Inspection·April 6, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and it is expected that the nursing staff will provide trimming and cleaning of residents fingernails to assist especially those residents requiring assistance to maintain hygiene and cleanliness. V2 also stated that when a resident's blanket needs changing the staff should change it to ensure resident's cleanliness. 3. The electronic medical record (EMR) shows that R27 is 63 years-old who has multiple medical diagnoses which include right sided weakness related to CVA (Cerebrovascular Accident) and has muscle weakness. On 4/04/23 at 10:57 AM, R27 was resting in bed. She was alert and oriented and was able to verbalize needs during the interview. R27 displayed long dirty fingernails (with black/brown substances underneath the resident's nails). R27 stated that she wanted someone to provide nail care for her. R27's Minimum Data Sheet (MDS) dated [DATE] shows that she is alert and oriented and requires extensive assistance for grooming and hygiene. 4. The electronic medical record (EMR) shows that R47 is 66 years-old who has multiple medical diagnoses which include paraplegia and muscle wasting and atrophy to multiple sites. MDS dated [DATE] shows that R47 is alert and oriented and requires extensive assistance with hygiene and grooming. On 4/03/23 at 12:30 PM, R47 was in the dining room, sitting in his wheelchair. R47 displayed long dirty fingernails (black/brown substances underneath nails and brownish discoloration in the nail beds). On 4/04/23 at 11:05 AM, R47 was sitting in his wheelchair in his bedroom, alert and oriented. R47 still displayed thick curly facial hair and long dirty fingernails. R47 stated that he wanted nail care. The staff does not have to clip his nails, but he wanted his nails to be cleaned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 2 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, interview and record review the facility failed to assess and provide adaptive equipment to a resident, to prevent further reduction in mobility and ROM (range of motion). This applies to 1 of 5 residents (R67) reviewed for limited range of motion in the sample of 20. The findings include: R67 has multiple diagnoses which includes cerebral infarction due to thrombosis of other precerebral artery, hemiplegia and hemiparesis following cerebral infarction affecting unspecified side, generalized muscle weakness and aphasia, based on the face sheet. R67's quarterly MDS (minimum data set) dated February 9, 2023 shows that the resident is severely impaired with cognitive skills for daily decision making. The MDS showed that R67 required extensive assistance from the staff with most of his ADLs (activities of daily living). The same MDS showed that R67 had functional limitation in range of motion to one side of both his upper and lower extremities. On April 3, 2023 at 11:32 AM, R67 was in bed, alert but non-verbal. R67's right arm and hand was observed positioned on top of his abdominal area with the palm facing down. R67 was unable to move his right arm and hand and his right hand remained open with the digits extended. R67 signaled using his left hand that he cannot lift or move his right arm and hand. No adaptive equipment/device was observed on the resident's right arm/hand. On April 4, 2023 at 3:17 PM, R67 was in bed, alert but non-verbal. R67's right arm and hand was observed positioned on top of his abdominal area with the palm facing down. R67 was unable to move his right arm and hand and his right hand remained open with the digits extended. V2 (Director of Nursing) was present when R67 signaled using his left hand that he cannot lift or move his right arm and hand. No adaptive equipment/device was observed on the resident's right arm/hand. V2 was prompted to have the OT (occupational therapist) evaluate R67 for the need for an adaptive equipment/device. On April 5, 2023 at 9:24 AM, V13 (PT (Physical Therapist)/Director of Rehab) stated that based on R67's last OT (occupational therapy) and PT (physical therapy) notes dated September 2022, R67 was admitted to the facility with fixed/contracted right upper extremity. R67 was evaluated for OT on September 2022 based on ADL (activities of daily living) skills and eating skills and at that time, no adaptive equipment/device was recommended. According to V13, R67 was evaluated by another occupational therapist on April 4, 2023 (night time) and based on the evaluation, R67's right upper extremity was impaired from the shoulder, elbow (fixed), wrist and hand with hand and fingers extended. V13 stated that based on the April 4, 2023 evaluation, the occupational therapist evaluated R67 based on ROM (range of motion) and had recommended for the resident to use a right hand resting hand splint at all times to prevent pain from muscle tightening and to improve PROM (passive range of motion) of the right hand. R67's OT evaluation and treatment plan dated April 4, 2023 showed, It is recommended the patient wear a resting hand splint on right fingers, on right hand and on right wrist at all times in order to reduce pain caused by muscle tightening, manage tone, inhibit abnormal reflex patterns, inhibit abnormal positions, improve PROM for adequate hygiene, develop/establish schedule and adapt/modify splint device. