Inspection·February 5, 2026

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few reading while high quality CPR is ongoing, BP (blood pressure) 145/107; PR (pulse rate)124; saturation 69%, blood sugar 201. IV (intravenous) access placed right AC (antecubital fossa) gauge 22 with 0.9 running. 10-15 minutes later, paramedics came and took over. ROSC (return of spontaneous circulation) achieved, and paramedics left the facility around 4:55 to hospital. Time stamped 5:42 AM: At 3:55 AM, found patient (R1) unresponsive and disconnected from vent. Vent did not alarm outside room or in room. Code blue called and emergency medical services (EMS) called. Began code blue support on R1 until paramedics arrived 10-15 minutes later to take over code. On [DATE] at 1:18 PM, V4 (Registered Nurse, RN) was asked regarding R1 and incident on [DATE]. V4 replied, R1 was non-verbal, responsive to tactile stimuli. She was on trache/vent 24/7. On [DATE] at 1:45 AM, I did tracheal suctioning because vent's alarm kept going off. I did oral suctioning, and I was able to get saliva. Then, I did tracheal suctioning. There were not many tracheal secretions. I did it once. Everything was still connected. She was connected to the vital signs machine, saturation was okay, vent was not alarming anymore. Around 4 AM, I was close to the nurses' station, saw RT (V5) came to her room and she (V5) called me that she needs a nurse in her (R1) room. I went to her room, and I found her (R1) pale, not moving, no response, no rise and fall of the chest, we started CPR. My other colleague was calling paramedics. Some nurses are already coming. I disconnected her tube feeding, we put the board on the back and continue CPR. No vitals. Defibrillator was used. In the middle of the CPR we got a vital sign, saturation was 69%. V5 was bagging. Paramedics came, when she was transported out, she was revived. Her alarm was working because it alarmed when I did my suction. I didn't touch the machine. Prior to that, I didn't hear any alarm go off. On [DATE] at 3:37 PM, V5 was interviewed regarding R1. V5 stated, I was the one who found her on [DATE] early morning. I was doing rounds a little like 4 AM. When I went to her (R1) room, I went to her roommate for suction. I washed my hands; I went to her (R1). She (R1) was unresponsive and pale, no vital signs at all. There was no alarm going on. She was disconnected from her vent. The [NAME] was disconnected and close to her trache. I did not hear anything. I did not hear any alarm prior. R1's Ambulance Report dated [DATE] recorded: Dispatched to a nursing home for cardiac arrest. Upon arrival the crew found staff doing CPR and an AED (automated external defibrillator) on the patient (R1) with no shock advised. The staff said the patient (R1) was last seen normal around 0200 (2 AM) and was found in her current state around 0415 (4:15 AM). They found her with the ventilator disconnected and no alarms sounding and they started CPR. No shock was ever given. The crew took over CPR efforts.CPR continued for roughly 18 minutes until a palpable pulse was felt. The patient was prepared for transport. Hospital was called and an abbreviated report was given for the cardiac arrest alert. Transport continued with the patient losing a pulse again. CPR restarted for about 4 minutes, and a pulse was again felt but lost after about 1 minute. CPR continued again as the crew arrived at hospital. Patient care was transferred to the nurse in room [ROOM NUMBER]. The following vitals were recorded by ambulance: 4:20 AM - HR (heart rate) 0; RR (respiratory rate) 0; cardiac rhythm was asystole4:39 AM - HR 83; rhythm regular; sinus rhythm; RR 184:48 AM - BP 83/52; HR 129; rhythm regular; sinus tachycardia; RR 164:50 AM - HR 0; RR 14 On [DATE] at 9:36 AM, V11 (Ambulance Crew) was interviewed regarding R1's condition on [DATE] upon arrival on scene. V11 replied, We got on scene around 4:20 AM, she was in cardiac arrest, staff were doing CPR on her. No pulse, no breathing, no heart electrical activity. They had their AED hook up and there was no shock given. They said they never gave a shock and machine stated no shock given. Usually, when it's not advising shock, patients are in asystole or in some other rhythm that would not advised AED to do the shock. We took over their CPR, we hooked her on the monitor. The first rhythm was asystole, no pulse, no heart activity. We started CPR manually then we put the chest compression device (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 2 of 7 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 02/05/2026 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few on her. According to our report, after 18 minutes of CPR, we