Inspection·April 11, 2025

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. Based on observations, interviews, and record reviews, the facility failed to follow its comprehensive care plans policy and accurately assess and revise care plans as changes in the residents' conditions dictate for three residents (R46, R49, and R91) out of three reviewed for care plans in a sample of 55. Findings include: On 4/9/25 at 12:00 PM, R49 was observed to have an electronic monitoring device on her left wrist. On 4/10/25 at 1:05 PM, V20 (MDS (minimum data set) coordinator) stated that this facility changed computer systems in October 2024. V20 stated that all care plans in the residents' current electronic medical record are up-to-date. V20 stated that care plans are important so that everyone is on the same page with the resident's care. V20 stated that a resident's care plan is updated when there is a change in resident's condition. V20 stated that care plans are reviewed quarterly, annually, and upon admission to this facility. V20 stated that care plans are reviewed with MDS. V20 stated that V20 is responsible for entering any new diagnosis that is identified. V20 stated that the interdisciplinary team participates and completes the appropriate portions of the care plan. R46: R46 was re-admitted to this facility on 1/25/25 from the hospital. R46 returned with a new diagnosis of iron deficiency anemia . R46's medical records notes R46 had a quarterly MDS completed on 11/4/24 and 2/3/25. R46's care plan does not note a care plan was initiated related to the new diagnosis of iron deficiency anemia. R49: R49's POS (physician order sheet), dated 9/19/24, notes an order for an electronic monitoring device check and record placement every shift. R49's medical records notes R49 had a quarterly MDS completed on 12/10/24 and 3/10/25. R49's care plan does not note a care plan was initiated related to wandering risk and use of electronic monitoring device. R91: R91's POS, dated 9/19/24, notes an order for regular diet pureed texture, nectar/mildly thick consistency, supercereal with breakfast. R91's medical records notes R91 had a quarterly MDS completed on 11/1/24 and 1/16/25. R91 also had an MDS for significant change on 3/14/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 2 of 14 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 04/11/2025 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete R49's care plan does not note a care plan was initiated related to mechanically altered diet or behaviors of taking other residents drinks. This facility's comprehensive care plans policy, reviewed 04/2017, notes the comprehensive care plan will be developed with input from the interdisciplinary team, which includes at a minimum: attending physician, registered nurse responsible for the resident, nurse aide with responsibility for the resident, a member of food and nutrition services staff, to the extent practicable, the participation of the resident and the resident's representative, other appropriate staff or professionals in disciplines as determined by the resident's needs. Services are to be furnished to attain or maintain the resident's highest practicable well being, measurable objectives and timeframes, the resident's goals for admission and desired outcomes. Care plans are revised as changes in the resident's condition dictates. Event ID: Facility ID: 145237 If continuation sheet Page 3 of 14 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 04/11/2025 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)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure low air loss mattress devices were on the correct weights setting for residents who are at risk in developing pressure ulcers. This failure has the potential to affect four (R28, R92, R116 and R168) out of four residents reviewed for pressure ulcer care in a final sample of 55 residents. Residents Affected - Some Findings include: On 4/8/25 at 10:45AM, observed R92 in bed, on low air loss mattress set to normal pressure below 80. Setting confirmed with V4 (LPN). Record reviewed R92 weight record dated 3/10/25 is 105.6 lbs. On 4/8/25 at 10:47AM, observed R116 in bed, on low air loss mattress set to normal pressure between 210 to 250. Setting confirmed with V4 (LPN). Record reviewed R116 weight record dated 3/10/25 is 113.9 lbs. On 4/8/25 at 10:50AM, observed R28 in bed, on low air loss mattress is power off. Mattress deflated. Confirmed with V4 (LPN) that the low air loss mattress is deflated. V4 checked and tried to turn on, observed it is unplugged. V4 plugged the low air loss mattress and turned the power on. Low pressure light on and blinking. Per V4 it would take a while for the inflation. Setting placed between 120 to150. R28's recorded weight on 3/10 25 is 139.6 lbs. On 4/9/25 at 9:48AM, observed R92 in bed and in low air loss mattress set on normal pressure between 150 to 180. Setting confirmed with V4 (LPN). Record reviewed R92 weight record dated 