Inspection·September 10, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few Based on record review and interview, the facility failed to follow their abuse policy for two residents (R1, R2,) out of five residents reviewed abuse. This failure resulted in staff not intervening in a timely manner, thus allowing R2 to hit R1 in the face, causing an injury to R1's right eye and nose.Findings include:R1's 8/26/2025 22:54 Nurses Note Narrative states: An agitated resident went into resident room and made contact with her. Resident was immediately separated from her and secure her safety. Complete assessment performed, provided first aid interventions and called 911. NP (Nurse Practitioner) notified. Family notified. Administrator, DON (Director of Nursing) and ADON (Assistant Director of Nursing) notified. Offered pain medication. BP (blood pressure)-146/70 P (pulse)-80 R (respirations)18 T (temperature)-97.5 Sat (oxygen saturation)-96% room air. Neuro (neurology checks) initiated.R1's 8/27/2025 05:41 Nurses Note Narrative states: Resident admitted at Hospital. Diagnosis: Retrobulbar Hematoma.R1's hospital records document: past medical history CVA (Cerebral Vascular Accident), COPD (Chronic Obstructive Pulmonary Disease), T2DM (type 2 Diabetes Mellitus), HTN (hypertension), hemiplegia. The patient presents emergency department for above complaint, report, nursing home staff witnessed another resident enter patient's room and assault her. Never fell out of bed. Hematoma noted on imaging after an unwitnessed assault at her extended care facility. The patient Physical Exam Vitals reviewed. Head: Comments: Facial trauma with R (right) eyelid edema and laceration Nose with abrasion. Underwent lateral canthotomy secondary to retrobulbar hematoma and increased eye pressures, Ophthalmology evaluation: Assault; Laceration of right canaliculus, initial encounter.R2's care plan documents potential to be physically or verbally aggressive towards staff related to anger. Poor impulse control and mental illness reviewed 3/27/25. Reviewed 5/7/25 R2 was aggressive with staff, punched a staff member in the face. Reviewed 8/12/25 R2 was throwing objects and spat on Social Service Director.R2's 8/26/2025 19:00 Nurses Note Narrative states: The resident was noted a little anxious, was redirected back to his room. The writer told the CNA (Certified Nursing Assistant) to accompany her to the resident room in order to give him his PRN (as needed) medication for his anxiety, which he took. Social worker was notified, and he came to the floor to see the resident. Resident was calm afterwards and stayed in his room while staff continued to do their other tasks.R2's Nurses 8/26/2025 20:00 Note Narrative states: Resident was noted coming out from his room agitated and running on the hallway and ended into another resident's room (residents initials) and made contact with her. He was taken away by staff immediately and placed on 1:1. Complete assessment performed on resident. Maintained 1:1 supervision on resident. Police called and took the resident to (name) Hospital. NP and Dr (doctor) notified. Resident mother notified via (phone number). Administrator, DON and ADON notified.R2's 8/26/2025 20:29 SOCIAL SERVICE Note Text states: Resident is exhibiting physical aggression to staff and peers, refused PRN. Poses as a danger to himself and others, placed on 1:1. Police transferred resident to Hospital.On 9/2/25 at 10:15 am, V6 (Licensed Practical Nurse) stated she was in another resident room across from R1's (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: 145244 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 145244 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Lakeshore 7200 North Sheridan Road Chicago, IL 60626 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)