Health inspection·August 26, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few brief and pull down R1's gown. V6 said, R1 was crying when she entered his room. V6 said, R1 reported not feeling safe at the facility and wanting to die. V6 said, R1 reported he has never been touch by a man before. V6 said, R1 reported R2 had his hand in R1's adult brief touching his penis. Nursing note dated 8/20/25 documents: Patient (R1) is going to be admitted for sexual assault.On 8/26/25 at 1:34pm, V5 (nurse) said, she was the reporting nurse for R1. V5 said, she was aware that R1 has a history of inappropriate touching other residents. V5 said, R1 reported, that R2 touch his anus. Nursing note dated 7/17/25 documents: RN (V5) noticed resident (R2) kept going into another resident room. The resident (R2) is trying to inappropriately touch the other resident and tell him he loves him. On 8/26/25 at 2:45pm, V12 (R2's power of attorney/POA) said, R2 has dementia and a history of same sex relationships. V12 said, she received a call about R2's incident with R1. V12 said, she has received calls from the facility prior to R1's incident about R2 inappropriate touching other residents. V12 said, the facility has been so patient with R2. Now the facility is acting like they do not have any patience with R2, like they can tolerate R2 anymore. R2 will do the same thing at any facility. The current facility found a new facility for R2 but they refused to accept him after R2's recent inappropriate touching incident with R1.R2's Behavior note created on 8/18/25 documents: Behavior Description: Inappropriately touching another resident. Behaviors: resident (R2) observed inappropriately touching a resident (R1). Nursing note dated 8/18/25 documents: Writer heard a resident (R1) yell out for help, writer got up to go to the yelling. Writer observed above resident (R2) in his wheelchair bending and reaching over to a resident (R1) in bed. Resident (R2) being petitioned to the hospital for inappropriate sexual behavior towards his peer. On 8/20/25 at 1:45pm, V2 (social service) said, she was made aware, R2 inappropriately touched R1 during the morning meeting. V2 said, she was informed, R2 opened R1's adult brief and had his hand in R1's brief. R1 reported he felt uncomfortable because he was not a homosexual. On 8/20/25 at 2:31pm, V3 (nurse practitioner) said, she was informed on Monday 8/18/25 that another resident touched R1. V3 said, she saw R1 on Tuesday. V3 said, R1 reported R2 lifted his gown and grabbed his penis. R1 reported he can't get erect because he is paralyzed. R1 said, he was not gay. R1 was crying. V3 said, she suggested R1 go to the hospital. On 8/20/25 at 11:49am, V10 (restorative aide) said, she was instructed to move R1 to a different room. V10 said, R1 requested that she stay with him because R1 reported being scared. V10 said, she was informed R1 was inappropriately touched by R2. On 8/20/25 at 11:59am, V11 (cna) said, she saw R1 crying. V11 said, she asked R1 was he okay. V11 said, R1 replied, please don't leave him. V11 said, R1 was scared to be left alone. V11 said, R1 is contracted and dependent on staff for assistance. V11 said, she was informed R2 took off R1's adult brief. On 8/20/25 at 12:12pm, V7 (nurse) said, she heard a resident yelling help, help, help. V7 said, staff started running towards the yelling. R1 was in bed on his back. R2 was standing by R1's bed, reaching under R1's gown. R1's adult brief was loose. V7 said, R1 reported he didn't know what R2 was doing. On 8/20/25 at 12:39pm, V8 (cna) said, she heard R3 telling R2 to get out of R1's room. R1 is contracted with his hands stuck behind his head. R1's legs are contracted opened. V8 said, R1 is dependent on staff for assistance. R2 is a wander. R2 should not have been in R1's room. Hospital Paperwork dated 8/19/25 documents: Patient (R1) present to emergency department for evaluation after an assault. R1 does not feel safe. Emergency Department diagnoses: Sexual assault of adult. Per emergency service: R1 was manually grouped by another resident, allegedly witness by another resident. (8/21/25) Case manager spoke with patient (R1) at bedside who was alert and orient times four, declined to discharge to long term care facility, states he just left a facility where he was molested. Police report dated 8/19/25 documents: office responded to nursing home in regard to a criminal sexual abuse report. R1 was lying in bed alone. While (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145087 If continuation sheet Page 2 of 7 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete laying down, R2 entered R1's room in a wheelchair. R1 rolled his wheelchair next to R1's bed and came to a stop. R2 then stood up and opened R1's diaper. R1 related that R2 placed his right hand in R1's adult brief and began to groan. R1 does not have any sense of feeling below the waist and did not know exactly what R2 was doing to his genitals. R1 began to call for a nurse while R2 was moving his hand around R1's genitals. R3 entered the room and began to shout at R2 to stop. Abuse policy dated 10/2022 documents: The facility affirms the right of our residents to be free from abuse, neglect or exploitation. Sexual abuse includes but is not limited to sexual harassment, sexual coercion or sexual assault including non-consensual or non-competent to consent sexual activity. Event ID: Facility ID: 145087 If continuation sheet Page 3 of 7 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to follow its abuse policy by not reporting an allegation of abuse to the regulatory state agency within 24 hours. This affected two of three residents (R1, R2) reviewed for abuse policy. Findings Include:R2's Behavior note created on 8/18/25 at (12:49) documents: Behavior Description: Inappropriately touching another resident. Behaviors: resident (R2) observed inappropriately touching a resident (R1). Nursing note dated 8/18/25 documents: Writer heard a resident (R1) yell out for help, writer got up to go to the yelling. Writer observed above resident (R2) in his wheelchair bending and reaching over to a resident (R1) in bed. Resident (R2) being petitioned to the hospital for inappropriate sexual behavior towards his peer. On 8/20/25 at 3:45pm, V1 (administrator) said, if she is aware of an abuse allegation it should be reported to Illinois Department of Public Health within two to twenty-four hours. V1 said, she was informed of R1's incident by V4 (assistant administrator) followed by V14 (director of nursing) on 8/19/25. V1 said, R1's incident should have been reported if staff felt like it was abuse. V1 said, she did not report the incident due to being off but V4 should have because she was in the building. On 8/23/25 at 2:45pm, R1 who was assessed to be alert and oriented to person, place and time, said he was in bed when R2 entered his room via wheelchair. R1 said, R2 rolled on the side of his bed, stopped his wheelchair, stood up, lifted R1's gown and ripped opened R1's adult brief. R1 said, R2 put his hand around his penis and started rubbing it. R1 said, he was scared, he yelled for help and R3 saved his life. R1 said, he felt uncomfortable. R1 said, he does not have sexual activities with men. R1 said, he is not like that. R1 said, the facility needs security. On 8/20/25 at 11:15am, R3 who was assessed to be alert and oriented to person, place and time, said R1 was yelling for about four minutes. R3 said, he walked to R1's room. R3 said, he saw R2 standing up on the side of R1's bed with his right hand on R1's penis moving up and down while holding his (R2's) penis while moving his left hand moving back and forth. R3 said, R2 is aware of his behavior. R3 said, R2 rolls through the hallway looking for bedbound residents. R2 does not bother residents that can walk. R2 has touched other bedbound residents before. R2 waits and watches until staff is not looking, go into resident's room and touch them inappropriately. R3 said, R1 is contracted with his arms up by his head and his legs are stuck open, knee up and apart. R1 could only yell for help. R3 said, V6 was the first to enter R1's room. On 8/20/25 at 12:26pm, V6 (cna) said, said when she entered R1's room. R1 was observed with his gown up. R2 pulled up R1's gown, pushed R1's adult brief to the side and touched R1's penis. R3 called the nurse. V6 said, she had to fix R1's adult brief and pull down R1's gown. V6 said, R1 was crying when she entered his room. V6 said, R1 reported not feeling safe at the facility and wanting to die. V6 said, R1 reported he has never been touched by a man before. V6 said, R1 reported R2 had his hand in R1's adult brief touching his penis. On 8/20/25 at 2:12pm, video watched with V1 (administrator), V4 (assistant administrator) and V14 (director of nursing/ DON). V1 said, the video time is an hour ahead. R1 was seen entered R2's room at 11:17am per the recording time on the video but it was actually 12:17 per V1. R2 was seen exiting R1's room at 11:19am per the recording time on the video but it was actually 12:19 per V1. Facility timeline documents: At 12:19, V6 (cna) was noted running from the east nurses' station area towards R1's room. V8 (cna) came from room [ROOM