Health inspection·July 22, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few consciousness), he is alert and fully alert and oriented and able to verbalize needs. Resident denies falling or striking any part of body while having syncope episode. 2. R2 is a [AGE] year-old male with a diagnoses history of Unspecified Mood Disorder, Conduct Disorder, Schizoaffective Disorder, Paranoid Schizophrenia, Bipolar Disorder, Degenerative Brain Disease, Parkinson's Disease without Dyskinesia (Involuntary Muscle Movement), and Homicidal Ideations who was admitted to the facility 11/09/2023. On 07/21/2025 at 12:50 PM When asked by surveyor if he and R1 had an incident a week or so ago on 07/15/2025, R2 stated yes R1 just ran over his foot on purpose with his walker and doesn't care where he's going or what he rolls over, he and R1 started fighting and he kicked R1's (derogatory word), R1 stated the incident hurt my spirit, and his foot was hurt too, R2 stated V5 (Mental Health Technician/Behavior Aide) broke up the fight and V5 grabbed him from behind to break up the incident. On 07/21/2025 at 12:52 PM V5 (Mental Health Technician/Behavior Aide) stated on 07/15/2025 he witnessed V4 (Registered Nurse) responding to a commotion between R1 and R2 in the hallway, he then responded as well and observed R1 and R2 holding each other and stumbling, he broke R2's fall and V4 assisted R1, and they separated them both. V5 stated R2 reported R1 ran over his foot, and it was explained it was an accident. V5 stated he did not see R1 and R2 hitting each other during the incident. On 07/21/2025 at 2:06 PM R2 stated he did have a cut on his lip from the incident with R1 and raised his upper lip to show the surveyor the cut underneath his lip. R2's Current Care Plan documents he has the potential to be physically aggressive related to poor impulse control; he has a behavior problem related to displaying inappropriate behavior towards peer; and he has a mood problem. R2's social service progress note dated 5/30/2025 at 5:22 PM documents the writer was informed that the resident displayed agitated behaviors towards staff. R2's social service progress note dated 7/8/2025 at 6:05 PM documents the writer was informed that resident displayed agitation towards peer. R2's nursing progress note created by V3 (Director of Nursing) dated 7/15/2025 at 2:29 PM documents the writer was made aware that co peer was using rolling walker to ambulate and accidently hit the back of resident foot and the resident responded to internal stimuli towards peer. Staff intervened immediately placing resident on 1:1 with staff. Nurse completed body assessment and the resident was noted with a small superficial cut on the inner lip. Ice pack was placed on resident lip. Physician, Director of Nursing, Administrator, and family were made aware; at 3:38 PM it was noted that resident's room was moved due to altercation with peer. R2's Psychosocial Assessment created by V8 (Registered Nurse) dated 07/15/2025 documents the reason for the assessment was a resident-to-resident physical altercation, he has full recollection and awareness of the event, and observed changes in his mood or behavior included increased agitation. R2's Behavior Management Team Review Meeting Note dated 07/15/2025 documents it was reported that he displayed agitated behavior towards a peer, this was the second occurrence of similar behavior in the past 30 days with the most recent hospitalizations related to behavior occurrences being from 05/31-25 - 06/01/2025, with precipitating and contributing factors including poor impulse control, poor conflict resolution, poor coping methods, and poor emotional regulation. R2's Behavior/Mood Charting created by V3 (Director of Nursing) dated 07/15/2025 documents he was observed in the evening in the hallway displaying physical aggression triggered by other resident becoming physically aggressive toward him in and the behavior lasted 2 minutes. R2's Skin Condition Report created by V3 (Director of Nursing) dated 07/15/2025 documents R2 had a new skin concern which included a laceration described as a small superficial cut to his inner lip. On 07/21/2025 at 1:09 PM V7 (Psychosocial Services Rehabilitation Coordinator/PRSC) stated she was informed by V6 (Psychosocial Services Rehabilitation Director/PRSD) that R2 and R1 Displayed agitation towards each other. On 07/21/2025 at 1:36 PM V3 (Director of Nursing) stated R2 had an altercation with R1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 2 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete on 07/15/2025, she received a report that R1 was pushing his walker, and it ran into the back of R2's feet and R2 reacted to internal stimuli. V3 stated someone reported to her there was an altercation during this incident, and that one of them was hit but she can't recall who reported this to her. V3 stated if residents hit each other, we tell the V1 (Administrator) and V1 (Administrator) was informed about this incident. V3 stated R1 and R2's rooms were on the same