Inspection·March 6, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some history of a Class 4 felony, was at moderate risk, and requires closer supervision and more frequent observation than standard or routine for most residents in an open facility. Care plan, initiated 9/5/24, shows R6 is to remain on his designated floor (2nd floor) and is not to enter other residents' rooms. [R6] will be escorted to and from floors if he is to participate in the designated smoke times, attend activities or go to therapy. Interventions include educating the resident on appropriate behavior redirect resident if seen on the first floor other than to smoke or participate in activities and monitor resident when in community areas to make sure actions are appropriate. 2. Facility Final Incident Investigation Report Form, provided 2/22/25, shows the facility substantiated R1 was abused by V8. The report shows the abuse occurred on 2/16/25 and R1 left the facility AMA on 2/18/25 at approximately 10:30 PM. Facility abuse investigation documents show V8 was interviewed and stated he assisted R1 with a shower, stood outside her curtain, assisted R1 as she stumbled, and then only washed her back and lower legs for R1. V8 denied touching R1 in inappropriate ways. V8 stated he and R1 connected on Facebook on 2/16/25 and messaged each other on the application. On 2/20/25 at 9:56 AM, V4 (PRSC- Psychiatric Rehabilitation Services Coordinator) stated R1 showed her a message from V8 on R1's phone regarding V8 becoming sexually aroused when V8 was near R1. V4 stated she was shocked and felt the messages were very inappropriate. V4 stated R1 told her that R1 kept the conversation going via the messages because she wanted proof of how V8 was talking to R1. On 2/20/25, V3 (assistant admininstrator) stated she was informed on 2/17/25 that V8 was messaging R1 via phone in a sexual nature. V3 stated she interviewed R1, R1 read V3 some of the messages, and V3 read messages which showed V8 was referring to becoming sexually aroused when he saw R1. V3 stated, I saw enough- they were very concerning. V3 stated by the time the police arrived, V8 deleted the messages on the messaging application. On 2/20/25 at 1:13 PM with V25 (R1's Friend), stated, R1 stated V8 would often bring R1 food from outside the facility including the day V8 inappropriately touched R1. R1 stated, Then as we were showering, he ended up washing my [internal reproductive area] and then my [buttocks]. R1 stated she almost fell prior in the shower and V8 steadied her but then continued washing areas of R1's body that she did not need assistance washing. R1 stated V8 never asked if he could wash R1's body. R1 stated after the shower R1 and V8 were in R1's room and V8 stated, Nice butt. R1 stated V8 stated, Could I tell you something without getting fired? You have a really nice butt and nice boobs. R1 stated after the comments, V8 asked to connect on Facebook with R1 and V8 used R1's phone to add V8 as her friend. R1 stated at that time they were sitting next to each other in her room and V8 stated, He told me how cute I was, that I had a cute butt and boobs again, and then he left. R1 stated V8 later messaged R1 telling her that V8 was sexually aroused, suggested he could have sexual intercourse with her while she was in the shower, and referenced the size of his sexual organ. R1 stated all of the administrative staff left the facility because it was late on a Sunday, so R1 reported the interactions the next day to V4 (PRSC- Psychiatric Rehabilitation Services Coordinator). R1 stated she showed V4 and V3 (Assistant Administrator) the messages from V8 before V8 deleted the messages on the application. R1 stated she didn't initially mention her concerns about the shower because R1 thought V8 was helping her but after R1 told her children about the interaction, they told R1 no staff should be helping her in the shower and R1 was capable of washing herself even if she became off balance. R1 stated she told V26 (Restorative CNA) about V8 washing her peri area in the shower and R1 stated V26 told R1 that R1 did not need assistance from staff to perform those tasks. R1 stated V26 never washed R1's peri area in all the times V26 provided R1 assistance in the shower. R1 stated she experienced (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 2 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some prior sexual assault at the facility by a resident and stated, Hence I am no longer there. I am not safe at all at that facility Nobody asked me if I felt safe at the facility this time. I had friends come and get me on Tuesday because I don't feel safe! On 2/20/25 at 3:15 PM, V26 (Restorative CNA) stated R1 could independently wash herself in the shower. V26 stated R1 could sit on a shower bench and wash all of their body in the shower. V26 stated R1 only needed supervision to help her get set up and regulate the water