felt pulse, we stopped CPR. We prepared her for transport to the hospital. And then it looked like we lost the pulse again when she got into the ambulance, we started CPR again. For four minutes, we got pulse again and lost it again. At the time, we arrived at the hospital, CPR is still ongoing, and we transferred the care to hospital staff. R1's hospital records dated [DATE] recorded in part but not limited to the following:Physical exam - HR none, RR noneGeneral: unresponsive without purposeful spontaneous movements, unresponsive to voice or painful tactile stimulus. HEENT (Head, Ears, Eyes, Nose, Throat): pupils fixed and dilated bilateralCardiovascular: absent heart sounds; no palpable carotid pulse bilateralPulmonary: mechanical breath sounds, no rise/fall of the chest, trach in place with significant discharge Extremities: cool dry to touch throughoutNeuro: GSC (Glasgow Coma scale) 3, unresponsive to voice/touch/painful stimulusEmergency Department (ED) Course: Chief complaint - cardiac arrest following disconnection from ventilatorBrief history: The patient, a [AGE] year-old, female, was found disconnected from her ventilator at approximately 4:15 AM without a pulse. AED was applied and it did not recommend defibrillation. NH (nursing home) staff started CPR. The last known well time was 2:00 AM. Upon discovery by paramedics, she was in asystole, and CPR was continued. The patient experienced brief return of spontaneous circulation (ROSC) with a BP of 80s/50s but repeatedly lost pulses. Initial rhythm here was asystole, with subsequent pulseless electrical activity (PEA). Epinephrine was administered, along with bicarbonate and calcium (when she had PEA). Her tracheostomy tube was suctioned. She was also given 1 liter bolus. Accucheck was 170. She had brief ROSC here but lost pulses shortly after. Despite these efforts, the patient remained in asystole for the majority of the resuscitation attempts. Time of death: 5:18 AM. Diagnosis:1.Cardiac arrest2. Cardiac asystole3. Chronic respiratory failure requiring continuous mechanical ventilation through tracheostomy. On [DATE] at 12:26 PM, V8 (Lead RT) was asked to show surveyor how ventilator alarms functioned. V8 verbalized, The whole second floor is the vent unit. The vent alarms make sounds when resident yawns, cough or move. The alarm is programmed by adjusting high and low pressures depending on resident. Low is 9/15 and high depends on resident, should be 20% of baseline. If it is disconnected, it will always alarm regardless of the setting. If it doesn't alarm, the vent might be faulty. It is a ventilator, it is super sensitive. Every vent has disconnection alarm. Every ventilator is connected to the wall and connects to outside by the door and hallway so alarm can be heard on the floor. The alarm lights up in the hallway for vent alarms. At this time, V8 triggered a vent alarm. The call light was turned on and vent alarms in the hallway also turned on. The alarm is heard throughout the vent unit. There are three vent alarms in the hallway: one on each side of the nurses' station, and one at the end of the hallway by room [ROOM NUMBER]. There is also a call light system at the nurses' station to show which room the call light was triggered. On [DATE] at 11:19 AM, surveyor and V8 reviewed the alarm logs in R1's ventilator called VOCSN (Ventilation, Oxygen, Cough, Suction, Nebulizer). V8 stated that the time in the log is one hour ahead as programmed. Upon review of VOCSN manual, under multi-view notes, the multi-view time is calculated backwards so that event times are relative to the most recent setting. This approach ensures the continuity of graphed and trended data in Multi-View reports; even though through time zones, daylight savings or other changes to the Date and time controls on VOCSN. R1's Multi-view usage report dated [DATE] to [DATE] revealed the following: 1/22 03:38:06 - High Inspiratory Pressure Alarm Triggered1/22 03:38:08 - High Inspiratory Pressure Alarm Resolved1/22 03:39:22 - Low Minute Volume Alarm Triggered1/22 03:39:25 - Low Minute Volume Alarm Resolved1/22 04:03:53 - Low Inspiratory Pressure Alarm Triggered 1/22 04:03:54 - Low Inspiratory Pressure Alarm Resolved1/22 04:04:02 - Low minute volume alarm triggered1/22 04:04:12 - Low minute volume alarm resolvedFrom 3:38:06 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 3 of 7 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 02/05/2026 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few to 3:39:25 (real time 02:38:06 AM to 2:39:25 AM) - high inspiratory pressure and low minute volume alarms were triggered alternating with high inspiratory pressure alarm resolved and low minute volume alarm