Health inspection·May 1, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and gowns are somewhat of a struggle for them to get. V10 showed the linen closet on the third floor, it showed shelves almost empty there were very few blankets, and linens, 11 towels and 8 gowns. There were 34 residents residing on this unit. On April 29, 2025, at 9:23 AM, V11 (CNA) stated that the facility frequently ran out of towels, sometimes there were totally no towels. The laundry staff would come in twice or three times, but they will give them 6 towels and linens for the whole unit, when there were lots of residents on the floor. On April 29, 2025, at 9:31 AM V12, V13, and V14 (All CNA) stated they ran out of linens and towels in general. There were days that they had difficulty arranging showers because there were no towels available. The laundry staff delivers 2-3 times, but it was not enough to meet residents' need. Laundry staff would deliver two to three pieces of linens, blankets, or towels, it just ranges but it was always not enough. V13 and V14 also said that it was so hard when they need to change the resident's linens because it was soiled and there was no linen available. On April 29, 2025, at 2:15 PM,V15 (Laundry Staff) was on the second floor ([NAME] Unit) delivering towels. V15 said they don't have enough circulating towels and linens in the whole facility, the number of towels and linens she delivers depends upon how much soiled towels and linens they collected from the units to wash. V15 also said they had to wait for towels and linens to be washed to distribute to the units. They only deliver what they have. There were 2 towels remaining and V15 delivered 9, making it 11 towels. There were a few linens and blankets on the shelves. On April 29, 2025, at 9:51 AM, on the second floor (Adam's Unit) there were seven remaining towels in the linen room and the laundry staff delivered 10 new towels. The linen room had shelves that were almost empty with scarce supply of linens and gowns. There were 54 residents residing on this unit. On April 29, 2025, at 9:57 AM, on the second floor ([NAME] Unit), the shelves in the linen closet looked almost empty there were 7 towels remaining and 12 new deliveries of towels, there were about 3 blankets and very few linens in the shelves. There were 53 residents residing on this floor. On April 29, 2025, at 2:39 PM, 2nd floor Dementia unit V16 (CNA) said there is shortage of towels and linens in the facility. Sometimes she couldn't give shower to residents because there was no towel at all. V16 continued, so far this is the most towels and linens that she had seen pointing at the almost empty shelves with linens and towels. On April 29, 2:47 PM, V17 (Activity Director) said the staffs frequently complaint of towel and linen shortage. V17 counted the linens and towels on the second floor Dementia unit. There were 24 towels, 4 blankets or big sheets, 11 drawsheets, 7 flat sheets. On April 29, 2025, at 2:53 PM, V18 (CNA) said they need more towels and sheets because it ran out quickly. There were times she goes to another floor, and they don't have linens and towel either. On April 29, 2025, at 4:04 PM, V1 (Administrator) stated they do purchase linens and towels, they need more in circulation. There's always linen available, it's just about having the right amount in circulation and the process of making sure that the linen room has enough supplies. They must figure out which they need to work on to, whether the purchasing or the process of distribution, but they will increase the circulation. V1 also stated they have no inventory of sheets and towels. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145246 If continuation sheet Page 2 of 5 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 145246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Hinsdale, The 600 West Ogden Avenue Hinsdale, IL 60521 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On April 30, 2025, at 9:35 AM, V22 (Laundry Staff) stated all the linens that were in the laundry room were being washed. Surveyor observed linens being washed in the washing machine. V22 stated that presently all the linens and towels they have in the laundry room were in the washer. It will all be delivered in the units after it was laundered. They were waiting from the unit floors to get all the soiled linens and towels to be washed. It takes 45 minutes for the laundry to wash and 30 minutes to dry. If staff could only bring the soiled linen on time, it would be washed on time. Surveyor observed that there was no extra clean linen nor towel noted in the laundry room. V22 stated everything was already delivered to the units. On April 30, 2025, at 10:17 AM, V23 (Environmental Services Director) stated that they don't have enough circulating linens and towels. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145246 If continuation sheet Page 3 of 5 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 145246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Hinsdale, The 600 West Ogden Avenue Hinsdale, IL 60521 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on observation, interview, and record review, the facility failed to ensure that menus and dietary orders are being followed to meet resident's needs. This applies to 6 of the 6 residents (R4, R6, R7, R8, R9, R11) reviewed for meal portions in the sample of 11. Findings include: 1. On April 28, 2025, at 12:18 PM, R4 stated that he was supposed to received double portions with meals as ordered. Sometimes they don't give it to him. The double portion was recommended to him because he was losing weight. R4's Physician Order Summary with revision date of September 18, 2025, shows general diet, double portions with meals. R4's ticket menu which was in his tray showed that he was supposed to received Double Portions of 4 ounces (oz) mixed fruit, 4 oz meatloaf, 4 oz mashed potatoes, 4 oz green beans, 1 slice bread, choice of milk, 8 oz beverage. On April 28, 2025, at 12:35 PM, during lunch time, V4 received 2 slices of meatloaf, 1 slice of bread, 1 scoop of mashed potatoes, 1 scoop of green beans, 6 small pieces of pineapple chunks. There was no milk and no beverage in his lunch tray. 2. On April 29, 2025, at 9:39 AM, R7 said that she was not satisfied with the breakfast this morning, she felt that the meal portion was small. R7 said she was given one slice of bacon, a cup of oatmeal, cinnamon roll, milk, and juice. R7 also said she's supposed to received cheesy ham and egg but got one piece of bacon instead. It does not match the menu on her ticket meal. There was no sign of egg in R7's plate, there was a very small piece of leftover of the cinnamon roll on her plate, an empty small bowl with traces of oatmeal. R7's ticket menu for breakfast dated April 29, 2025, showed: Juice of choice, oatmeal or cereal, cheesy ham and egg scramble (3 oz), 1 slice of toast, milk of choice, hot tea or coffee. 3. On April 29, 2025, at 10:09 AM, R11 stated he has a cinnamon roll, a chocolate milk, 2 slices of bacon, coffee, and oatmeal. R11's menu ticket dated April 29, 2025, shows chocolate milk, oatmeal, cheesy ham and egg, 1 slice of toast with butter, and coffee. 4. On April 29, 2025, at 11:14 AM, R6 stated that he would like more available food. There were times the food served to them does not match the things listed on the menu. Sometime last week the menu showed chicken sandwich but what they served was a baked chicken breast only with no bread. R6 wished that they gave him bread to complete the meal. 5. On April 29, 2025, at 1:21 PM, R8 said that frequently the menu does not match what they were being served. This morning, she was given 2 eggs, 2 slices of bacons, cinnamon roll, coffee. R8 requested a cream of wheat but they did not give it to her. 6. On April 29, 2025, at 1:25 PM, R9 said there were times their menu was not accurate. There were circumstances when R9 ordered a ham sandwich, but they gave her a grilled cheese sandwich, and she was lactose intolerant. Another circumstance, R9 did not like the dinner they were serving so R9 ordered a hot dog sandwich, but they gave her a piece of toast. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145246 If continuation sheet Page 4 of 5 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 145246 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearl of Hinsdale, The 600 West Ogden Avenue Hinsdale, IL 60521 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On April 29, 2025, at 3:28 PM, V6 (Dietary Manager) and V5 (Regional Director of Operations), both said that double portion means double of everything unless specified by the physician to give double protein only. Menu is supposed to be followed. V6 also said they dropped the pan of eggs this morning. They did not have enough fresh eggs and extra liquid eggs to serve for the whole building. They did not have enough time to serve the residents the eggs because the delivery truck came in at 9AM. They gave them 2 slices of bacon because they had to give them something at that moment. The Resident Council Minutes dated January 31, 2025, shows food items are not always on tray. Council minutes dated March 28, 2025, shows food is getting better but would like big portions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145246 If continuation sheet Page 5 of 5