Health inspection·September 30, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview and record the facility failed to follow their fire prevention policy by not ensuring residents where free from hazardous fire conditions. This affected one of three residents (R9) reviewed for resident safety. This failure resulted in R9 having a refrigerator plugged into an unapproved, non-medical grade, surge protector which sparked and ignited a small fire leaving black smoke in the room and soot on the floor. This failure has the potential to affect all the twenty- two resident who reside on the units. The findings include:On 9/25/25 at 12:27PM, a code red (fire) to R9/R10's room was announced over the public announcement system during an interview with V1 (administrator). V1 left to attend to code.On 9/25/25 at 12:48PM, observations were made in R9's room of outlets near R9's bed. There was black soot noted on the floor. R9's nightstand was moved away from the wall. R9 had a mini refrigerator on top of the nightstand. There was burning smell present in R9's room.On 9/25/25 at 12:52PM, V7 (maintenance) said, there was smoke in R9's room. V7 said, he removed power surge device and thinks the smoke was from the mini refrigerator. Power surge was observed with 6 outlets plugs. Three of the six plug inserts were melted and shaped irregular. The side of the power surge near the red power button was melted area as well as a hole on the bottom of the power surge about size a nickel. V7 said, residents can have surge protectors but should not be used for medical devices.On 9/25/25 at 3:07PM, R9 who was alert and oriented x/times three at time of interview, was observed in her room. Mini refrigerator was removed from her room. R9 said, she was sitting on her bed near the window and heard a pop noise. R9 did not think anything of it but then she heard a pop again a few moments later. R9 said, she was not sure what it was, then began to smell burning and see black smoke. R9 said, she went to her refrigerator, looked on the sides behind the nightstand and saw small sparks coming from the power surge. R9 said, she observed a small flame near on the cord of refrigerator in the back. The flame was a little a larger that the flame on a lighter. R9 said, she yelled fire and went to get staff, who responded to the room. R9 said, the mini refrigerator was her own refrigerator. The power surge was in her room when she got there. R9's roommate R10 was alert and oriented at time of interview was also present, said she was in room at time of incident, R10 said she smelled something burning and heard R9 yell fire and they left the room. Staff came immediately.On 9/26/25 at 11:30am, V1 (administrator) said, there was a short circuit in the refrigerator compressor/motor. V1 said, the surge protector did its job, it melted with no fire. V1 said, the residents were not in the room. V1 said, we don't provide power surge protectors to the residents. If we provided a surge protector, it would have to be medical grade and approved by the maintenance director. On 9/26/25 at 1:45pm, V15 (fire department personnel) said, a refrigerator should not be plugged into a surge protector. The popping sound was the plastic on the conductor in the surge protector starting to fail. The refrigerator should have been plug into an outlet. All the manuals will document, to plug into an outlet.On 9/26/25 at 2:24pm, V7 said, he did not approve R9's surge protector. V7 said, he was not aware of R9 had a surge protector.Fire Page 1 of 2 145070 145070 09/30/2025 Nexus at Berwyn 3601 South Harlem Avenue Berwyn, IL 60402

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some department report dated 9/25/25 documents: Upon arrival maintenance said R9's room had a surge protector started smoking. Maintenance quickly unplugged unit from wall. Fire Prevention Policy undated documents: It is the policy of the facility to make concerted efforts to protect persons and property of the facility from hazards related to fires through adherence to comprehensive safety policies, local, state and federal fire regulation and safe practices in all aspects of work performance and the resident's daily living activities. Electrical- ganged or multiple outlet plugs are not used. 145070 Page 2 of 2