temperature in the shower. V26 stated she assisted R1 with a shower on 2/18/25 and R1 did not require assistance to physically wash R1. On 2/20/25 at 11:54 AM, V23 (R1's Daughter) stated R1 was sexually assaulted at the facility in the past and V23 stated R1 was sexually abused a second time by facility staff. V23 stated the facility staff did not need to assist R1 to walk to the shower but recently a male CNA was allowed to wash her body and her privates. V23 stated on 2/17/25 at 12:44 AM, R1 messaged V23 stating she had to report a male CNA because he helped R1 in the shower and made verbal and written sexual comments toward R1 via phone, and suggested R1 allow V8 have sexual intercourse while being showered by V8. R1 identified the staff as V8. V23 stated she called the facility at approximately 2:15 PM on 2/17/25 and spoke to V4 (PRSCPsychiatric Rehabilitation Services Coordinator). V23 stated she told V4 she was aware of V8 sexually messaging R1 as well as touching R1 inappropriately in the shower. V23 stated she called the police at 2:30 PM to report the allegation that V8 touched R1 inappropriately in the shower and the inappropriate messages because V4 stated they were not going to call the police but instead would handle it in house. V23 stated she pulled R1 out of the facility and sent R1 to the hospital to be examined on 2/18/25. On 2/20/25 at 12:53 PM, V24 (R1's Friend) stated she was with R1 at the hospital on 2/17/25 and R1 told the staff V8 asked R1 if she needed help with her shower and R1 told him she did not because she was fully capable of washing herself. V24 stated R1 told the staff V8 proceeded to wash her vaginal and buttocks areas which shocked R1. V24 stated on 2/16/25 evening, R1 messaged V24 stating V8 made verbal sexual comments toward R1. On 2/20/25 at 4:00 PM, V9 (Police Officer) stated V3 told her that V3 did see some of the messages and described the messages as very disturbing. At 7:00 PM, V9 stated V8 came to the police station to do an interview but would not speak with the police officers and requested a lawyer. On 2/20/25 at 11:15 AM, V5 PRSD (Psychiatric Rehabilitation Services Director) stated she spoke with V8 who stated he stood outside the shower curtain during R1's shower until R1 stumbled. V8 stated he helped R1 and then helped R1 wash her legs and back. V5 stated V8 was very short with his answers and not forthcoming. On 2/20/25 at 9:15 AM. V1 (Administrator) stated on 2/17/25 he received report that R1 alleged V8 (CNA) sent sexual messages via phone to R1. V1 stated the messages included phrases such as you are hot or you are sexy. V1 stated when he asked to see the messages, the messages were deleted. V1 stated he spoke with V8 who admitted to messaging R1 but denied ever physically touching R1. V1 stated V8 resigned from facility employment. V1 stated later in the day on 2/17/25, R1 contacted V1 and informed V1 she spoke with her daughter who informed R1 that V8 assisting R1 in the shower was sexual abuse because R1 did not require physical assistance with her showers. V1 stated R1 told V1 that V8 unnecessarily wiped R1's peri area and buttocks during her shower. On 2/25/25 at 12:38 PM with V27 (R1's Friend), stated, R1 stated since R6 sexually abused R1, R1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 3 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some experienced R6 in close physical proximity and unsupervised to her several times and as recent as January 2025. R1 stated, I was freaked out and stated she told a staff member. R1 stated R6 would visit the table at which she was sitting for approximately 10 minutes and talk to all of the residents at the table other than her. R1 stated R6 at times pushed a resident around the first floor in his wheelchair unsupervised where she resided. R1 stated R6 was not supposed to be on the first floor and was supposed to remain on the second floor where he resided because of the sexual abuse she experienced by R6. R1 stated R6 came down to the first floor unsupervised other than during designated smoking breaks. On 2/20/25, V23 (R1's Daughter) stated R1 messaged her on 1/26/25 at 11:25 AM telling V23 that R6 was walking by R1. V23 stated R1 pressed charges against R6 last year after R6 sexually assaulted her and R1 recently went to court on the case and there was an upcoming court date in April of 2025. V23 stated R1 left the facility because R1 was not safe at the facility. On 2/20/25 at 1:13 PM with V25 (R1's Friend), R1 stated she was sexually assaulted by R6 the prior year and she was in disbelief she was sexually assaulted again the facility recently by staff. R1 stated she no longer felt safe at the facility because she experienced sexual abuse twice and she chose to discharge AMA from the facility to a friend's home until she could find a different facility in which to live. On 2/24/25 at 3:55 PM, R6 stated he travels up and downstairs