NUMBER] and noted walking towards R1's room. R3 was noted talking and pointing into R1's room while standing in the hallway. R2 out of R1's room with V7 (nurse) behind him. At 12:22pm, V14 (therapy director), V15 and R3 walked over to administrators' office to report that R2 was noted in R1's room standing over R1 by the foot of the bed. On 8/26/25 at 1:34pm, V5 (nurse) said, she was the reporting nurse for R1 on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145087 If continuation sheet Page 4 of 7 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 8/18/25. V5 said, R1 reported, that R2 touch his butt hole. Facility reportable date of the incident 8/19/25 documents: Time of incident: 2:30pm: Sexual: Describe Alleged Incident: Nurse Practitioner who reported the resident, R1 reports to her that another resident (R2) was sexually inappropriate towards him, Hospital Paperwork dated 8/19/25 documents: Patient (R1) present to emergency department for evaluation after an assault. Emergency Department diagnoses: Sexual assault of adult.Police report dated 8/19/25 documents: office responded to nursing home in regard to a criminal sexual abuse report. R1 was lying in bed alone. While laying down, R2 entered R1's room in a wheelchair. R1 rolled his wheelchair next to R1's bed and came to a stop. R2 then stood up and opened R1's diaper. R1 related that R2 placed his right hand in R1's adult brief and began to groan. R1 does not have any sense of feeling below the waist and did not know exactly what R2 was doing to his genitals. R1 began to call for a nurse while R2 was moving his hand around R1's genitals. R3 entered the room and began to shout at R2 to stop. Abuse policy dated 10/2022 documents: Internal reporting requirement and identification of allegations. Employee are required to report any incident, allegation or suspicion of potential abuse, neglect, exploitation, mistreatment or misappropriation of resident property they observed, hear about, or suspect to the administrator or the compliance officer. In the absence of the administrator, reporting can be made to an individual who has been designated to act in the administrator's absence. Any allegation of abuse or any incident that results in serious bodily injury will be reported to Illinois Department of Public Health immediately, but not more than two hours after the allegation of abuse. Any incident that does not involve abuse and does not result in serious bodily injury shall be reported with in twenty-four hours. Event ID: Facility ID: 145087 If continuation sheet Page 5 of 7 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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. Based on interview and record review, the facility failed to effectively monitor and supervise a resident with a diagnosis of dementia from wandering into another resident's room without permission and sexually touching another resident. This affected two of three residents (R1, R2) reviewed for supervision of resident with dementia.Findings Include:On 8/23/25 at 2:45pm, R1 who was assessed to be alert and oriented to person, place and time, said he was in bed when R2 entered his room via wheelchair. R1 said, R2 rolled on the side of his bed, stopped his wheelchair, stood up, lifted R1's gown and ripped opened R1's adult brief. R1 said, R2 put his hand around his penis and started rubbing it. R1 said, he was scared, he yelled for help and R3 saved his life. R1 said, he felt uncomfortable. R1 said, he does not have sexual activities with men. R1 said, he is not like that. R1 said, the facility needs security. On 8/20/25 at 11:15am, R3 who was assessed to be alert and oriented to person, place and time, said R1 was yelling for about four minutes. R3 said, he walked to R1's room. R3 said, he saw R2 standing up on the side of R1's bed with his right hand on R1's penis moving up and down while holding his (R2's) penis while moving his left hand moving back and forth. R3 said, R2 is aware of his behavior. R3 said, R2 rolls through the hallway looking for bedbound residents. R2 does not bother residents that can walk. R2 has touched other bedbound residents before. R2 waits and watches until staff is not looking, go into resident's room and touch them inappropriately. R3 said, R1 is contracted with his arms up by his head and his legs are stuck open, knee up and apart. R1 could only yell for help. R3 said, V6 was the first to enter R1's room. On 8/20/25 at 2:12pm, video watched with V1 (administrator), V4 (assistance administrator) and V14 (director of nursing/ DON). V1 said, the video time is an hour