resolved. From 04:03:53 to 04:03:54 (real time 03:03:53 AM to 03:03:54 AM) - low inspiratory pressure alarm was triggered, resolved. From 04:04:02 to 04:04:12 (real time 3:04:02 AM to 3:04:12 AM - low minute volume alarm was triggered, resolved. There was no documentation indicating nurses or RTs responded to the triggered alarms. R1's progress notes did not show any documentation that she was assessed, and ventilator machine was evaluated due to on/off alarms between 2:38 AM to 3:04 AM. At 3:55 AM, she (R1) was found unresponsive, pale and disconnected from vent. On [DATE] at 12:00 PM, V8 was asked regarding R1's alarm logs. V8 verbalized, High pressure alarm means secretions, there's something in there that needs to be removed. The volume and pressure given by the vent is increased in that closed circuit due to secretions, obstruction, anything in the way getting the air to be delivered to the patient, like coughing or repositioning and airway is not patent. Low pressure alarm means the volume that is supposed to be delivered is lower. Secretions blocking the airway can be a cause, so suction patient, remove secretions and volume delivered. Pressure alarm resolved means patient coughed, then stop, resolved on its own, patient may need suction. Based on the alarm logs, her machine produced an alarm. Looking into her alarm logs, it did alarm. It triggered an alarm then stopped alarming. Staff need to check the patient (R1) and assess what is going on. Do not ignore on and off alarms. We have to physically go to the room and check the patient. The alarm is working, it's hard to ignore the alarm and it's the purpose of the alarm, to resolve the issue. Generally, we check residents on vent and if not every two hours, often more than every hour. We also rely on ventilators, so we check it physically and make sure all pieces are together and connected. Everyone is mandated to answer all alarms, maybe not address the issue but in tune with the alarms.On [DATE] at 1:21 PM, V10 (Nurse Practitioner, NP) was interviewed regarding R1. V10 verbalized, She is non-verbal; opens eyes; unresponsive to any stimuli; quadriplegic, unable to move; dependent on ventilator. Staff should do rounds on her every two hours and as needed. If vent alarm is triggered, staff need to get up and physically check resident (R1); perform trache care, oral care, suctioning, assess while providing care; monitor vital signs; medication administration is vital, making sure gtube is running and give water flushes; turningevery 2 hours and making sure brief is clean and dry. I was called in the morning that she (R1) was found pulseless, they did CPR and that she left with paramedics. They told me that she was stable and found her pulseless and unresponsive, they did code her and left with paramedics to hospital. She was there and she passed away. The nurse did not tell me that her vent was disconnected. They did not tell me. When she was found pulseless and unresponsive, her organs start to shut down, if the vent is not connected to what she was found to be, she would asphyxiate because there is no oxygen reaching her airway because she cannot breathe on her own. If she is disconnected from the vent, the vent will alarm, any alarm heard, staff need to respond immediately to the alarm. On [DATE] at 3:15 PM, V12 (Vice President of Respiratory Services) was asked regarding staff training on responding to ventilator alarms. V12 stated, V8 and me are responsible for providing in-services on RTs and nurses annually and on orientation. Prior to start working in the vent unit, staff need to have an orientation. Second floor is the only vent unit in the facility. Currently, we have 19 residents on vent and trache - 12 vents and 7 traches. We do in-services on suctioning, responding to vent alarms, trache care and suctioning, oxygen. With responding to vent alarms, RTs and nurses should respond to vent alarms right away. They have to look at the residents, if there is something wrong with the vent, they have to call RTs. Make sure residents are okay and all lines are connected. On a ventilator-dependent resident became disconnected from the trache, the vent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 4 of 7 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 02/05/2026 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few will alarm. There are different high levels of alarm, if the alarm is triggered and then resolved constantly, it is a priority alarm. Regardless of what the alarm is, staff need to check the residents immediately. And staff are in-serviced on responding to the alarm. The alarm is so loud, made on purpose. On [DATE] at 2:33 PM, V16 (Medical Director) was