by himself to smoke breaks at the facility. On 2/25/25 at 1:35 PM on the first floor, R6 walked off the elevator with female resident and independently walked into the dining room. R6 then began walking around the dining room talking to residents with no direct supervision from staff. V28 (Social Services) was sitting at a table with a resident engaged 1:1 in an interview of the resident. R6 stood at R14's table talking to residents with no direct supervision and then walked to R9's table and then back to R14's table. At 1:40 PM, an announcement was made overhead the facility that the smoking patio would be opened in five minutes. R6 continued to walk around the dining room speaking to R9 and other residents. There were 11 females and 11 males in the dining room in addition to R6. On 2/26/25 at 9:45 AM, V1 stated R6 did not need any kind of supervision at the facility. V1 stated R6 was moved to the second floor because of his isolated behavior of sexual abuse toward R1 (which was substantiated) and to reduce interactions with R1 when the incident was new. V1 stated he did not deny R6 was coming down to the first floor unsupervised. On 2/24/25 at 3:47 PM, V31 (CNA- Certified Nursing Assistant) stated R6 travels back and forth on the elevator to the first floor independently without supervision. On 2/24/25 at 3:45 PM, V30 (Registered Nurse) stated R6 was not allowed to go downstairs due to an incident a year ago which was why R6 was moved to the second floor. V30 stated R6 did travel back and forth on the elevator without an escort to the first floor. 2. Face sheet, dated 2/22/25, shows R5's diagnoses included Huntington's disease and mood disorder. R5 was admitted to the facility on [DATE]. MDS, dated [DATE], shows R5 was cognitively intact and R5 was able to propel in a wheelchair once set up in the wheelchair. Care plan, dated 4/23/24, shows R5 was admitted to the facility on [DATE] with a criminal history (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 4 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of violating an order of protection and domestic battery. Approaches include, Review of my past behavior and evaluate the potential for me to engage in inappropriate / high risk behavior, provide R5 with supportive group intervention and/or 1:1 via a qualified provider, to promote safety intervene when I am observed to be engaging in inappropriate behavior, teach me impulse control strategies and communicate to me that I am responsible for all my actions/behavior and must therefore exercise control over my impulses and behavior. Care plan, dated 10/17/24, shows R5 had a history of a hit and run accident and may have flashbacks, become upset, and become aggressive verbally and physically with staff. Care plan, dated 11/4/24, shows R5 was observed with manipulative behaviors and approaches included providing educations to not fabricate stories, perform check-ins with residents, and providing 1:1 interaction with R5 to help find solutions towards issues. Behavioral care plan, initiated 2/10/25, shows R5 displayed verbal and physical aggressive behaviors toward others, uncontrolled behavior outbursts and requires the use of non-pharmacological and pharmacological interventions to address and mitigate behaviors. Interventions included Social Services will continue to educate resident on aggressive behaviors and encourage resident to utilize healthier ways to communicate thoughts and feelings. Social services will work with resident to establish better communication and mechanisms. Delusions/paranoia care plan, dated 2/14/25, shows R5 was diagnosed with Huntington's disease and believes everyone is making fun of his disability. Interventions include psychiatric management, minimizing risk factors through interventions such as assessment, team, consultation, supervision, observation, structured environment, peer-buddy system, contracting and medication management. Other interventions include teaching stress/anxiety management techniques, discussing benefits of therapy with physicians, encouraging resident to follow mental health treatment plans and encouraging resident to attend groups. Illinois State Police report, dated 1/2/24, shows R5 was convicted of domestic battery/bodily harm, revisiting a peace officer, criminal trespassing, possession of drug paraphernalia, manufacturing/delivering controlled substances. Facility Final Incident Investigation Report Form, dated 2/10/25, shows on 2/6/25 R5 stood up and attempted to hit R7 in the face. The report shows R5 was sent to the hospital and R7 declined to press charges. The report shows R5 has a history of dwelling in the past which leads him to become physically aggressive with co-residents. The report shows R5 was educated on the facility policy and proper way of communicating. R7 was educated on the proper way to speak to his co-residents. Investigation witness statement, shows R7 