Inspection·January 8, 2026

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to develop care plan interventions for a resident that refuses personal care and meals. This failure applies to 1 of 3 (R30) residents reviewed for care planning in a total sample of 15. The findings include: R30 is an [AGE] year-old male with a diagnosis history including Dementia, Protein Calorie Malnutrition, Depression, Anxiety Disorder, and Anorexia who was admitted to the facility 10/21/2024. On January 05, 2026 at 10:30 AM R30 was lying in his bed wearing a gown, with his hair extremely oily. R30 exhibited agitation when asked how he was feeling. On January 06, 2026 at 1:10 PM R30 was in is his room lying in his bed with extremely oily hair and a thick large layer of white flakes on the front of his shirt. V7 (Certified Nursing Assistant) said the flakes are probably dandruff and she hasn't seen R30 showered since she started working at the facility three months ago. On January 06, 2026 at 1:23 PM V19 (Licensed Practical Nurse) said R30 consistently refuses showers. R30's point of care bathing reports from 12/10/2025 - 01/06/2026 shows missing information for bathing on most days and two refusals. R30's current care plan does not include interventions for refusing bathing/showering. On January 05, 2026 at 12:41 PM R30 was in his room not eating his lunch meal and said maybe he'll eat later. At 12:50 PM R30's meal tray was removed from his room and most of his meal was untouched. On January 05, 2026 at 1:05 PM V10 (Certified Nursing Assistant) said R30 is a very picky eater, when she asked if he was done eating, he said yeah, and she didn't ask if he wanted any alternative choices because usually if R30 wants something different he'll ask for it. V10 said R30 didn't eat any of his meal and has a poor appetite. On January 06, 2026 at 12:35 PM R30 was in his room eating a piece of bread and said he was not interested in eating the rest of his meal. R30's meal included turkey and gravy, baked sweet potato, peas, pumpkin mousse, and a dinner roll. On January 06, 2026 at 1:03 PM V7 (Certified Nursing Assistant) removed R30's meal tray without offering alternative foods or cueing and prompting him to eat and only asking was he done with his meal. R30's meal was untouched. V7 said she didn't ask R30 if he wanted any other alternative foods, he doesn't eat much and just drinks a lot. R30's Nutritional Risk assessment dated [DATE] shows he is underweight, with increased nutritional needs for underweight status. R30 would benefit from gradual weight gain. R30's current care plan does not include interventions for refusing meals. On January 07, 2026 at 1:41 PM V25 (Minimum Data Set Coordinator) said the dietitians implement and are responsible for nutrition care plans. V2 (Director of Nursing) said there should be personalized care plan interventions in place to encourage residents to participate in bathing and grooming, refusals should be care planned and there should be interventions in place to address refusal of bathing and grooming. V1 (Administrator) said appropriate interventions for refusal of bathing and grooming would include preferences of bathing times, toiletries, days, and family support which V2 agreed with. On January 07, 2026 at 2:08 PM V3 (Administrator) said that according to V26's (Dietitian) progress notes R30 is at high risk for (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 145111 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 145111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elmhurst Extended Care Center 200 East Lake Street Elmhurst, IL 60126 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)