Inspection·December 19, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain environment free of bedbugs for residents reviewed for a safe and comfortable environment. These failures affected 7 residents that were exposed to bed bugs and has the potential to affect 74 residents living on the same floor.Findings include: On 12/17/2025 at 1:54 PM, R4 was seen in her room with R5. R4 spoke more Bangladesh, less English. R4 would start with a few words of English, then would continue with Bangladesh. R5 was able to express her thoughts clearly within topic during conversation. R5 stated she transferred into another room last month because this room she currently occupies was infested with bed bugs. R5 stated she was bitten by bed bugs scratching her arms. R5 stated people came to fumigate the room due to bed bugs. On the same floor, at the door, a tape was seen with Do Not Enter written with R6's, R7's, and R8's names written as occupants in the room. V10 (Registered Nurse) was asked about the room. V10 stated she does not know why there was a tape with Do Not Enter on the door. V10 paged V5 (Maintenance Director). V5 went to the floor and denied any knowledge of the tape on the door. V7 (Scheduler/Former Housekeeping Director) introduced herself as former housekeeper and went inside the room with writer and V5. The room was without residents and was crowded with multiple plastic bags and clutter. Per V7, it is the Housekeeping Director, not Maintenance Director, that is in-charge of bed bug problems. V5 and V7 went to the basement where V8's (Housekeeping Director) office was located. V8 was found inside laundry room; denied any knowledge of bed bug issue or treatment in the facility. V8 (Assistant Administrator) was asked about bed bug concerns. V8 said V11 (Pest Control Company) will come on Monday to address bed bugs concern in room identified with bed bugs. Per resident's census history, R6, R7, and R8 used to occupy the room that was seen full of plastic bags and clutter on top of the bed and floor. The room looked more like a storeroom than a bedroom. On 12/17/2025 at 2:24 PM, R6 stated she was transferred to her current room because she was bitten by bed bugs and the problem of bed bugs has been going on for weeks. R7 stated that she was relocated because her roommate was bitten by bedbugs that is the reason that she was transferred to her current room. R8 was seen on the same floor but different room. R8 stated that she was transferred into her current room [ROOM NUMBER] to 7 days ago because of bedbugs. R8 stated that she must kill bedbugs on the curtains and on her bed. Room that has R9 and R10's names also have a tape with (Do Not Enter) written on it. On 12/19/2025 at 10:35 AM, V1 stated the room that was found to have full of plastic bags and clutter needs to be decluttered and currently was in the process of decluttering. The same room was not yet treated for bedbugs because it needs to be empty of personal belongings. V1 stated he always listens to residents 100%. When residents state that they were bitten by bedbugs he takes it 100%. V1 stated they found only 2 live bedbugs; when pest control reports document dead bedbugs, it means there are bedbugs in the facility. V1 stated V6, Housekeeping Director, is also the Environment Service Director and should be aware of the bedbug situation in the facility. V1 stated he understands residents are Residents Affected - Some (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 12/19/2025 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)