hallway, so R2 was moved to another hallway to prevent any further altercations. V3 stated the nurses assessed R1 and R2 after the incident. On 07/21/2025 at 1:54 PM V1 (Administrator) stated on 07/15/2025 she responded to some commotion she could hear from a distance from her office, and found R1 at the central nurses station, she asked R1 what happened, and he told her he accidentally bumped R2's foot with his walker, R2 tapped him on the head, and he hit R2 back. V1 stated she then went to talk to R2, and he told her R1 hit him first, he doesn't like R1, but they never had any issues before, then began making delusional statements that she couldn't understand. V1 stated after explaining to R2 that R1 accidentally rolled over his foot, R2 stated R1 did it to him on purpose. V1 stated they did move R2's room because he and R1 were located on the same unit. On 07/21/2025 2:21 PM When asked by the surveyor if R1 and R2 hitting each other was deliberate V1 (Administrator) stated she doesn't think that R1 and R2 were maliciousness hitting each other, she wouldn't say that those hits were deliberate, a deliberate hit is if you're trying to cause the resident harm or if it causes harm where one of the residents went out to the hospital that would be considered deliberate. On 07/21/2025 at 3:40 PM V1 (Administrator) stated on 07/08/2025 it was reported to her that R2 was displaying aggression in the dining room. On 07/22/2025 at 11:18 AM V9 (Licensed Practical Nurse) stated she assessed R1 after the incident he had with R2 on 07/15/2025 and he had a little scratch on his finger, but she didn't see the incident and was told R1 and R2 hit each other during the incident. V9 stated R1 and R2 were already separated by the time she arrived down the hall where the incident took place. V9 stated she works with R1 regularly and the bump on his forehead is new. V9 stated the bump on R1's forehead doesn't look old, and he told her he did inform the Director of Nursing about it. V9 stated R1 is alert and oriented and is not cognitively impaired. On 07/22/2025 at 11:28 AM V9 (Licensed Practical Nurse) stated R1 did complain of pain in his hands after the incident on 07/15/2025. The facility's Abuse Policy received 07/21/2025 states: The facility affirms the right of our residents to be free from abuse. This facility therefore prohibits abuse. 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 it's control to prevent occurrences of abuse. Abuse means any physical or mental injury inflicted upon a resident other than by accidental means. Abuse is willful infliction of injury. This assumes that all instances of abuse of residents, even those in a coma, cause physical harm or pain or mental anguish. The term (willful) in the definition of (abuse) means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Having a mental disorder or cognitive impairment does not automatically preclude a resident from engaging in deliberate or non-accidental actions. Physical Abuse is the infliction of injury on a resident that occurs other than by accidental means. Physical abuse includes hitting. A resident-to-resident altercation should be reviewed as a potential situation of abuse. Event ID: Facility ID: 145180 If continuation sheet Page 3 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 observations, interviews, and record reviews the facility failed to follow their policy and procedures for abuse by not reporting an allegation of physical abuse to the state agency. This failure applies to two of three residents (R1 and R2) reviewed for abuse.Findings include: The facility did not provide any abuse investigation reports or documentation of any abuse investigation reports being submitted to the state agency for July 2025 in response to the surveyor's request upon survey entrance for any reportable investigations including interviews and witness statements. On 07/21/2025 at 10:55 AM V1 (Administrator) stated there had not been any reportable events in the facility in July 2025. 1. R1 is a [AGE] year-old male with a diagnoses history of Paranoid Schizophrenia, Generalized Anxiety Disorder, Secondary Parkinsonism, and Dystonia (Involuntary Muscle Contractions) who was admitted to the facility 11/23/2022. On 07/21/2025 at 1:27 PM When asked by surveyor if he had an incident with R2 a week ago on 07/15/2025 R1 stated he ran over R2's foot and didn't know it, R2 hit him and he hit R2 back, then he pushed R2 down on the floor, a female staff broke it up, his head was hurt and he has a bump on his head, R1 stated he didn't want to fight, then showed the surveyor a small bump on the left side of his forehead and stated that's where R2 hit him on his head. R1's Annual Minimum Data Set documents his BIMS (Basic Interview for Mental Assessment) score was 15 indicated he is cognitively intact. R1's Current care plan documents he has a history of harming others, exhibits poor impulse control, has the potential to be physically aggressive related to Anger, and he is at risk for abuse. R1's Incident Report dated 