3/10/25 is 105.6 lbs. On 4/9/25 at 10AM, observed R168 in bed, on low air loss mattress setting between 250 to 280. Setting confirmed with V4 (LPN). Recorded weight on 3/10/25 is at 247.8 lbs. On 4/10/25 at 9:57AM, V11 (Wound nurse) stated that they place residents in low air loss mattress because they are either with pressure ulcer or at risk for pressure ulcer injury, especially those who are high risk. Stated that R92 has no active wound but assessed as High Risk. R168 has no active wounds, and also assessed as high risk. R116 has no active pressure wound and assesses as high risk. That R116 has vascular wounds in lower extremities and on hospice. R28 has no active wound and assessed to be at high risk, V11 stated that the setting is set based on residents weights. And if there are changes in resident's weight, then the staff need to adjust the setting. I check and the other staff checks the setting and if the bed is in working order. If the low air loss mattress is not on and deflated, then the preventative measure would not be working. R92's Braden scale for predicting pressure sore risk dated 3/1/25 is 11 (High Risk). Care plan for potential skin breakdown/pressure ulcer with interventions of may use low air loss mattress for pressure reduction. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 4 of 14 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 04/11/2025 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)

F 0686 Level of Harm - Minimal harm or potential for actual harm R168's Braden scale for predicting pressure sore risk dated 3/14/25 is 13 (Moderate Risk). Care plan for potential skin breakdown with intervention of may use low air loss mattress for pressure reduction. R116's Braden scale for predicting pressure sore risk dated 1/14/25 is 13 (Moderate Risk). Care plan for potential skin breakdown/pressure ulcer. Residents Affected - Some R28's Braden scale for predicting pressure sore risk dated 1/06/25 is 12 (High Risk). Care plan for potential for skin breakdown/pressure ulcer with intervention of may use low air loss mattress for pressure reduction. Alternating Pressure Air Mattress policy with a revision date of 5/17, reads in part: objective is to provide pressure relief. Pressure Ulcer Treatment and Management with a revision date of 5/`7, reads in part: Residents with pressure ulcers will have a physician's order for treatment. The plan of care will include the presence of the pressure ulcer and include the individual description of the treatment plan including: pressure relief, turning and repositioning, additional nutritional measure, need for assistance with mobility and range of motion. Resident with pressure ulcers will be determined to be high risk for pressure ulcer prevention and all components of the At Risk protocol will include: pressure relieving devices, nutritional support, and assistance with mobility including repositioning and ROM (Range of Motion) as outlined in the At Risk Protocol. Pressure Ulcer Prevention Protocol with a revision date of 5/18, reads in part: Resident will be assessed to determine their risk factors for pressure ulcer development. Resident will be assessed to determine their risk factor for pressure ulcers development, upon admission and at least quarterly thereafter. All beds in the facility will have pressure reducing mattresses unless pressure relieving mattresses are required according to resident's needs. Interventions necessary to maintain skin integrity or to promote healing will be incorporated into the plan of care based on each resident's individual needs and risks, which may include: Use of pressure reducing devices, such as pressure reducing mattresses, mattresses overlays, w/c cushioning devices if needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 5 of 14 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 04/11/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to effectively supervise one resident on a thickened liquid diet from drinking a cup of thin liquids from another resident's meal tray for a resident assessed with mild to moderate risk for aspiration. This failure affected one resident (91) out of three reviewed for mechanically altered diets in a sample of 55. Based on observation, interview and record review, the facility failed to present a smoking policy that included the safe use and how the facility would supervise residents using electronic smoking materials and failed to complete quarterly smoking assessments. This affected four of four residents (R111, R61, R8, and R161) reviewed for smoking safety and supervision. Findings include: On 4/8/25 at 12:05 PM, staff was observed pouring thin liquid juice container, 120ml (milliliters) into a cup for R165 and placing the cup on her tray. 04/08/25 at 12:05 PM R91 was observed taking a cup filled with thin liquids off another resident's tray and drink from it. Resident consumed 100% of the liquid in this cup. At 12:15 PM, R91 was given her lunch tray, pureed diet