Inspection·January 9, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent and protect a resident from resident-to-resident physical abuse. This failure applied to two of two (R1, R2) residents reviewed for abuse. Findings include: Facility reported incident (FRI) dated 10/11/2024 documents: R1 reported to the nurse that R2 slapped her in the face. R1 was noted to have a scratch to the left side of face. R1's face sheet dated 01/08/2025 documents that R1 is a [AGE] year-old female admitted to the facility on [DATE] with diagnosis history of Hypertensive heart disease, dyslipidemia, gastroesophageal reflux disease, chronic obstructive pulmonary disease, chronic kidney disease and depression. R1's Minimum Data Set (MDS) dated [DATE] documents that R1 has a Brief Interview for Mental Status (BIMS) score of 9 (moderate cognitive impairment). 1/06/2025 at 12:05 PM V9 (Licensed Practical Nurse/LPN) said that R1 does have behaviors during her shift and speaks the same language as R1 and able to communicate well. R1 is alert but forgetful and has no aggressive behaviors. R1 experiences behaviors during the PM shift/sundowning such as crying and talking continuously. V9 (LPN) translated for R1 and said that R1 was using the restroom and was coming back to her bed when R2 got upset, slapped her face and left two red marks to the face. R1 said that the nurses were putting medication on her face but the scratch is healed and the roommate is no longer in the room. R1's nurses notes dated 10/11/2024 documents: R1 noted to have small red scratches on left side of the face, and order for bacitracin medication twice a day for 7 days. R2 is a female admitted to the facility on [DATE] with the diagnosis history of dementia, strokes, atrial fibrillation, end stage renal disease on hemodialysis, diabetes, depression, arthritis, heart failure, hypertension, and Hyperlipidemia. R2's Minimum Data Set (MDS) dated [DATE] documents that R1 has a Brief Interview for Mental Status (BIMS) score of 8 (moderate cognitive impairment). 1/06/2025 at 11:55AM R2 was sitting at the edge of the bed and waiting for lunch, verbalized being tired and did not want to talk regarding the incident with R1. R2 said, I do not remember anything, leave me alone. (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 2 Event ID: 145237 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 145237 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Generations at Regency 6631 Milwaukee Avenue Niles, IL 60714 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)