interviewed regarding R1 and ventilator alarms. V16 replied, They informed me that she (R1) was at the hospital that she was unresponsive, and she passed away. She was on ventilator 24/7. She cannot breathe on her own. Any patients who are ventilator-dependent when disconnected from their vents cannot breathe. When disconnection from vent occurs, the alarm will go off, RT or nurses should go to patient and check what was going on and intervene. If patient's vent has issue, alarm has to go off, care team should see patient. Check for any disconnection and connect the circuit. Evaluate patient immediately. Address, evaluate, understand and act upon. All staff, especially RT, nurses or whoever is in charge of patients should respond to any alarm. On [DATE] 1:26 PM, V2 was interviewed regarding expectations on staff related to respiratory care and ventilator alarms. V2 stated, Staff should follow our policies and procedures; be aware of the residents' condition; make sure there are no alarm sounding and respond to vent alarms immediately. Make sure residents on ventilators are positioned properly and everything is connected properly. V3 was also interviewed on [DATE] at 1:30 PM regarding respiratory care and ventilator alarms. V3 replied, Staff need to use their critical thinking skills; be familiar with patient's condition; respond to alarms right away, any alarm like call light or vent alarms. All staff, including CNAs to respond to alarms and report to nurses and RTs. Facility's policy titled Mechanical Ventilation dated [DATE] documented in part but not limited to the following:Policy:All residents on mechanical ventilation will be monitored by respiratory therapist every shift and PRN. Ventilator alarm settings:Respiratory therapists and nurses are responsible for responding to ventilator alarms. The manufacturer's manual for R1's ventilator (VOCSN) documented in part but not limited to the following: AlarmsA VOCSN alarm will activate whenever the device detects a condition that requires clinician or caregiver attention. Alarms will generate an audible tone, and/or a blue, yellow or red alert banner across the top of the VOCSN screen. VOCSN has three alarm priority categories:Alarm priority: HighVisual indicator: red bannerAuditory indicator: 10 tones every 3 secondsClinician or caregiver response: Requires immediate clinician or caregiver response.Alarm priority: MediumVisual indicator: yellow bannerAuditory indicator: 3 tones every 7 secondsClinician or caregiver response: Requires prompt clinician or caregiver response.Alarm priority: LowVisual indicator: blue bannerAuditory indicator: no auditory indicatorClinician or caregiver response: Requires clinician or caregiver response.Alarm conditions and settingsThe high pressure alarm activates when the monitored airway pressure exceeds the set high pressure alarm limit for more than the number of consecutive breaths set with the High pressure Delay control. Recommended action: Monitor the patient closely and check for reduced patient lung compliance during volume ventilation. Check (brand name) circuit for occlusions. This is a high priority alarm.The low minute volume alarm activates when the monitored minute volume falls below the set low minute volume alarm limit. Recommended action: Monitor the patient closely to ensure adequate ventilation therapy is delivered. Check the (brand name) circuit for leaks or disconnection. During pressure-control ventilation, check the patient for reduced lung compliance or airway occlusion.NOTE: The Patient Circuit Disconnect alarm may not activate with every disconnect condition. (Name of company) recommends using the Low minute Volume, Low Inspiratory pressure and apnea alarms in addition to the Patient Circuit disconnect alarm to ensure (brand name) circuit disconnections are detected. The low inspiratory pressure alarm activates when the monitored peak inspiratory pressure falls below the set low inspiratory pressure alarm limit. Recommended action: Check the (brand name) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 5 of 7 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 02/05/2026 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few circuit for leaks or disconnection. Monitor the patient closely to ensure adequate ventilation therapy is delivered. This is a high priority alarm. Responding to Alarms: The VOCSN operator must be capable of responding to alarm conditions and promptly performing the necessary corrective actions. R1 had low minute volume and low inspiratory pressure alarms per ventilator alarm logs. The Immediate Jeopardy that began on [DATE] was also removed on [DATE] when the facility took the following actions to remove the immediacy.Corrective Actions Taken:On [DATE] at 3:55 AM, V5 noted R1 unresponsive and disconnected from vent. V4 was called. R1 was found pale, no breathing noted, high quality CPR initiated, code blue called, emergency medical services were called. CPR continued until EMS arrived and transferred out to the hospital. These were verified with V4 and V5 during interviews and per review of hospital records and progress notes. 