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 3 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. R12 is a female resident. R12 has multiple diagnoses which includes dementia without behavioral disturbance, neuromuscular dysfunction of bladder and history of UTI (urinary tract infection), based on the face sheet. R12's quarterly MDS (minimum data set) dated January 12, 2023 shows that the resident is severely impaired with cognition and required extensive assistance from the staff with most of her ADLs (activities of daily living) including toilet use and personal hygiene. The same MDS shows that R12 is incontinent of bowel and uses an indwelling urinary catheter. On April 5, 2023 at 12:37 PM, after gathering her needed supplies, V14 (CNA/Certified Nursing Assistance) with the assistance of V4 (Treatment Nurse) provided bowel incontinence care to R12. V14 and V4 positioned R12 on her right side. V4 unfastened R12's disposable brief. R12 had a moderate amount of wet stool. V14 used wash cloth wet with soap and water and cleaned R12's buttocks and anal area. After cleaning R12's back area, while the resident was still on her right side, V14 placed the disposable brief under the resident. Then, V14 and V4 turned and repositioned R12 on her back and fastened the disposable brief without cleaning the resident's front perineal area. R12 had an indwelling urinary catheter in place and catheter care was also not provided. When V14 and V4 were asked why R12's front perineal area was not cleaned and catheter care was not provided since the resident had bowel incontinence. V4 did not respond, while V14 stated that she normally just clean R12's buttocks and anal area after every bowel incontinence and she does not provide any front perineal care and catheter care. R12's active care plan showed that the resident is at risk for incontinence related to neuromuscular dysfunction of bladder. The same care plan showed multiple interventions which includes, Clean peri-area with each incontinence episode. On March 5, 2023 at 12:57 PM, V2 (Director of Nursing) stated that all residents who had bowel incontinence should be cleaned, on the back area for both buttocks and anal area, and including the front perineal area, especially for resident's with indwelling urinary catheter. V2 added that for female resident's the labial fold should be separated and thoroughly cleaned, including the groin and thigh areas to prevent potential infection of the urinary tract and to maintain hygiene. The facility's perineal care policy and procedure dated February 2018 showed, The purpose of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition. The same policy and procedure showed in-part that for a female resident, a. Wet washcloth and apply soap or skin cleansing agent. b. Wash perineal area, wiping from front to back. (1) Separate labia and wash area downward from front to back. (Note: If the resident has an indwelling catheter, gently wash the juncture of the tubing from the urethra down the catheter about 3 inches. Gently rinse and dry the area.) (2) Continue to wash the perineum moving from inside outward to the thighs. Rinse perineum thoroughly in same direction, using fresh water and a clean washcloth. (3) If the resident has an indwelling catheter, hold the tubing to one side and support the tubing against the leg to avoid traction or unnecessary movement of the catheter. The facility's urinary catheter care policy and procedure revised in September 2014 showed, The purpose of this procedure is to prevent catheter-associated urinary infections. The policy and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 4 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0690 Level of Harm - Minimal harm or potential for actual harm procedure showed that for a female resident, Use a washcloth with warm water and soap and cleanse the labia. Use one area of the washcloth for each downward, cleansing stroke. Change the position of the washcloth with each downward stroke. Next, change the position of the washcloth and cleanse around the urethral meatus. Do not allow the washcloth to drag on the resident's skin or bed linen. With a clean washcloth, rinse with warm water using the above technique. Residents Affected - Some 4. R55 has multiple diagnoses which includes acute pyelonephritis, type 2 diabetes mellitus and sepsis (unspecified organism), based on the face sheet. R55's admission MDS dated [DATE] shows that the resident is cognitively intact and required limited to extensive assistance from the staff with ADLs. The same MDS shows that the resident is using an indwelling urinary catheter. R55's active order summary report