07/15/2025 documents he hit a co peer's foot while using a rolling walker, and reported he was walking down the hallway hit his (co peer) foot and he hit me, and he was fully alert and oriented, the report writer was informed that R1 and co peer had a physical altercation. R1's Nursing progress note dated 7/15/2025 at 12:19 PM documents the writer was made aware that co peer was using rolling walker to ambulate and accidently hit the back of resident foot. Staff intervened immediately placing resident on 1:1 with staff. Physician, Director of Nursing, Administrator, and family were made aware. R1's Social Services Progress note dated 7/15/2025 at 5:48 PM documents the writer was informed that the resident displayed agitation towards peer. The resident was separated from the peer to de-escalate the situation. Resident was educated on effective coping skills, including deep breathing, counting, and walking away. Resident was also educated on establishing and maintaining healthy boundaries with peers, particularly in relation to the use of his rollator and practicing mindfulness. The writer encouraged the resident to seek staff when needed. R1's Behavior Management Team Review Meeting Note created by [NAME] (Psychosocial Rehabilitation Services Director) dated 07/15/2025 documents it was reported that he displayed agitated behavior towards a peer with precipitating and contributing factors including poor coping methods, poor conflict resolution, and poor impulse control. R1's Behavior/Mood Charting Report created by V3 (Director of Nursing) dated 07/15/2025 documents in the evening he was observed in the hallway displaying physical aggression triggered by other resident becoming physically aggressive toward him, and the behavior lasted 3 minutes. R1's Nursing Progress note dated 7/17/2025 at 08:02 AM documents he states his pain level is a 3 and he was given and as needed pain medication; at 5:01 PM it was noted R1 returned to facility from the hospital, he was sent to hospital from day program and was diagnoses with Syncope (sudden temporary loss of consciousness), he is alert and fully alert and oriented and able to verbalize needs. Resident denies falling or striking any part of body while having syncope episode. 2. R2 is a [AGE] year-old male with a diagnoses history of Unspecified Mood Disorder, Conduct Disorder, Schizoaffective Disorder, Paranoid Schizophrenia, Bipolar Disorder, Degenerative Brain Disease, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 4 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 Parkinson's Disease without Dyskinesia (Involuntary Muscle Movement), and Homicidal Ideations who was admitted to the facility 11/09/2023. On 07/21/2025 at 12:50 PM When asked by surveyor if he and R1 had an incident a week or so ago on 07/15/2025, R2 stated yes R1 just ran over his foot on purpose with his walker and doesn't care where he's going or what he rolls over, he and R1 started fighting and he kicked R1's (derogatory word), R1 stated the incident hurt my spirit, and his foot was hurt too, R2 stated V5 (Mental Health Technician/Behavior Aide) broke up the fight and V5 grabbed him from behind to break up the incident. On 07/21/2025 at 12:52 PM V5 (Mental Health Technician/Behavior Aide) stated on 07/15/2025 he witnessed V4 (Registered Nurse) responding to a commotion between R1 and R2 in the hallway, he then responded as well and observed R1 and R2 holding each other and stumbling, he broke R2's fall and V4 assisted R1, and they separated them both. V5 stated R2 reported R1 ran over his foot, and it was explained it was an accident. V5 stated he did not see R1 and R2 hitting each other during the incident. On 07/21/2025 at 2:06 PM R2 stated he did have a cut on his lip from the incident with R1 and raised his upper lip to show the surveyor the cut underneath his lip. R2's Current Care Plan documents he has the potential to be physically aggressive related to poor impulse control; he has a behavior problem related to displaying inappropriate behavior towards peer; and he has a mood problem. R2's social service progress note dated 5/30/2025 at 5:22 PM documents the writer was informed that the resident displayed agitated behaviors towards staff. R2's social service progress note dated 7/8/2025 at 6:05 PM documents the writer was informed that resident displayed agitation towards peer. R2's nursing progress note created by V3 (Director of Nursing) dated 7/15/2025 at 2:29 documents the writer was made aware that co peer was using rolling walker to ambulate and accidently hit the back of resident foot and the resident responded to internal stimuli towards peer. Staff intervened immediately placing resident on 1:1 with staff. Nurse completed body assessment resident was noted with a small superficial cut on the inner lip. Ice pack was placed on resident lip. Physician, Director of Nursing, Administrator, and family were made aware; at 3:38 PM it was noted that resident's room was moved due to altercation with peer. R2's Psychosocial Assessment created by