2. All 11 ventilator-dependent residents were checked for proper connection and alarm function. This was verified with V12 and through record review of the code blue debrief documentation conducted on [DATE] by V12. 3. Identification of other potentially affected residents and action: Resident with an open airway; Resident utilizing a ventilator. This was verified with V12 and through record review of the code blue debrief documentation conducted on [DATE] by V12. 4. All ventilator-dependent residents were checked for proper connection and alarm function. This was verified with V12 and through record review of the code blue debrief documentation conducted on [DATE] by V12, and in-services provided to staff on [DATE]. This was also verified through observation on [DATE] at 10:15 AM on R5, R7, R8 and R9's ventilators. 5. All ventilators were checked, ensuring all maintenance was performed as required. This was verified with V1and V20 (Maintenance Director) and per record review of facility's code blue debrief documentation on [DATE]. 6. All ventilator-dependent residents are checked by the assigned RT for proper connection and alarm function every 2 hours and PRN. These checks are documented once per shift. This was verified with V2 and V3 and per record reviews of audit tools from [DATE] to current. 7. Staff education was conducted by the ADON, lead RT, Regional Nurse Consultant and shift supervisor. This was verified with V3, V7 (Licensed Practical Nurse, LPN); V13 (RN) and V12; and per review of in-service on Respiratory Unit Care Guidelines dated [DATE]. 8. All staff assigned to the respiratory unit received education. Staff not on site for education were contacted by telephone and received verbal education. They will sign in service education forms before the start of their next shift. This includes PRN staff. This was verified with V1 and V3 and per review of in-service on Respiratory Unit Care Guidelines dated [DATE]. The facility does not use an agency for the respiratory unit. This was verified with V1 that facility does not use agency staff. 9. The facility has implemented a monitoring process conducted by the respiratory therapist to randomly audit ventilator residents to ensure ventilator settings, connections and alarm functionality are assessed after care activities that could disrupt the ventilator circuit. Ongoing every shift for 4 weeks. This was verified with V2, V3 and V8 and per review of audit tools from [DATE] to current. 10. The facility implemented observation audits of ventilator-dependent residents for secure connections. This was verified with V3 and per review of audit tools from [DATE] to current. This was also verified through observation on [DATE] at 10:15 AM on R5, R7, R8 and R9's ventilators. 11. Director of Nursing or designee will conduct direct observation in the respiratory unit to ensure prompt response to alarms at random shifts. This was verified with V1, V2, V3 and V18 and per review of audit tools from [DATE] to current. 12. Director if Nursing or designee will conduct direct observation of staff to ensure residents with an open airway are repositioned in bed appropriately and carefully to prevent interruption of respiratory tubing. This was verified with V1 and V2 and per review of audit tools from [DATE] to current. 13. Audits will be conducted 5 times a week for 2 weeks for all residents with open airway then weekly for 4 weeks. This was verified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 6 of 7 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 02/05/2026 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 0684 Level of Harm - Immediate jeopardy to resident health or safety with V1, V2 and V3; and per review of audit tools from [DATE] to current. 14. Results of the audits will be presented to the QAPI committee for recommendations of further auditing and actions as appropriate. This was verified with V2 and per record review of all audits from [DATE] to current. 15. Code blue debrief is completed, and the action plan is discussed and approved by the Ad-Hoc committee. This was verified with V1 and V2 and per record review of all audits from [DATE] to current. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145237 If continuation sheet Page 7 of 7