showed an order dated March 20, 2023 for indwelling urinary catheter. On April 3, 2023 at 11:31 AM, R55 was in bed, alert and verbally responsive. R55's urinary drainage bag was hooked on the bedframe of the bed by the foot board area, however the said bag was resting directly on the floor. On April 4, 2023 at 3:12 PM, R55 was in bed, alert and verbally responsive. R55's urinary drainage bag was hooked on the bedframe of the bed by the foot board area, however the said bag was resting directly on the floor. This observation was pointed to V2 (Director of Nursing). V2 stated that the urinary catheter drainage bag should not be touching the floor to prevent urinary infection and to maintain infection control. The facility's urinary catheter care policy and procedure revised in September 2014 showed, The purpose of this procedure is to prevent catheter-associated urinary infections. The same policy and procedure showed under infection control, 2. Maintain clean technique when handling or manipulating the catheter, tubing or drainage bag. b. Be sure the catheter tubing and drainage bag are kept off the floor. Based on observation, interview, and record review, the facility failed to provide incontinence care in a manner that would prevent urinary tract infection (UTI) and failed to provide and maintain indwelling urinary catheter care. This applies to 4 of 4 residents (R11, R12, R55, R79) reviewed for incontinence and catheter care in the sample of 20. The findings include: 1. On 4/05/23 at 11:11 AM, V15 and V17 (Both Certified Nursing Assistants/CNA) entered R11's bedroom to render incontinence care. V15 and V17 donned PPE (personal protective equipment) such as gown and gloves. V15 stated that R11 is on contact isolation for ESBL (Extended-spectrum Beta-lactamases) in the urine. On 4/05/23 at 11:15 AM, V15 and V17 (Both Certified Nursing Assistants/CNA) rendered incontinence care to R11 who was wet with urine. V15 wiped R11's outer labia with wet washcloth, however he did not separate the labia to clean the inner folds. V15 and V17 assisted to position R11 on her left side then V15 proceeded to clean buttocks but he did not clean the rectal area and inner buttocks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 5 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0690 Level of Harm - Minimal harm or potential for actual harm 2. On 4/05/23 at 11:31 AM, V15 rendered incontinence care to R79 who was wet with urine. R79 also had a stain of fecal matter in the disposable brief. V15 wiped her buttocks, but did not clean the rectal area, applied new brief, then repositioned R79 and proceeded to clean her frontal peri-area while wearing same gloves. V15 wiped R79's outer labia with wet washcloth, however he did not separate the labia to clean the inner folds. Residents Affected - Some On 4/05/23 at 4:05 PM, V2 (Director of Nursing/DON) stated that when staff provide incontinence care, the staff must clean from front to back and must include all the frontal and back peri-area to prevent infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 6 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to ensure puree food was prepared to a smooth consistency for the lunch meal. This applies to 8 of 8 residents (R15, R35, R53, R54, R62, R69, R246, R248) reviewed for pureed diets in the sample of 20. The findings include: On April 4, 2023 at 11:30 AM, inside the kitchen, V10 (Dietary aide) placed 10 scoops (using scoop size #12 equivalent to 1/3 cup) of the facility prepared and cooked chicken enchilada inside a metal pan. V10 stated that the cook will puree the 10 scoops of the chicken enchilada for the lunch meal. At 11:36 AM, V11 (Cook) was observed preparing to puree the lunch meal. V11 used the chicken enchilada that was earlier measured and placed inside a metal pan by V10. V11 placed the chicken enchilada inside the food processor, added 2.5 tablespoons of thickener into the same food processor and started to puree the mixture. V11 then opened the food processor cover, placed the pureed chicken enchilada mixture inside the metal pan and stated that the chicken enchilada mixture is ready to be served after she reheats the said food. The final prepared pureed chicken enchilada was noted to have variable small pieces of chicken and onions. When the chicken enchilada mixture was tasted, there were small pieces of chicken and onions that could be swallowed. V8 (Dietary Supervisor) who was inside the kitchen was notified that the pureed chicken enchilada mixture was not safe to serve due to the varying consistency. V8 went to the area where the food processor was located and upon seeing the pureed chicken enchilada mixture that was inside the metal pan, V8 stated, that needs to be pureed more, I can see it. V11 and V8 processed the said chicken enchilada mixture five times in the food processor, until it reached the desired smooth consistency of the pureed food. On April 4, 2023 at 12:20 PM, V12 (Dietary Aide) was observed preparing