ahead. R1 was seen entered R2's room at 11:17am per the recording time on the video but it was actually 12:17 per V1. R2 was seen exiting R1's room at 11:19am per the recording time on the video but it was actually 12:19 per V1. On 8/20/25 at 12:26pm, V6 (cna) said, said when she entered R1's room. R1 was observed with his gown up. R2 pulled up R1's gown, pushed R1's adult brief to the side and touched R1's penis. R3 called the nurse. V6 said, she had to fix R1's adult brief and pull down R1's gown. V6 said, R1 was crying when she entered his room. V6 said, R1 reported not feeling safe at the facility and wanting to die. V6 said, R1 reported he has never been touched by a man before. V6 said, R1 reported R2 had his hand in R1's adult brief touching his penis. Nursing note dated 8/20/25 documents: Patient (R1) is going to be admitted for sexual assault.On 8/26/25 at 1:34pm, V5 (nurse) said, she was the reporting nurse for R1. V5 said, she was aware that R1 has a history of inappropriate touching other residents. V5 said, R1 reported, that R2 touch his butt hole. Nursing note dated 7/17/25 documents: RN (V5) noticed resident (R2) kept going into another resident room. The resident (R2) is trying to inappropriately touch the other resident and tell him he loves him. On 8/26/25 at 2:45pm, V12 (R2's POA) said, R2 has dementia and a history of same sex relationships. V12 said, she received a call about R2's incident with R1. V12 said, she has received calls from the facility prior to R1's incident about R2 inappropriate touching other residents. V12 said, the facility has been so patient with R2. Now the facility is acting like they do not have any patience with R2, like they can tolerate R2 anymore. R2 will do the same thing at any facility. The current facility found a new facility for R2, but they refused to accept him after R2's recent inappropriate touching incident with R1.R2's Behavior note created on 8/18/25 (12:49) documents: Behavior Description: Inappropriately touching another resident. Behaviors: resident (R2) observed inappropriately touching a resident (R1). Nursing note dated 8/18/25 documents: Writer heard a resident (R1) yell out for help, writer got up to go to the yelling. Writer observed above resident (R2) in his wheelchair bending and reaching over to a resident (R1) in bed. Resident (R2) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145087 If continuation sheet Page 6 of 7 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 145087 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Oak Lawn 6300 West 95th Street Oak Lawn, IL 60453 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 FORM CMS-2567 (02/99) Previous Versions Obsolete being petitioned to the hospital for inappropriate sexual behavior towards his peer. On 8/20/25 at 2:31pm, V3 (nurse practitioner) said, she was informed on Monday 8/18/25 that another resident touched R1. V3 said, she saw R1 on Tuesday. V3 said, R1 reported R2 lifted his gown and grabbed his penis. R1 reported he can't get erect because he is parlayed. R1 said, he was not gay. R1 was crying. V3 said, she suggested R1 go to the hospital. On 8/20/25 at 12:39pm, V8 (cna) said, she heard R3 telling R2 to get out of R1's room. R1 is contracted with his hands stuck behind his head. R1's legs are contracted opened. V8 said, R1 is dependent on staff for assistance. R2 is a wander. R2 should not have been in R1's room. Hospital Paperwork dated 8/19/25 documents: Patient (R1) present to emergency department for evaluation after an assault. R1 does not feel safe. Emergency Department diagnoses: Sexual assault of adult. Per emergency service: R1 was manually grouped by another resident, allegedly witness by another resident. (8/21/25) Case manager spoke with patient (R1) at bedside who was alert and orient time four declined to discharge to long term care facility, states he just left a facility where he was molested. Police report dated 8/19/25 documents: office responded to nursing home in regard to a criminal sexual abuse report. R1 was lying in bed alone. While laying down, R2 entered R1's room in a wheelchair. R1 rolled his wheelchair next to R1's bed and came to a stop. R2 then stood up and opened R1's diaper. R1 related that R2 placed his right hand in R1's adult brief and began to groan. R1 does not have any sense of feeling below the waist and did not know exactly what R2 was doing to his genitals. R1 began to call for a nurse while R2 was moving his hand around R1's genitals. R3 entered the room and began to shout at R2 to stop. Event ID: Facility ID: 145087 If continuation sheet Page 7 of 7