V8 (Registered Nurse) dated 07/15/2025 documents the reason for the assessment was a resident-to-resident physical altercation, he has full recollection and awareness of the event, and observed changes in his mood or behavior included increased agitation. R2's Behavior Management Team Review Meeting Note dated 07/15/2025 documents it was reported that he displayed agitated behavior towards a peer, this was the second occurrence of similar behavior in the past 30 days with the most recent hospitalizations related to behavior occurrences being from 05/31-25 - 06/01/2025, with precipitating and contributing factors include poor impulse control, poor conflict resolution, poor coping methods, and poor emotional regulation. R2's Behavior/Mood Charting created by V3 (Director of Nursing) dated 07/15/2025 documents he was observed in the evening in the hallway displaying physical aggression triggered by other resident becoming physically aggressive toward him in the and the behavior lasted 2 minutes. R2's Skin Condition Report created by V3 (Director of Nursing) dated 07/15/2025 documents R2 had a new skin concern which included a laceration described as a small superficial cut to his inner lip. On 07/21/2025 at 1:09 PM V7 (Psychosocial Services Rehabilitation Coordinator/PRSC) stated she was informed by V6 (Psychosocial Services Rehabilitation Director/PRSD) that R2 and R1 Displayed agitation towards each other. On 07/21/2025 at 1:36 PM V3 (Director of Nursing) stated R2 had an altercation with R1 on 07/15/2025, she received a report that R1 was pushing his walker, and it ran into the back of R2's feet and R2 reacted to internal stimuli. V3 stated someone reported to her there was an altercation during this incident, and that one of them was hit but she can't recall who reported this to her. V3 stated if residents hit each other, we tell the V1 (Administrator) and V1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 5 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 (Administrator) was informed about this incident. V3 stated R2 and R1's rooms were on the same hallway, so R2 was moved to another hallway to prevent any further altercations. V3 stated the nurses assessed R1 and R2 after the incident. On 07/21/2025 at 1:54 PM V1 (Administrator) stated on 07/15/2025 she responded to some commotion she could hear from a distance from her office, and found R1 at the central nurses station, she asked R1 what happened, and he told her he accidentally bumped R2's foot with his walker, R2 tapped him on the head, and he hit R2 back. V1 stated she then went to talk to R2, and he told her R1 hit him first, he doesn't like R1, but they never had any issues before, then began making delusional statements that she couldn't understand. V1 stated after explaining to R2 that R1 accidentally rolled over his foot, R2 stated R1 did it to him on purpose. V1 stated they did move R2's room because he and R1 were located on the same unit. When asked by surveyor why the incident wasn't reported to the state agency, V1 stated it was a minor injury to R2's lip, it was a superficial cut, and R1 didn't have any injuries. On 07/21/2025 2:21 PM When asked by the surveyor if R1 and R2 hitting each other was deliberate V1 (Administrator) stated she doesn't think that R1 and R2 were maliciousness hitting each other, she wouldn't say that those hits were deliberate, a deliberate hit is if you're trying to cause the resident harm or if it causes harm where one of the residents went out to the hospital that would be considered deliberate. On 07/21/2025 at 3:40 PM V1 (Administrator) stated on 07/08/2025 it was reported to her that R2 was displaying aggression in the dining room. On 07/22/2025 at 11:18 AM V9 (Licensed Practical Nurse) stated she assessed R1 after the incident he had with R2 on 07/15/2025 and he had a little scratch on his finger, but she didn't see the incident and was told R1 and R2 hit each other during the incident. V9 stated R1 and R2 were already separated by the time she arrived down the hall where the incident took place. V9 stated she works with R1 regularly and the bump on his forehead is new. V9 stated the bump on R1's forehead doesn't look old, and he told her he did inform the Director of Nursing about it. V9 stated R1 is alert and oriented and is not cognitively impaired. On 07/22/2025 at 11:28 AM V9 (Licensed Practical Nurse) stated R1 did complain of pain in his hands after the incident on 07/15/2025. The facility's Abuse Policy received 07/21/2025 states: The facility affirms the right of our residents to be free from abuse. This facility therefore prohibits abuse. 