reported R5 repeatedly came into R7's room and when R7 asked if R5 had a problem, R5 stood up and started punching R7. The statement shows R7 covered his head while R5 swung but R5 missed which caused R7 to fall. Investigation witness statement shows V17 (Registered Nurse) heard R7 was calling R5 the n word and R7 told R5 to get away from R7. The statement shows R5 stood, leaned into R7 and hit him in the left side of the face. The statement shows R7 pushed R5 off of him and R5 lost his balance and fell. Investigation witness statement shows V11 (Registered Nurse) saw R7 and R5 arguing, R5 stood and hit R7, and R5 fell to the floor. The report shows the facility did not substantiate the abuse because R5 stood up from his wheelchair and attempted to hit [R7], but has an unsteady gait, which caused him to lose balance and fall into [R7]. Nursing note, dated 2/5/25, shows, Writer was standing near nursing station, turned around to note this resident standing up and using profanity towards a co-resident. As soon as writer began to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 5 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some approach the situation, this resident stood up, leaned into co-resident and was physically aggressive. Co-resident pushed this resident to the ground. The writer and other staff members separated the resident from each other. On 2/25/25 at 2:59 PM, R7 stated he had a previous altercation with R5 approximately a year ago when the two were roommates and R5 hit (R7) in the head several times. R7 stated the most recent altercation happened a few weeks ago when R5 hit him in the head several times and R7 stated he had several knots on his head. Social Services note, dated 2/5/25, shows the PRSD was informed that R5 and another co-resident got into a physical altercation by the nursing station, R5 hit another co-resident, and R5 was being sent out for a psychiatric evaluation. Social Services note, dated 2/5/25, shows R5 got in a physical altercation with co-resident as resident claimed that this co-resident had insulted him. PRSC explained to resident that he cannot get physical with co-residents whatsoever. PRSC explained to resident that if he has an issue with co-resident, he must find a PRSC to intervene. Resident was therefore educated on facility policy and proper communication. Will continue to monitor. Review of R5's clinical record showed no interventions were put into place to prevent further physical aggression by R5. Progress note, dated 2/6/25, shows R5 angrily knocked on R7's door to get in, entered R7's room, and knocked R7's belongings around the room and was verbally aggressive. The note shows R5 hit R7 the day prior and R5 was told to stay away from R7. The progress notes show R5 was sent to the hospital for evaluation and returned the same day to the facility. Review of R5's clinical record showed no interventions were put into place to prevent further physical aggression by R5. 3. Face sheet, dated 2/20/25, shows R4's diagnoses included schizoaffective disorder, epilepsy, convulsions, post-traumatic stress disorder, and cocaine/cannabis abuse. MDS, dated [DATE], shows R4 was cognitively intact and could independently ambulate at the facility. Care plan note, dated 1/28/25, shows R4 was reported to be making inappropriate remarks, becoming aggressive with staff, and verbally aggressive with co-residents. Care plan notes, dated 1/28/24, show R4 experiences auditory and visual hallucinations and paranoia when discussing his symptoms. Progress note, dated 2/9/25, shows R5 was in a second physical altercation at the facility. The note shows, Writer was notified that [R5] was fighting with other resident at the end of the hallway 400. We proceeded to separate them, assess them, and place them in different areas. I notified [Psych Nurse Practitioner], who ordered to send the resident to the [Psychiatric Hospital] for a psychiatric evaluation Facility Final Incident Investigation Report form, submitted 2/14/25, shows on 2/9/25 in the 400 hallway, R5 stood up and hit R4 in the face after R4 was speaking with V14 (Housekeeping). V14's statement shows R4 did nothing to provoke R5 to hit R4 and V14 was hit during the altercation. The investigation shows R4 stated R5 caught R4 off guard and R5 smacked [R4] on the lips. The investigation showed R4 was protecting his head because of his seizures and was trying to run away but was not able (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 6 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some to do so because of his clinical condition. The statement shows staff assisted to stop R5 and staff assisted R4 up off the floor and took him upstairs. The report shows R4 was educated not to go to the first floor, R5 was sent to the hospital for a psychological evaluation, local police were called, and R5 was educated on facility policies and the proper way of communicating. The report shows the facility substantiated R5 physically abused R4. Progress notes, dated 2/9/25, shows R5 was sent to the psychiatric hospital and returned to the facility the same day. Review of R5's clinical record showed no interventions were put into place to prevent further physical aggression by R5. Social Services note, dated 1/24/25, shows R4 was reported to have called a co-resident in a wheelchair a vegetable. The note shows R4 had a history of bullying co-residents and was told he could not bully residents. Social Services note, dated 2/10/24, shows R4 was educated to stay away from R5 and R4 was encouraged to stay on the second floor during meal times. The note shows R4 verbalized understanding. 