Inspection·October 10, 2025

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some incident occurred on 1/18/25. V4 said that he should initiate an abuse prevention care plan when abuse trauma assessment triggered score of 2 or more and he should update the abuse prevention care plan after an allegation report investigation of resident-to-resident altercation. 3.On 10/8/25 at 11:58AM, Observed R4 sitting at the hallway. He is alert but confused with flight of ideas. He responds incoherently. R4 is initially admitted on [DATE] with diagnosis listed in part but limited to Parkinson's disease, schizoaffective disorder bipolar type, Alcohol abuse intoxication, Age related cataract bilateral. Abuse/Trauma assessment done on 1/24/24 indicated score of 6 at risk for abuse/trauma related symptomatology. No Abuse prevention care plan was initiated. On 8/29/25, physical resident to resident altercation investigation report was submitted to IDPH between R4 and R2. Abuse/trauma assessment was completed on 8/29/25 with score of 9 at risk for abuse but no abuse prevention care plan was initiated and updated. On 10/9/25 at 10:12AM, Reviewed R4 medical records with V4 SSD. Informed V4 of concern identified with R4 regarding implementation of abuse prevention program policy. No abuse prevention care plan was initiated when Abuse /Trauma assessment scored 6 and 9 indicated at risk for Abuse. No abuse prevention care plan was initiated and updated after resident-to-resident physical altercation incident occurred on 8/25/25. V4 said that he should initiate an abuse prevention care plan when abuse trauma assessment triggered score of 2 or more and he should update the abuse prevention care plan after an allegation report investigation of resident-to-resident altercation. 4.On 10/9/25 at 11:30AM, Observed R5 lying in bed. She is alert and responds coherently. She can verbalize her needs to staff. R5 is initially admitted on [DATE] with diagnosis listed in part but not limited to Elevated white blood cell count, Acute kidney failure, Paroxysmal atrial fibrillation, Chronic obstructive pulmonary disease, ileostomy status, pressure ulcer sacral region stage 4 and left buttocks stage 3, Obesity. Abuse/Trauma assessment on 10/31/23 indicated score of 3 at risk for trauma related symptomatology. No Abuse prevention care plan was formulated. On 8/25/25, verbal/mental abuse investigation report was submitted to IDPH due to R5's allegation of verbal abuse. No abuse/trauma assessment was completed, and no abuse prevention care plan was initiated or updated. On 10/9/25 at 10:30AM, Reviewed R5's medical records with V4 SSD. Informed V4 of concern identified with R5 regarding implementation of abuse prevention program policy. No abuse prevention care plan was initiated when Abuse /Trauma assessment scored 3 indicated at risk for Abuse. No abuse/trauma assessment was done after verbal abuse allegation incident occurred on 8/25/25 and no abuse prevention care plan was initiated or updated. V4 said that he should initiate an abuse prevention care plan when abuse trauma assessment triggered score of 2 or more. He should complete an abuse/trauma assessment and update the abuse prevention care plan after an allegation report investigation of resident-to-resident altercation. On 10/9/25 at 1:30PM, Informed V1 Administrator, V2 ADON (Assistant Director of Nursing), V4 SSD and V13 Care Plan Coordinator of above concerns identified in implementation of abuse prevention policy.Facility's policy on Abuse Prevention and Reporting - Illinois revised 10/24/22 indicated: Guidelines: The facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property and mistreatment of residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff and mistreatment of residents. Facility's policy on Abuse Prevention: Establishing a resident sensitive environment: Resident assessment: As part of the resident's life history on the admission assessment, comprehensive care plan (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145171 If continuation sheet Page 2 of 3 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 145171 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Northbrook 270 Skokie Highway Northbrook, IL 60062 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete and MDS assessments, staff will identify residents with increased vulnerability for abuse, neglect, exploitation, mistreatment, history of trauma or misappropriation of resident property, who have needs, triggers and behaviors that might lead to conflict. Through the care planning process, staff identify any problems, goals, and approaches, which would reduce the chances of abuse, neglect, exploitation, mistreatment, or misappropriation of resident property for these residents. Staff will continue to monitor the goals and approaches on a regular basis and update as necessary. Event ID: Facility ID: 145171 If continuation sheet Page 3 of 3