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 it's control to prevent occurrences of abuse.This will be done by: Orienting and training employees on how to recognize and report occurrences of abuse. Abuse means any physical or mental injury inflicted upon a resident other than by accidental means. Abuse is willful infliction of injury. This assumes that all instances of abuse of residents, even those in a coma, cause physical harm or pain or mental anguish. The term (willful) in the definition of (abuse) means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Having a mental disorder or cognitive impairment does not automatically preclude a resident from engaging in deliberate or non-accidental actions. Physical Abuse is the infliction of injury on a resident that occurs other than by accidental means. Physical abuse includes hitting. A resident-to-resident altercation should be reviewed as a potential situation of abuse. Resident to resident altercations that include any willful action that results in physical injury, must be reported in accordance with regulations. Any allegation of abuse will be reported to the department of Public Health immediately, but not more than two hours after the allegation of abuse. When an allegation of abuse has occurred, the resident's representative and the Department of Public Health's regional office shall be informed by telephone or fax. Public Health shall be informed that an occurrence of potential abuse has been reported and is being investigated. Event ID: Facility ID: 145180 If continuation sheet Page 6 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to follow their policy and procedures for abuse by not investigating an allegation of physical abuse. This failure applies to two of three residents (R1 and R2) reviewed for abuse.Findings include: 1. R1 is a [AGE] year-old male with a diagnoses history of Paranoid Schizophrenia, Generalized Anxiety Disorder, Secondary Parkinsonism, and Dystonia (Involuntary Muscle Contractions) who was admitted to the facility 11/23/2022. On 07/21/2025 at 1:27 PM When asked by surveyor if he had an incident with R2 a week ago on 07/15/2025 R1 stated he ran over R2's foot and didn't know it, R2 hit him and he hit R2 back, then he pushed R2 down on the floor, a female staff broke it up, his head was hurt and he has a bump on his head, R1 stated he didn't want to fight, then showed the surveyor a small bump on the left side of his forehead and stated that's where R2 hit him on his head. R1's Annual Minimum Data Set documents his BIMS (Basic Interview for Mental Assessment) score was 15 indicated he is cognitively intact. R1's Current care plan documents he has a history of harming others, exhibits poor impulse control, has the potential to be physically aggressive related to Anger, and he is at risk for abuse. R1's Incident Report dated 07/15/2025 documents he hit a co peer's foot while using a rolling walker, and reported he was walking down the hallway hit his (co peer) foot and he hit me, and he was fully alert and oriented, the report writer was informed that R1 and co peer had a physical altercation. R1's Nursing progress note dated 7/15/2025 at 12:19 PM documents the writer was made aware that co peer was using rolling walker to ambulate and accidently hit the back of resident foot. Staff intervened immediately placing resident on 1:1 with staff. Physician, Director of Nursing, Administrator, and family were made aware. R1's Social Services Progress note dated 7/15/2025 at 5:48 PM documents the writer was informed that the resident displayed agitation towards peer. The resident was separated from the peer to de-escalate the situation. Resident was educated on effective coping skills, including deep breathing, counting, and walking away. Resident was also educated on establishing and maintaining healthy boundaries with peers, particularly in relation to the use of his rollator and practicing mindfulness. The writer encouraged the resident to seek staff when needed. R1's Behavior Management Team Review Meeting Note created by [NAME] (Psychosocial Rehabilitation Services Director) dated 07/15/2025 documents it was reported that he displayed agitated behavior towards a peer with precipitating and contributing factors including poor coping methods, poor conflict resolution, and poor impulse control. R1's Behavior/Mood Charting Report created by V3 (Director of Nursing) dated 07/15/2025 documents in the evening he was observed in the hallway displaying physical aggression triggered by other resident becoming physically aggressive toward him, and the behavior lasted 3 minutes. R1's Nursing Progress note dated 7/17/2025 at 08:02 AM documents he states his pain level is a 3 and he was given and as needed pain medication; at 5:01 PM it was noted R1 returned to facility from the hospital, he was sent to hospital from day program and was diagnoses with Syncope (sudden temporary loss of consciousness), he is alert and fully alert and oriented and able to verbalize needs. Resident denies falling or striking any part of body while having syncope episode. 