Health inspection·October 26, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete On 10/26/23 at 12:07 PM, V2 DON (Director of Nursing) said the units have always had paging, it is not used after night time but during the day. The staff should only be announcing needing assistance. V2 said she could possibly see the bathroom announcement as a dignity issue. The facility's 8/2023 Resident Rights policy documents it is dedicated to promoting the highest quality of life for their resident's. The Center strives to ensure that these rights are protected and respected by the resident, staff, volunteers and visitors at the Center. Event ID: Facility ID: 145050 If continuation sheet Page 2 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 0558 Reasonably accommodate the needs and preferences of each resident. 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 ensure the call light system was in reach for 1 of 1 resident (R42) reviewed for call lights not in reach in the sample of 36. Residents Affected - Few The findings include: R42's admission Record, printed by the facility on 10/26/23, showed she had diagnoses including hemiplegia and hemiparesis following a cerebral infarction affecting her left side (left-sided paralysis and weakness following a stroke), vascular dementia, visual loss in her left eye, glaucoma, osteoarthritis. The facility assessment dated [DATE], showed R42 had severe cognitive impairment and was dependent on staff for eating, toileting, bathing, personal hygiene, and transfers. The assessment showed R42 was always incontinent of bowel and bladder. R42's care plan dated 12/1/21, showed she has an ADL (activities of daily living) self-care deficit related to activity intolerance, hemiplegia, impaired balance and stroke. One of the interventions in place was Encourage the resident to use bell to call for assistance. R42's care plan with a revision date of 10/25/23, showed she has impaired cognitive function/dementia or impaired though processes related to difficulty making decisions. One goal of the care plan was R42 would be able to communicate basic needs on a daily basis. R42's fall risk care plan, with a revision date of 10/25/23, showed she is at risk for falls related to poor communication/comprehension, unaware of safety needs, stroke, left hemiplegia, cognitive deficit, impaired vision, incontinence, and lack of standing tolerance. One intervention for the care plan is Be sure the resident's call light is within reach and orient her to location due to blindness. Encourage the resident to use it for assistance as needed. The resident needs prompt responses to all requests for assistance. On 10/24/23 at 12:55 PM, R42 was sitting in a reclining geriatric chair by the end of her bed. R42 said sometimes she has to wait about an hour for staff to help her. R42's call light was on the bed, not in reach of resident. R42 said that happens often and it is aggravating. R42 said she sits there, yelling for help over and over, and no one comes. R42 said staff say they cannot hear her. R42 said she cannot reach over and get the call light. On 10/26/23 at 8:36 AM, V5 (Manager of Rehab) said R42 is in a (reclining geriatric chair) because she does not have enough support, or upper trunk control to use a high-back chair due to her hemiplegia . V5 said R42 had a stroke, and it affected her left side. V5 said R42 is weak on her right side as well. V5 said R42 had therapy to try to increase her strength on her right side. She has no movement on her left side and minimal movement on her right side. V5 said it would be important to make sure the call light is within reach. She is pretty dependent on staff for everything. On 10/26/23 at 12:32 PM, V2 (Director of Nursing) said staff should absolutely make sure that the call light is within R42's reach because that is the only thing she can press for assistance. That is her means of communicating to us what she needs. The facility's Wheel Chair System-Patient Evaluation Information form, provided by the facility on 10/26/23, showed R42 was assigned a Broda chair on 1/19/23 due to sliding from a high-back recliner. The facility's Call Light Protocol, with a revision date of 6/19/2009, showed Policy .3. It is the policy of (the facility) to provide all residents with the proper equipment to notify staff that assistance is needed .Procedure: 1. A working call light is to remain within reach of the resident at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 3 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 0558 all times when they are in their room; if they are in bed, a wheelchair, a Geri chair, the toilet or a commode. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 4 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. R87's face sheet, printed on 10/26/23, showed diagnoses including but not limited to cerebrovascular disease, osteoporosis, chronic pain, difficulty walking, muscle weakness, and right artificial knee joint. R87's facility assessment dated [DATE] showed staff assistance required for toilet transfer. The same assessment showed no cognitive impairment. R87's care plan showed an intervention revision dated 2/9/23 for: Restorative-transfer program-Transfer with one person gait belt. On 10/24/23 at 10:34 AM, R87 was seated on the toilet and V9 (CNA-Certified Nurse Aide) was present. V9 was wearing a gait belt around her own waist. V9 held onto both of R87's hands and instructed her to stand. R87 slowly stood up then suddenly grabbed the side bars by the toilet. V9 performed personal hygiene care while R87 was standing. R87 said, Don't wipe me too hard or I will go over and fall. V9 completed care and held R87's hands while pivoting her into the wheelchair. R87 was weak, shaky, and bent forward throughout care and the transfer. V9 did not apply the gait belt to R87 and continued to wear it around her own waist during care. On 10/24/23 at 10:44 AM, V15 (Unit Nurse) stated R87 has a history of falls and recently became a hospice resident. She has been evaluated by therapy and is a one assist with a gait belt. She needs the gait belt to transfer safely. On 10/25/23 at 9:21 AM, R87 was seated on her bed eating. R87 was alert and oriented. R87 said staff never use any gait belt to transfer her. They just hold her hands or arm while she walks. On 10/26/23 at 10:35 AM, V2 (Director of Nurses) stated gait belts are needed while transferring. Anyone who needs help stabilizing is required to always have one on. Gait belts provide support in case a resident begins to fall. (R87) absolutely needs one. She is a stand pivot and staff need to hold onto the gait belt at her back. It is unsafe to hold her by the hands or arms. The facility Gait Belt policy reviewed dated 8/2023 states: Staff must always follow the transfer method set forth in the resident assessment and care plan. Based on observation, interview, and record review, the facility failed to ensure a resident was transferred in a safe manner for 2 of 5 residents (R69, R87) reviewed for falls in the sample of 36. The findings include: 1. R69's face sheet showed a [AGE] year old male with diagnosis of diabetes, osteoarthritis of the knee, chronic kidney disease, bilateral artificial hip joints, muscle weakness, and malignant neoplasm of the prostate. R69's 8/30/23 facility assessment showed he was cognitively intact and required extensive assistance of one person to physically assist with transfer, bed mobility, and toilet use. R69's care plan showed he was at risk for falls. On 10/24/23 at 1:15 PM, V6 Certified Nursing Assistant (CNA) applied the mechanical stand lift transfer harness to R69's upper body and attached it to the lift. Once R69 was off the toilet and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 5 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 - Minimal harm or potential for actual harm upright (with knees bent), the safety belt was noted to be very loose. This surveyor reached to the belt to show the excess slack in the belt in relation to R69's body. R69's heels extended beyond the posterior edge of the foot plate (were not on the foot plate all the way). V6 did not tighten the belt, did not ensure his feet were on the foot plate, and continued to move R69 in the lift out of the bathroom and transferred R69 to a wheelchair. R69 did not request a preference for how loose fitting the safety belt was secured. Residents Affected - Few On 10/26/23, R69 said he did not believe the lift strap was secured tight enough during the transfer observed by this surveyor on 10/25/23. The strap was too loose and I did not request that it be that loose. On 10/26/23 at 12:03 PM, V5 Manager of Rehabilitation Services said her department does all the assessments to determine what transfer technique is recommended for each resident. V5 said R69's assessment done on 8/23/23 showed to use a mechanical stand lift for transfers. Not all residents can stand upright. They need to be able to bear weight, hold on with their hands and maintain that position during the transfer. Both feet should be on the foot plate during a transfer. The belt should be secure enough to the resident's body to allow for one hand to fit between the strap and the resident. It's important to use the lift correctly for resident safety. This includes ensuring both feet are on the foot plate and the strap is close to the resident's body without slack. The facility's 4/2023 Transfers-EZ Lift/EZ Stand Policy showed Safety measure: Securely fasten the safety strap around the resident's chest. Secure the buckle and pull the loose strap to tighten. The EZ Way Stand Operator's Instructions showed patients should be able to follow simple commands, bear some weight, and have upper body strength. For the safety of the patient, securely fasten the the safety strap around the patient's torso. Secure the buckle and pull the strap to tighten. As the patient is being raised, simultaneously tighten the safety strap buckled around their torso. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 6 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 - Few 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. R22's admission Record (Face Sheet) showed his diagnoses to include Cerebral Palsy, hemiplegia affecting his left dominate side, retention of urine, personal history of UTI's (urinary tract infections), and ESBL (Extended Spectrum Beta Lactamase) resistance. On 10/25/23 at 10:08 AM, R22 was sitting up in bed watching TV. R22 has an indwelling catheter due to urinary retention. During an inspection of the tubing and catheter bag, the bag was found to be on the floor on the right side of the bed. On 10/25/23 at 10:10 AM, R22 said, the CNA's (Certified Nursing Assistants) were just in his room giving him care. On 10/25/23 at 10:25 AM, V3 ADON (Assistant Director of Nursing) said, the catheter bag should not be touching the floor because the floor is dirty and it could increase his chance of infection. R22's 7/19/23 Progress notes showed his urine was positive for E-Coli (Escherichia coli) and proteus. R22 received IV (Intravenous) antibiotics for this infection. R22's 7/19/23 MDS (Minimum Data Set) showed he requires extensive assistance with his ADL's (Activities of Daily Living). The Catheter Management Policy and Procedure (revised 8/2023) shows it's purpose is to reduce nosocomial-associated infections (in house infections) and complications. The same document shows the urinary catheter bag should be hung on the frame of the bed and should not touch the floor. 