharyngeal phase, and gastrostomy status. R28's Quarterly (MDS) Minimum Data Set, dated [DATE], showed R28 had severe cognitive impairment and impairment to upper and lower extremities on both sides. The same MDS also showed that R28 is dependent on the facility staff for all areas of self-care and mobility. On Monday, December 22, 2025, at 9:00 AM, R28's G Tube site was covered with an undated gauze dressing. The gauze dressing on R28's G Tube site was wet, and there was a large amount of thick yellow-greenish color drainage on and around the G Tube site area when V29 (Nurse) lifted up the gauze dressing around R28's G-tube stoma (the opening on the abdomen connecting the G Tube to the digestive system). R28's skin around the G tube was also moist and red, with rashes. V29 said she did not work at the facility on Saturday, December 20, and Sunday, December 21, 2025, but it did not look like R28's G-tube site had been cleaned during the weekend shifts. R28's POS Physician Order Sheet, showed active orders to cleanse the enteral tube feeding site with wound cleanser, pat dry, and apply dry dressing every night shift and (PRN) as needed in two separate orders dated December 1, 2025. R28's PRN TAR (Treatment Administration Record) with a start date of December 1, 2025, showed to cleanse the enteral tube feeding site with wound cleanser, pat dry, and apply dry dressing. A review of the TAR flowsheet from December 1, 2025, to December 21, 2025, did not show any documentation to show that R28's G tube feeding site cleansing and dressing were performed. R28's Night shift TAR with a start date of December 1, 2025, showed to cleanse the enteral tube feeding site with wound cleanser, pat dry, and apply dry dressing. A review of R28's Night Shift TAR flowsheet from December 1, 2025, to December 21, 2025, showed there was no documentation to show that R28's tube feeding site cleansing and dressing were done on Sunday, December 7, 2025; Sunday December 14, 2025; and Saturday, December 20, 2025. 2. According to the face sheet, R50 had multiple diagnoses, including Parkinson's disease, Dysphagia, gastrostomy status, dementia, history of transient ischemic attack, and cerebral infarction. R50's Quarterly MDS dated [DATE], showed R50 had severe cognitive impairment and was dependent on the facility staff for all self-care and mobility. On Monday, December 22, 2025, at 9:55 AM, V29 was administering medication through R50's G tube. There was a large amount of yellowish-green thick drainage on and around R50's G Tube stoma site, and no gauze dressing was present underneath or on top of the G Tube bumper. V29 said there were foul odors coming from R50's G tube and that V50 should have had a dressing under the G Tube bumper to help with drainage. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 7 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some R50's POS showed an active order on November 21, 2025, to cleanse the enteral tube feeding site with wound cleanser, pat dry, and apply dry dressing every night shift. R50's TAR with a start date of November 21, 2025, to cleanse the enteral tube feeding site with wound cleanser, pat dry, and apply dry dressing every night. Review of R50's TAR flowsheet from December 1, 2025, to December 21, 2025, showed there was no documentation to show that R50's G tube site cleansing and dressing were done on December 9, 2025, December 19 and December 20, 2025. There was no additional PRN order on the TAR to cleanse the G Tube site as needed. On December 22, 2025, V3 (Assistant Director of Nursing/ADON) said the resident's G tube site should always be kept clean and the nurses were supposed to inspect the residents' G tubes site every shift to check for drainage and the skin around the G-tube site to determine whether it needed cleaning. V3 also said the nurses should have called the doctor to notify them of any skin breakdown, yellow or greenish drainage, and foul odors, which are signs of potential infection. In V3 also added that even if the order says to clean the G-tube sites every night shift or PRN, it is the responsibility of every nurse to inspect the residents' g-tube site and clean as needed every shift to prevent skin breakdown, support infection control, and ensure proper placement of the G-tubes. 3. The Electronic Medical Record (EMR) shows that R12 had a diagnosis of cerebral infarction with residual hemiparesis and hemiplegia. The Physician Order Sheet (POS) for December 2025 included an order dated December 2, 2025, to cleanse the gastrostomy tube (G-tube) insertion site with wound cleanser, pat dry, and apply a dry dressing daily. The care plan dated November 26, 2025, documented that R12 had a gastrostomy tube for enteral feeding due to dysphagia. Interventions included maintaining the gastrostomy tube insertion site free from complications and infection, monitoring the site, and following physician orders for gastrostomy tube care and dressing changes. On December 21, 2025, at 11:11 a.m., R12 was lying in bed with an intravenous pole positioned next to the bedside for tube feeding administration. When asked if he had a gastrostomy tube, R12 lifted his gown and exposed the insertion site. The gastrostomy tube insertion site was observed without a dressing. The site also had encrusted material present around the insertion area. On December 22, 2025, at 12:15 p.m., R12 was in the therapy room. Along with V3 (Assistant Director of Nursing), the gastrostomy tube insertion site was assessed. R12 had a dressing to the G tube site at this time. V3 stated that R12 must have a dressing applied to the gastrostomy tube insertion site per physician order. 4. The EMR showed that R101 had diagnoses including vascular dementia, major depressive disorder, anemia, schizophrenia, dysphagia, and gastrostomy status. The Physician Order Sheet for December 2025 included an order dated December 1, 2025, directing staff to cleanse the gastrostomy tube insertion site with wound cleanser, pat dry, and apply a dry dressing daily. The care plan dated August 13, 2025, identified the need to monitor the gastrostomy tube insertion site for signs and symptoms of infection, including drainage. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 8 of 9 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 145029 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avantara Joliet 210 North Springfield Avenue Joliet, IL 60435 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 0693 Level of Harm - Minimal harm or potential for actual harm On December 22, 2025, at 12:15 p.m., R101 was lying in bed. Along with V3, the gastrostomy tube insertion site was assessed and there was no dressing at the G tube site. The insertion site had encrusted material present, which had seeped through R101's facility gown. V3 stated that R101 must have a dressing applied to the gastrostomy tube insertion site and that the site should be clean per physician order. Residents Affected - Some The facility's Enteral Tube Feeding Care revised on June 30, 2025, stated, Procedure . 8. Enteral tube stoma care: Site must be cleansed and covered with dry gauze daily. Dry gauze should be placed on top of the G tube bumper, otherwise, a slim layer of light breathable gauze can be inserted under the disc. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145029 If continuation sheet Page 9 of 9