the pineapple tidbits to be pureed. V12 placed 8 scoops (using 6 ounces ladle) of the canned pineapple tidbits inside the food processor and started pureeing the said food. V12 then opened the food processor cover, placed the pureed pineapple tidbits in small dessert cups and stated that the pineapple tidbits is ready to be served as desserts to the residents that are on pureed diet. The final prepared blended pineapple tidbits was noted to have variable small pieces. When the pureed pineapple tidbits was tasted, there were small pieces that could be swallowed. V8 (Dietary Supervisor) who was inside the kitchen (doing the tray line) was notified that the pureed pineapple tidbits was not safe to serve due to the varying consistency. V8 instructed V12 to put back the pureed pineapple tidbits that were placed in the small dessert cups and re-processed it again in the food processor, until it reached the desired smooth consistency of the pureed food. The facility identified eight residents (R15, R35, R53, R54, R62, R69, R246 and R248) that are on pureed diet consistency. Review of R15, R35, R53, R54, R62, R69, R246 and R248's active order summary reports showed that they have orders to receive pureed consistency diet. On April 5, 2023 at 11:00 AM, V16 (Registered Dietician) stated over the phone that when the dietary staff are preparing pureed food, the finished consistency should be smooth like pudding or mashed potato. V16 stated that the pureed food should not have any pieces or solid contents to ensure safety of the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 7 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0805 The facility's policy and procedure regarding guidelines for pureed preparations dated 2018 shows, The pureed diet provides food with a semi-liquid to semi-solid consistency (i.e., pudding like). Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 8 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to follow standard infection control practices related to hand hygiene and change of gloves during provisions of care. This applies to 2 of 20 residents (R11, R79) reviewed for infection control during provisions of care in the sample of 20. Residents Affected - Few The findings include: 1. On 4/05/23 at 11:11 AM, V15 and V17 (Both Certified Nursing Assistants/CNA) entered R11's bedroom to render incontinence care. V15 and V17 donned PPE (personal protective equipment) such as gown and gloves. V15 stated that R11 is on contact isolation for ESBL (Extended-spectrum Beta-lactamases) in the urine. On 4/05/23 at 11:15 AM, V15 and V17 rendered incontinence care to R11 who was wet with urine. V15 cleaned V11 from front to back of the perineum. While wearing the same soiled gloves, V15 applied barrier cream to R11. After V15 applied the barrier cream, he changed his gloves and without performing hand hygiene he applied clean incontinence brief. Then V17 took the soiled incontinence pad and continued to straighten R11's clean beddings while wearing same soiled gloves. 2. On 4/05/23 11:31 AM, V15 rendered incontinence care to R79 who was wet with urine. V15 removed the soiled brief, cleaned R79's peri-area, touched other clean surfaces, repositioned R79, applied new incontinence brief while wearing same soiled gloves. Then V15 removed his gloves and without performing hand hygiene he applied new pair of pajamas and assisted R79 back to wheelchair. After V15 transferred R79 to the wheelchair, he applied new gloves without performing hand hygiene, secured garbage in the plastic bag, picked up soiled incontinence pad and carried it outside the bedroom. V15 did not perform hand hygiene all throughout the care. On 4/05/23 at 3:02 PM, V6 (Infection Control Nurse) stated that the staff should perform hand hygiene before and after care, make sure they change gloves and do hand hygiene after they touched something soiled and before they touch another surface. They need to wash their hands before leaving the resident's room, this is to prevent cross contamination and prevent spread of infection. Facility's Policy and Procedure for Hand Hygiene indicates: Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infection. Policy Interpretation and Implementation: 7. Use an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: i. After contact with a resident's skin. h. Before moving from a contaminated body site to a clean body site during resident care. j. After contact with blood and bodily fluids. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 9 of 10 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 145043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Kankakee 900 West River Place Kankakee, IL 60901 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 0880 l. After contact with objects in the immediate vicinity of the resident. Level of Harm - Minimal harm or potential for actual harm m. After removing gloves. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145043 If continuation sheet Page 10 of 10