4. Progress notes, dated 2/13/25, show R5 was in a third physical altercation at the facility (R5's second altercation with R4 within two days), 911 was called, the police and fire department arrived at the facility and R5 was escorted from the facility by the police. The progress notes show R5 was being involuntarily admitted to the psychiatric hospital with diagnoses including aggression/mood disorder. Facility Final Incident Investigation Report Form, dated 2/18/25, shows on 2/13/25 at approximately 7:40 AM, R5 again hit R4 which was witnessed by staff. Witness statement by V15 (Registered Nurse) shows R5 suddenly got up from his wheelchair and pushed [R4] against the wall, [R4] hit his head to the wall and fell on the floor. [V15] immediately ran towards and separated [R5] from [R4], [R4] was on the floor, he was unconscious [V11] called 911 while we were monitoring[R4]. R5's statement stated R4 was picking on R5 so R5 got up from his wheelchair to try to hit [R4] but lost his balance and grabbed onto his sweatshirt instead to gain back balance. R4's statement shows R4 briefly spoke to R5 when he walked past R5 with nice words and when walking away from R5 R5 pulled his sweatshirt and fell to the floor, and R4 thought he fell to the floor because he had a seizure. Investigation witness statement by V11 (Nurse) shows V11 saw R5 and R4 next to each other and V11 immediately told R4 to move. The statement shows R4 began to walk away and then R5 suddenly got up from his chair and tried to walk toward R4 but because of R5's disease R5 fell. The witness statement shows R4 had a seizure and the police removed R5. The report summary shows the facility concluded that the allegation of physical abuse by R5 was substantiated. The report shows R4 was educated to keep his distance from R5, was told not wander to the first floor during mealtimes and wait until mealtimes are over to go to the first floor. The report shows R5 was educated to not use physical violence towards co-resident and to speak to case workers to resolve issues with residents. The report shows R5 believed people are against him and residents make fun of him even if they are not. R5 was sent to the hospital for psychological evaluation and returned to the facility, the residents were separated by floors, and plans were made to move R5 to a private room. On 2/20/25 at 11:27 AM, V16 (PRSC) stated R5 felt like residents like R4 make fun of R5's disability and that was why R5 hit R4. Social Services Note, dated 2/14/25, shows, Resident is no longer a part of the work program due to numerous aggressive incidents in past week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 7 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Progress note, dated 2/14/25, shows the facility spoke with [V12 (Psychiatrist)] to place [R5] in a different nursing due to increase aggressive behaviors. [V12] is working with hospital caseworkers to find a appropriate placement. Progress note, dated 2/18/25, shows R5 was readmitted to the facility from the psychiatric hospital. Review of R5's clinical record showed no interventions were put into place to prevent further physical aggression by R5. 5. Progress note, dated 2/20/25, shows R5 was in a fourth physical altercation at the facility with a co-resident in the back patio of the facility. Facility Final Incident Investigation Report Form, submitted 2/25/25, shows the facility substantiated the allegation that R5 physically abused R6. The report shows R6 was punched unprovoked by R5 and the altercation was witnessed by R8-R11. Witness statements shows R8 stated he intervened to try to prevent R5 from hitting a staff member and fell, R9 was talking to R6 and R5 began hitting R6 without provocation, R10 stated R5 got up and grabbed R6, and R11 stated R5 got out of his chair and swung at R6. Staff witness statements show V18 (Activities) stated R5 started swinging at R6 and R8 tried to intervene. On 2/21/25, V22 (Hospital Case Manager), stated when R5 was admitted to the hospital emergency department, there was no medical necessity to admit R5 to the hospital, but the facility would not allow R5 to return to the facility. V22 stated R5 reported