with nectar thick liquids. On 4/10/25 at 10:00 AM, V12 NP (nurse practitioner) stated that mechanically altered diets are ordered for a reason. When informed that R91 drank a cupful of thin liquids, V12 responded that V12 didn't think R91 was able to feed or drink by herself. On 4/10/25 at 1:20 PM, 17 CNA (certified nurse aide) stated that R91 will reach for cups that are close by R91 and drink from cup. On 4/10/25 at 1:35 PM, V16 LPN (licensed practical nurse) stated that R91 has a behavior of reaching for cups nearby and drinking from the cups. R91's modified barium swallow study, dated 11/5/2020, notes R91 presented with a mild-moderate oropharyngeal phase dysphagia. Reduced safety with thin liquids due to premature spillage, impulsive sips, and delayed pharyngeal swallow response resulting in silent aspiration in slight amounts with thin liquids at the onset of the swallow and frequent deep penetration to the vocal folds with accumulating residue. Aspiration also noted after the swallow due to mild-moderate to moderate levels of thin residue spilling into the trachea after the swallow without sensation or ability to elicit a cough. No airway invasion noted with puree or mildly thickened liquids (nectar thick liquids). This facility's supervision of resident nutrition policy, dated 05/2017, notes nursing personnel are responsible for assuring that residents are served the correct dietary tray. R111 was admitted to the facility on [DATE] with a diagnosis of type II diabetes, hemiplegia affecting left side, major depressive disorder and peripheral vascular disease. R111's brief interview for mental status dated 2/22/25 documents a score of 14/15 which indicates cognitively intact. On 4/8/25 at 10:14AM, R111 was observed with smoking material in his room. R111 said he is a smoker (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 6 of 14 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 04/11/2025 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)

F 0689 and is able to smoke on the patio unsupervised. Level of Harm - Minimal harm or potential for actual harm R111 smoking risk assessment dated [DATE] documents a score of 3 which indicates safe smoker. The facility was asked to present any other smoking assessments for R111. No other assessments were given to the surveyor. R111 medical record did not document any other assessments upon review. Residents Affected - Some R111 current plan of care did not document any current smoking plan of care. On 4/10/25 at 9:42AM, V2(Vice president Operations) said smoking assessments are conducted on admission, quarterly, annual and with changes, V2 said the smoking assessments were not conducted until this morning and care plans were updated this morning. Smoking Policy 2/2017 documents: Resident's clinical record will be updated to reflect smoking status. Resident will be re-evaluated quarterly and annually thereafter unless circumstances warrant an off-cycle assessment related to a change in baseline, i.e change in cognition, change in physical functioning or behavioral concerns that may impact the safety and welfare of the resident or others. Care plans will be created/updated as necessary to reflect the resident's preference or needs. R61 R61 brief interview for mental status dated 3/24/25 documents a score of eight which indicates moderate cognitive impairment. On 4/8/25 at 10:33am, R61 who was assessed to be alert and oriented to person place and time, said he is a smoker and inhaled on his vape pen. On 4/9/25 at 4:10pm, V3 (don) said, R61 does not have a smoking assessment. R61 was supposed to quit smoking in September 2024. Independent smokers can hold on to their smoking material. V3 said, she was not aware R61 had a vape pen. R61's progress note dated 9/24/24 documents: former smoker. On 4/10/25 at 9:42AM, V2(Vice President Operations) said, smoking assessments are conducted on admission, quarterly, annual and with changes, V2 said, the smoking assessments were not conducted until this morning. Care plans were also updated this morning. R61's smoking and safety assessment dated [DATE] documents: Supervision, designated smoking location and smoking times are determined by facility policy. R61 use tobacco and vape products. Smoking Management care plan dated 4/10/25 documents: I (R61) desire to smoke. I have been assessed to determine safety factors. I am aware of the facility policy encompassing electronic, as well as tobacco-based products does not allow a resident to carry any smoking materials. Smoking is only allowed outside at designated times with proper distancing. I have been made of the rules and I voluntarily agree to follow all the rules. I acknowledge that smoking is a privilege and I agree to behave safely. Smoking Policy 2/2017 documents: Resident's clinical record will be updated to reflect smoking status. Resident will be re-evaluated quarterly and annually thereafter unless circumstances warrant an off-cycle assessment related to a change in