2. R2 is a [AGE] year-old male with a diagnoses history of Unspecified Mood Disorder, Conduct Disorder, Schizoaffective Disorder, Paranoid Schizophrenia, Bipolar Disorder, Degenerative Brain Disease, Parkinson's Disease without Dyskinesia (Involuntary Muscle Movement), and Homicidal Ideations who was admitted to the facility 11/09/2023. On 07/21/2025 at 12:50 PM When asked by surveyor if he and R1 had an incident a week or so ago on 07/15/2025, R2 stated yes R1 just ran over his foot on purpose with his walker and doesn't care where he's going or what he rolls over, he and R1 started fighting and he kicked R1's (derogatory word), R1 stated the incident hurt my spirit, and his foot was hurt too, R2 Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 7 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated V5 (Mental Health Technician/Behavior Aide) broke up the fight and V5 grabbed him from behind to break up the incident. On 07/21/2025 at 12:52 PM V5 (Mental Health Technician/Behavior Aide) stated on 07/15/2025 he witnessed V4 (Registered Nurse) responding to a commotion between R1 and R2 in the hallway, he then responded as well and observed R1 and R2 holding each other and stumbling, he broke R2's fall and V4 assisted R1, and they separated them both. V5 stated R2 reported R1 ran over his foot, and it was explained it was an accident. V5 stated he did not see R1 and R2 hitting each other during the incident. On 07/21/2025 at 2:06 PM R2 stated he did have a cut on his lip from the incident with R1 and raised his upper lip to show the surveyor the cut underneath his lip. R2's Current Care Plan documents he has the potential to be physically aggressive related to poor impulse control; he has a behavior problem related to displaying inappropriate behavior towards peer; and he has a mood problem. R2's social service progress note dated 5/30/2025 at 5:22 PM documents the writer was informed that the resident displayed agitated behaviors towards staff. R2's social service progress note dated 7/8/2025 at 6:05 PM documents the writer was informed that resident displayed agitation towards peer. R2's nursing progress note created by V3 (Director of Nursing) dated 7/15/2025 at 2:29 documents the writer was made aware that co peer was using rolling walker to ambulate and accidently hit the back of resident foot and the resident responded to internal stimuli towards peer. Staff intervened immediately placing resident on 1:1 with staff. Nurse completed body assessment resident was noted with a small superficial cut on the inner lip. Ice pack was placed on resident lip. Physician, Director of Nursing, Administrator, and family were made aware; at 3:38 PM it was noted that resident's room was moved due to altercation with peer. R2's Psychosocial Assessment created by V8 (Registered Nurse) dated 07/15/2025 documents the reason for the assessment was a resident-to-resident physical altercation, he has full recollection and awareness of the event, and observed changes in his mood or behavior included increased agitation. R2's Behavior Management Team Review Meeting Note dated 07/15/2025 documents it was reported that he displayed agitated behavior towards a peer, this was the second occurrence of similar behavior in the past 30 days with the most recent hospitalizations related to behavior occurrences being from 05/31-25 - 06/01/2025, with precipitating and contributing factors include poor impulse control, poor conflict resolution, poor coping methods, and poor emotional regulation. R2's Behavior/Mood Charting created by V3 (Director of Nursing) dated 07/15/2025 documents he was observed in the evening in the hallway displaying physical aggression triggered by other resident becoming physically aggressive toward him in the and the behavior lasted 2 minutes. R2's Skin Condition Report created by V3 (Director of Nursing) dated 07/15/2025 documents R2 had a new skin concern which included a laceration described as a small superficial cut to his inner lip. On 07/21/2025 at 1:09 PM V7 (Psychosocial Services Rehabilitation Coordinator/PRSC) stated she was informed by V6 (Psychosocial Services Rehabilitation Director/PRSD) that R2 and R1 Displayed agitation towards each other. On 07/21/2025 at 1:36 PM V3 (Director of Nursing) stated R2 had an altercation with R1 on 07/15/2025, she received a report that R1 was pushing his walker, and it ran into the back of R2's feet and R2 reacted to internal stimuli. V3 stated someone reported to her there was an altercation during this incident, and that one of them was hit but she can't recall who reported this to her. V3 stated if residents hit each other, we tell the V1 (Administrator) and V1 (Administrator) was informed about this incident. V3 stated R2 and R1's rooms were on the same hallway, so R2 was moved to another hallway to prevent any further altercations. V3 stated the nurses assessed R1 and R2 after the incident. On 07/21/2025 at 1:54 PM V1 (Administrator) stated on 07/15/2025 she responded to some commotion she could hear from a distance from her office, and found R1 at the central nurses station, she asked R1 what happened, and he told her he accidentally bumped R2's foot with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 8 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few his walker, R2 tapped him on the head, and he hit R2 back. V1 stated she then went to talk to