2. R200's admission Record, printed by the facility on 10/26/23, showed he had diagnoses including hemiplegia and hemiparesis following a cerebral infarction affecting left side (left-sided paralysis and weakness following a stroke), neuromuscular dysfunction of bladder, and urine retention. R200's Order Summary Report, printed by the facility on 10/26/23, showed an order for an indwelling (urinary drainage) catheter. R200's care plan initiated on 6/29/23 showed he had an indwelling catheter due to neurogenic bladder after a stroke. The care plan showed R200 had a personal history of UTI (urinary tract infection). On 10/24/23 at 3:52 PM, R200 was in his room, lying in bed. R200's urinary drainage bag was lying directly on the floor. The side of the urinary drainage bag with the tubing was touching the floor. On 10/26/23 at 12:44 PM, V2 (Director of Nursing) said catheter bags should be kept off of the floor to prevent infection, and for the resident's dignity. The facility's policy and procedure titled Catheter Management: Urinary Indwelling, with a revision date of 8/2023, showed 5. Secure bedside drainage bag to bed frame. Make sure the bag (is) covered and is kept off the floor. Based on observation, interview, and record review the facility failed to ensure incontinence care was performed in a manner to prevent cross contamination and failed to ensure urinary drainage bags were off the floor for 3 of 3 residents (R28, R200, R22) reviewed for incontinence care in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 7 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 sample of 36. Level of Harm - Minimal harm or potential for actual harm The findings include: Residents Affected - Few 1. R28's face sheet printed on 10/26/23 showed diagnoses including, but not limited to, depression, atrial fibrillation, hydronephrosis, and obstructive uropathy (urine accumulation in kidney). R28's facility assessment dated [DATE] showed staff assistance required for toilet use, and always incontinent of urine and bowel. R28's care plan showed a focus area related to at risk for complications from removal of right ureteral stone on 10/18/23 with recent complicated urinary tract infection and hydronephrosis, cystoscopy, right ureteral stent placement on 9/27/23. R28's physician orders showed an order start dated on 10/18/23 for: Cedfinir capsule (antibiotic) 300 milligram two times daily for infection (s/p surgical procedure stent placement) for 7 days. On 10/24/23 at 11:12 AM, R28 was lying in bed while V8 and V9 (CNAs-Certified Nurse Aides) changed her incontinence brief. Both V8 and V9 wore gloves while R28 was rolled to her side. V9 removed the urine-soaked brief from under her and used a wet towel to wipe her buttocks. V9 used the same towel area to dry her buttocks. V9 rolled R28 onto her back, while V8 exited the room to get barrier cream. V9 continued wearing the same contaminated gloves to put a fresh brief under R28, touch the bed side rails, adjusted the pillow under R28's head, and searched through the bedside table drawer. V8 returned with barrier cream and V9 applied it to R28 still wearing the dirty gloves. R28's brief was closed without any vaginal pericare performed. V8 and V9 transferred R28 using a mechanical lift into her wheelchair. V9 continued wearing the same contaminated gloves to touch the lift controls and sling. V9 exited the room and placed the mechanical lift in the hallway. V9 wore the same gloves to comb R28's hair and adjust her clothing. On 10/24/23 at 11:27 AM, V9 said R28 wets a lot so we check her every two hours. Her brief was a medium level of saturation today. V9 said incontinent residents should be cleaned with a wet cloth and dried with a fresh one. V9 said gloves should be tossed if they are dirty with bowel movement or urine. It stops germs from transferring to other residents or other items. V9 was asked why she did not cleanse R28's vaginal area after the wet brief was removed or change her gloves. V9 replied, I thought I did. I just forgot. On 10/26/23 at 10:26 AM, V2 (Director of Nurses) stated CNAs are expected to cleanse incontinent residents and change gloves appropriately. Fresh gloves should be worn before touching anything else. It stops the spread of infection. Germs on the dirty gloves can go to other areas. Pericare involves going in the correct order and thorough cleaning. It is not appropriate to use the same side towel to clean and dry. It should be folded over or get a new one. Incontinent residents need to be cleaned whenever they are wet. Urine is harsh to skin. It can cause skin irritation, odors, and skin breakdown if it remains on the body. The facility's Perineal Care policy review dated 8/2023 states: All residents will receive proper hygiene as part of our daily care procedures and infection control program. The facility's Hand Hygiene policy review dated 8/2020 states under the aftercare section: Performing your personal hygiene, removing gloves or aprons. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 8 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 The facility was unable to provide a glove use policy. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 9 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 serve residents trays at an appetizing temperature for eight residents (R5, R12, R128, R119, R19, R79, R72, & R61) outside of the sample. Residents Affected - Some The findings include: On 10/24/23 at 11:17 AM, the first tray cart containing lunch trays was delivered to the third floor. Residents were sitting in the common area at tables. Staff were not passing any of the lunch trays. At 11:37 AM, the second tray cart containing lunch trays was delivered to the third floor. V7 CNA (Certified Nursing Assistant) took a rolling cart over to the first tray cart, opened the doors to look for certain trays and placed them on her rolling cart. V7 went to the second tray cart, opened the doors to look for certain trays and placed them on her rolling cart. V7 took 4 resident trays and walked down the hall. At 11:42 AM, V8 CNA started serving lunch trays. V9 CNA opened the first tray cart, removed a couple of trays, left the doors open and went to the second cart to look for additional trays. At 11:48 AM, there were 5 trays left sitting on the racks of the first cart that had the door left open. V7 CNA, V10 CNA, and V11 CNA removed lunch trays from the side of the first cart that had the door left open. At 11:50 AM, the last tray was removed from the first cart on the side with the door open. The tray was for R5. V13 (Dietary Manager) took temperatures of the food on R5's tray. The salmon was 116 degrees Fahrenheit and the potatoes were 119 degrees Fahrenheit. V13 stated when they temperature test for test trays the food temperatures should be 120 - 125 degrees Fahrenheit. V13 stated the reason they do two tray carts to the floor is so the first cart will come up and trays will served before the second cart comes up. V13 stated this was done so staff can serve food at the temperature it needs to be. V13 stated it was important to serve food at the appropriate temperature because it tastes better for the residents. V13 observed the staff leaving the doors open on the tray carts while searching for residents lunch trays. V13 stated that leaving the doors open on the tray carts contributes to cold food. At 12:10 PM, forty-three minutes after the first tray cart was delivered to the floor, the last meal tray on that cart was ready to be served to R12; she had a mechanical soft diet. V13 took the following temperatures in degrees Fahrenheit of R12's lunch tray: pork - 108 degrees, rice 105 degrees, and carrots 106 degrees. V13 stated the food was too cold. V13 stated he noticed staff spend a lot of time searching for trays in the carts while other staff go up and down different halls delivering lunch trays. At 12:12 PM, V12 (Registered Dietician) stated the tray carts don't go up at the same time so nursing staff can pass trays from one cart before the other cart comes so the food doesn't get cold. On 10/25/23 at 1:26 PM, during the group meeting R128, R119, R19, R79, R72 and R61 stated the food is served cold. R128 and R72 stated when the tray carts are brought up the staff is busy and they can't get the food trays out fast enough so the food is served cold. R72 stated two carts will come up to the floor and staff will sometimes wait for both of the food carts to come up before they start serving the food. R61 stated staff leave the doors open on the food carts and the food gets cold. On 10/26/23 at 10:40 AM, R5 stated the food is always cold and tastes awful. R5 stated, I don't know why it's cold all of the time; but it doesn't taste good like that. I can have it warmed up if I ask them to do that and if I can get someone to do it. The Face Sheet dated 10/26/23 for R5 showed medical diagnoses including spina bifida, paraplegia, disorder of adrenal gland, gastroesophageal reflux disease, absence of other parts of digestive tract, deficiency of other vitamins, obstructive and reflux uropathy, hypertension, and kidney stones. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 10 of 11 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 145050 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dupage Care Center 400 N County Farm Rd Wheaton, IL 60187 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The Dietary Note dated 10/25/23 for R5 showed she has had an 8 percent weight loss in three months with variable appetite. R5 is provided select menus for lunch and dinner to choose her meals. R5's food preferences were updated. The Care Plan dated 8/10/23 for R5 showed she has a potential nutritional problem. Regular diet; provide and serve diet as ordered. The Minimum Data Set (MDS) dated [DATE] for R5 showed no cognitive impairment; set up only needed for eating; extensive assistance needed for bed mobility, dressing, and toilet use; total dependence on staff for transfers. The facility's Dining Services policy (no date) showed, Meals shall be prepared using quality ingredients and standardized recipes, and served in a palatable, attractive and at a safe and appetizing temperature. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145050 If continuation sheet Page 11 of 11