baseline, i.e. change in cognition, change in physical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 7 of 14 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 04/11/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some functioning or behavioral concerns that may impact the safety and welfare of the resident or others. Care plans will be created/updated as necessary to reflect the resident's preference or needs. Those resident who have been assessed and determined to be an at risk smoker will be allowed to participate in the center's supervised smoking programs. These identified individuals will have smoking material made available to them when under direct supervision of a staff member. Individuals who smoke will smoke in designated areas only. R8's R8's smoking and safety assessment dated [DATE] documents: Supervision, designated smoking location and smoking times are determined by facility policy. R8 use tobacco. Balance problems while sitting and standing. Unable to extinguish tobacco or marijuana safely. Requires supervision to ensure tobacco extinguish properly. Resident has a brace on right leg from injury prior to admission. On 4/10/25 at 9:42AM, V2(Vice President Operations) said, smoking assessments are conducted on admission, quarterly, annual and with changes, V2 said, the smoking assessments were not conducted until this morning. Care plans were also updated this morning. Smoking Management care plan dated 4/10/25 documents: I (R8) desire to smoke. I have been assessed to determine safety factors. I am aware of the facility policy encompassing electronic, as well as tobacco-based products does not allow a resident assessed as compromised to carry any smoking materials. Smoking is only allowed outside, at designated times with proper distancing. I have been made aware of the rules and I voluntarily agree to follow all the rules. I acknowledge that smoking is a privilege and I agree to behave safely. I have been counseled concerning the innumerable hazards, health risks and complications associated with smoking. Smoking Policy 2/2017 documents: Resident's clinical record will be updated to reflect smoking status. Resident will be re-evaluated quarterly and annually thereafter unless circumstances warrant an off-cycle assessment related to a change in baseline, i.e change in cognition, change in physical functioning or behavioral concerns that may impact the safety and welfare of the resident or others. Care plans will be created/updated as necessary to reflect the resident's preference or needs. R161 R161's brief interview for mental status dated 1/13/25 documents a score of fifteen which indicates cognitively intact. R161's smoking and safety assessment dated [DATE] documents: Supervision, designated smoking location and smoking times are determined by facility policy. Product resident use: Tobacco, Marijuana and vape product not check. On 4/10/25 at 9:42AM, V2(Vice President Operations) said, smoking assessments are conducted on admission, quarterly, annual and with changes, V2 said, the smoking assessments were not conducted until this morning. Care plans were also updated this morning. On 4/11/25 at 11:30am, R161 who was assessed to be alert and orient to person, place and time, said, he smokes occasionally. Smoking Management care plan dated 4/10/25 documents: I (R161) have been assessed to determine safety factors. I am aware of the facility policy encompassing electronic, as well as tobacco-based products does not allow a resident assessed as compromised to carry any smoking materials. Smoking is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 8 of 14 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 04/11/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete only allowed outside, at designated times with proper distancing. I have been made aware of the rules and I voluntarily agree to follow all the rules. I acknowledge that smoking is a privilege and I agree to behave safely. Smoking Policy 2/2017 documents: Resident's clinical record will be updated to reflect smoking status. Resident will be re-evaluated quarterly and annually thereafter unless circumstances warrant an off-cycle assessment related to a change in baseline, i.e change in cognition, change in physical functioning or behavioral concerns that may impact the safety and welfare of the resident or others. Care plans will be created/updated as necessary to reflect the resident's preference or needs. Event ID: Facility ID: 145237 If continuation sheet Page 9 of 14 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 04/11/2025 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to document accurate meal intakes, offer alternative meal options, and notify the physician or nurse practitioner of significant weight loss. Additionally, the facility failed to implement the dietitian ' s recommendations and follow the physician ' s orders to increase Remeron for weight management. This deficient practice affected two of