R2, and he told her R1 hit him first, he doesn't like R1, but they never had any issues before, then began making delusional statements that she couldn't understand. V1 stated after explaining to R2 that R1 accidentally rolled over his foot, R2 stated R1 did it to him on purpose. V1 stated they did move R2's room because he and R1 were located on the same unit. On 07/21/2025 2:21 PM When asked by the surveyor if R1 and R2 hitting each other was deliberate V1 (Administrator) stated she doesn't think that R1 and R2 were maliciousness hitting each other, she wouldn't say that those hits were deliberate, a deliberate hit is if you're trying to cause the resident harm or if it causes harm where one of the residents went out to the hospital that would be considered deliberate. On 07/21/2025 at 3:40 PM V1 (Administrator) stated on 07/08/2025 it was reported to her that R2 was displaying aggression in the dining room. On 07/22/2025 at 11:18 AM V9 (Licensed Practical Nurse) stated she assessed R1 after the incident he had with R2 on 07/15/2025 and he had a little scratch on his finger, but she didn't see the incident and was told R1 and R2 hit each other during the incident. V9 stated R1 and R2 were already separated by the time she arrived down the hall where the incident took place. V9 stated she works with R1 regularly and the bump on his forehead is new. V9 stated the bump on R1's forehead doesn't look old, and he told her he did inform the Director of Nursing about it. V9 stated R1 is alert and oriented and is not cognitively impaired. On 07/22/2025 at 11:28 AM V9 (Licensed Practical Nurse) stated R1 did complain of pain in his hands after the incident on 07/15/2025. The facility did not provide any abuse investigation reports or documentation of any abuse investigation reports being submitted to the state agency for July 2025 in response to the surveyor's request upon survey entrance for any reportable investigations including interviews and witness statements. On 07/21/2025 at 10:55 AM V1 (Administrator) stated there had not been any reportable events in the facility in July 2025. The facility's Abuse Policy received 07/21/2025 states: The facility affirms the right of our residents to be free from abuse. This facility therefore prohibits abuse. 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 it's control to prevent occurrences of abuse.This will be done by: Implementing systems to promptly and aggressively investigate all reports of allegations of abuse.Filing accurate and timely investigative reports. Abuse means any physical or mental injury inflicted upon a resident other than by accidental means. Abuse is willful infliction of injury. This assumes that all instances of abuse of residents, even those in a coma, cause physical harm or pain or mental anguish. The term (willful) in the definition of (abuse) means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Having a mental disorder or cognitive impairment does not automatically preclude a resident from engaging in deliberate or non-accidental actions. Physical Abuse is the infliction of injury on a resident that occurs other than by accidental means. Physical abuse includes hitting. A resident-to-resident altercation should be reviewed as a potential situation of abuse. Resident to resident altercations that include any willful action that results in physical injury. Any incident or allegation involving abuse will result in an investigation.Investigation Procedures Include The appointed investigator will, at a minimum, attempt to interview anyone likely to have direct knowledge of the incident. Any written statements that have been submitted will be reviewed, along with any pertinent medical records or other documents. Residents to whom the accused has regularly provided care, and employees with whom the accused has regularly worked, will be interviewed to determine whether any one has witnessed any prior abuse by the accused individual. The administrator or person designated to act as administrator in the administrator's absences will review the report. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 9 of 10 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 145180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Chicago Heights 490 West 16th Place Chicago Heights, IL 60411 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 0610 Level of Harm - Minimal harm or potential for actual harm The administrator or designee is then responsible for forwarding a final written report of the results of the investigation and of any corrective action taken to the Department of Public Health within five working days of the reported incident. When an allegation of abuse has occurred, the resident's representative and the Department of Public Health's regional office shall be informed by telephone or fax. Public Health shall be informed that an occurrence of potential abuse has been reported and is being investigated. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145180 If continuation sheet Page 10 of 10