the seven residents (R62 and R103) reviewed for nutrition and unplanned weight loss prevention. As a result, Resident R62 experienced a 10% unplanned weight loss over a six-month period. Residents Affected - Few Findings include: On 4/8/25 at 12:10 PM, R62 was observed in dining room for lunch meal. Staff were observed setting up R62's tray. R62 was observed replacing the cover on plate and self propelling wheelchair out of dining room. On 4/8/25 at 12:15 PM, R62 was observed self propelling wheelchair into dining room. R62 lifted the cover over plate then replaced cover and left dining room. Staff were observed removing R62's tray and place on the cart for dirty plates. R62 did not consume meal. On 4/9/25 at 11:15 AM, V7 RD (registered dietitian) stated that V7 audits all resident weights each month. V7 stated that V7 will request a resident be re-weighed if there is a change in weight of 5 or more pounds in one month. V7 stated that residents with weight loss are monitored and discuss during morning meeting with the interdisciplinary team. On 4/10/25 at 1:00 PM, V15 LPN (licensed practical nurse) stated that the CNAs (certified nurse aides) document the amount eaten for each resident in their POC (point of care) charting. V15 stated that the CNAs will inform the nurse if the resident does not eat a meal. When questioned if V15 was aware that R62 did not eat lunch on 4/8, V15 did not respond. R62's POC charting, dated 4/8/25, does not note amount eaten for lunch was documented. R62's medical record does not note any documentation on 4/8/25 related to R62 not eating lunch. R62's POS (physician order sheet) notes an order for LCS (Low Concentrated Sweets) diet, Regular texture, Regular/Thin consistency. R62's weight documentation: On 4/9/25, R62's weight was 125 pounds On 3/10, R62's weight was 128 pounds On 1/8, R62's weight was 130.6 pounds On 10/4/24, R62's weight was 139 pounds R62's weight documentation notes 10.07% weight loss for 6 months. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 10 of 14 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 04/11/2025 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few V7 RD (registered dietitian) note, dated 4/10/25, notes significant weight loss review. Current weight record for 4/9/25 recorded at 125 pounds. Weight over 1, 3, and 6 months are as follows: 1 month - 3/10/25 128(2.3%), 3 months - 1/8/25 - 130.6(4.3%), and 6 months - 10/4/24 - 139(10.1%). Significant weight loss at 6 months, which is unplanned/unavoidable and likely related to a combination of variable oral intake at mealtimes and behaviors associated with her diagnosis of dementia. Recommendations were to have a psychiatric consult placed as resident has the tendency to wheel herself around the unit throughout the day, and sometimes during mealtimes, in which case she may miss her meal. Nurse practitioner was also informed of recommendations. BMI (body mass index): 22.1 - underweight; desirable BMI for age >65: 23-29.9. Diet: Regular, LCS, thin liquids. Double portions and snack at lunch and dinner. Supplement(s): Supercereal at breakfast and Med Pass 120 ml (milliliters) three times daily. R62's medical record notes R62 was last seen by V7 on 12/4/24. This facility's weight maintenance policy, revised 03/2022, notes all significant, unplanned, or trending weight changes must be investigated by the facility. The director of nursing will refer all concerns and recommendations to the appropriate department for action. The director of nursing or designee will ensure physicians and resident representatives are informed of significant or trending weight fluctuations or concerns regarding a change in the resident's nutritional status. R103 was admitted to the facility on [DATE] with a diagnosis of parkinsonism, dementia, and contractures. R103 progress notes dated 1/15/25: Registered Dietician follow up. Resident's weight has trended down x past 6 months, in which weight history and current nutritional interventions were discussed with Nurse Practitioner. Resident is receiving Super cereal at breakfast, Health Shake q meal, Pro-Stat Sugar Free 30 ml every day and Remeron 7.5 mg at bedtime, thus Nurse Practitioner was agreeable to increasing dose of Remeron to 15 mg q HS. R103's nurse practitioner progress notes dated 1/17/25: patient seen and examined. Reason for visit: Weight loss. dietician following discussed with dietician will increase Remeron to 15mg continue all interventions per dietician. On 4/10/25 at 10:29AM, V12 (Nurse practitioner) said she would expect her orders to be followed as ordered. V12 said any new orders are verbally relied to the nurse to put into the electronic computer system. V12 said Remeron would be ordered to help increase a resident's appetite with weight loss. On 4/9/25 at 11:13AM, V7(dietician) said he expects his recommendations to be followed unless the physician does not agree. V7 said he recalls speaking to the V12 (nurse practitioner) about increasing Remeron due to weight loss for R103. V7 said R103 body max index was 14.3 which is considered underweight. R103's current physician order documents. Remeron 15 mg. Give 0.5 tablet (7.5MG) orally at bedtime with a start date of 10/24/24. R103's medication administration record for January, February. March and April documents: Remeron 15 mg. Give 0.5 tablet (7.5MG) orally at bedtime. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 11 of 14 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 04/11/2025 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Facility policy physician orders revised 5/2017 documents: all residents medications, and treatments must be ordered by a licensed physician or nurse practitioner. Physician orders must be reviewed every 60 days. The nursing staff member who took the order or the one assigned to the resident is responsible to transcribe the order. On monthly basis, the physician orders will be reviewed for accuracy by nursing personal. Event ID: Facility ID: 145237 If continuation sheet Page 12 of 14 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 04/11/2025 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)

F 0776 Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their radiology or other diagnostic ordering policy by not following physician orders to obtaining an x-ray for one resident (R60) for one of one reviewed radiology services. Residents Affected - Few Findings include: R60 admitted to the facility on [DATE] with a diagnosis of anemia, type II diabetes, pain in left and right shoulder R60's nurse practitioner progress note dated 3/28/25 documents: history of shingles, neuropathy and neuropathic pain / left shoulder pain. patient wants another left shoulder x-ray done. One was done in the past and showed shoulder dislocation and patient refused to have it corrected. Will repeat x-ray. R60's physician order dated 3/28/25 document left shoulder x-ray. On 4/10/25 at 10:29AM, V12 (Nurse practitioner) said she ordered x-ray for R60 due to complaints of pain. V12 said she would expect the x-ray to be completed within a few days and was unaware the x-ray was not completed until after the surveyor requested the results on 4/8/25. V12 said she did receive the results and put in a referral for rehab specialist to see the resident and possible give a pain injection due to arthritis. On 4/9/25 at 1:02PM, V3(director of nursing, DON) said R60's x-ray was not completed as ordered. V3 said there was an error in placing the order and the x-ray was not completed until 4/9/25. V3 said when an x-ray order is placed it will usually be conducted within 24 hours. Facility policy or other diagnostic ordering policy dated 9/17 documents under objective: to provide or obtain radiology or other diagnostic monitoring in accordance with the orders of the physician, physician assistant or nurse practitioner. Upon receipt of the order, the nurse processing the order will notify the appropriate service provider. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 13 of 14 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 04/11/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to follow its the posted infection control signage and don appropriate PPE (personal protective equipment) prior to entering one resident's room that is on enhanced barrier precautions and performing blood draw This affected one of one resident (R105) reviewed for infection control in a sample of 55. Residents Affected - Few Findings include: On 4/9/25 at 9:45 AM, signage noting enhanced barrier precautions was noted on entry door to R105's room. On 4/9/25 at 9:45 AM, V8 (outside laboratory staff) was observed in R105's room on the left side of R105's bed leaning over R105 to draw blood from R105's right hand. V8 was not wearing gloves or gown while performing direct resident care. On 4/9/25 at 2:30 PM, V9 IP nurse (infection prevention nurse) stated that staff are expected to don gown and gloves prior to performing direct resident care for residents on enhanced barrier precautions. V9 stated that the outside laboratory staff are aware of this facility's infection control policy and are expected to follow it. V9 stated that V9 spoke with V8 regarding not wearing appropriate PPE (personal protective equipment) when performing blood draws for residents. V9 stated that V8 informed her that she is unable to feel the resident's vein when wearing gloves. V9 stated that it is not acceptable to not wear gloves. V9 stated that she is responsible for infection control and this will not be tolerated at this facility. R105's POS (physician order sheet) dated 1/23/25, notes enhanced barrier precautions: related to medical device, wound site, and history of C-Auris CRAB sputum, NDM of the urine and CRE urine and sputum and wound site. The enhanced barrier precautions signage notes all providers and staff must wear gloves and gown for high-contact resident care activities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 14 of 14