to hospital staff that he was constantly being placed near a resident that constantly bullied and harassed him and R5 felt like he needed to defend himself. V22 stated while R5 had been in the hospital R5 had not shown any aggression. V22 stated, While he has been at the hospital, he has been fine. Maybe they aren't moving him away from this person like he is asking! Hospital Nurse Practitioner note, dated 2/21/25, shows, R5 was previously admitted to the inpatient psychiatric unit between 2/13/25 and 2/18/25. The note shows R5 was returned to the emergency room on 2/20/25 with the facility stating he was not welcome back to the facility. The note shows R5 was discharged previously from the facility to a different hospital for the same reason and returned to the facility at that time. During this admission, R5 was unable to be admitted to inpatient psychiatry due to not meeting criteria. The note shows the facility stated R5 was aggressive and injured six other residents and the facility would not allow him to return. On 3/325 at 12:30 PM, V12 (Physician) stated when R5 arrived at the hospital R5 was appropriate and there was no sign of aggression from R5. V12 stated there was no reason to admit R5 to the hospital however the hospital was forced to take R5 because the facility would not accept R5 back. 6. MDS, dated [DATE], shows R2 was cognitively intact. Review of R2's care plan showed no concerns with aggressive behaviors. MDS, dated [DATE], shows R3 was cognitively intact. Care plan, initiated 9/11/24, shows R3 displayed verbal aggressive behaviors toward others, uncontrolled outbursts, and changes his story to make himself look like the victim. On 2/20/25 at 3:30 PM, R3 stated he was attempting to wake his friend, who was sleeping on a table, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 8 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 Level of Harm - Immediate jeopardy to resident health or safety so he began banging on the table. R2 told R3 he was going to go to the hospital and R2 hit R3. R3 stated he was hit first by R2, but R3 hit him back. On 2/20/25 at 3:00 PM R2 stated R3 began messing with a resident and R3 threw a punch at R2. R2 had a healed scratch on his left upper cheek. R2 stated if he had not slipped, he would have fought back and hit R3. Residents Affected - Some Social Services note, dated 2/13/25, shows at 3:55 PM in the first-floor dining room, R3 was having a conversation with another co-resident when he alleged another resident interrupted him. R3 alleged that the other resident then punched R3 in the side of the head and R3 responded by punching him and knocking him to the ground and then hit him again. Final Incident Investigation Report Form, dated 2/18/25, shows on 2/13/25 R3 hit R2 after a verbal argument in the first-floor dining room. The Form shows V6 (Registered Nurse) witnessed the end of the occurrence and R2 sustained a scratch on his left check. The report shows the police were called, R3 was sent to the hospital for a psychiatric evaluation, and R2 was treated at the facility. The Form shows R3 was educated on not using physical violence toward other residents and the facility substantiated R2 was physically abused by R3. Abuse Prevention Program - Policy, dated 11/22/17, shows, Residents have the right to be free from abuse, neglect, exploitation, misappropriation of property or mistreatment The facility prohibits abuse, neglect, misappropriation of property, and exploitation of its residents including verbal, mental, sexual or physical abuse .The facility has a no tolerance philosophy; persons found to have engaged in such conduct will be terminated. Definitions: Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means Abuse is also the willful infliction of injury Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Physical abuse is the infliction of injury on a resident that occurs other than by accidental means and that requires medical attention Sexual abuse is non-consensual sexual contact of any type with a resident Mental abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation, or offensive physical contact by a licensee, employee or agent. Mental abuse is also the use of verbal or nonverbal conduct which causes or has the potential to cause the resident to experience humiliation, intimidation, fear, shame, agitation, or degradation Facility Abuse Prevention Training Program, dated 11/22/17, shows, .Protection - The facility will remove any alleged perpetrator(s) of abuse or neglect from any further contact with residents pending an investigation . If the perpetrator is a resident, the residents will be separated from the alleged victim The facility presented an abatement plan to remove the immediacy on 2/19/25. The survey team reviewed the abatement plan and was unable to accept the plan to remove the immediacy. The abatement plan was returned to the facility for revisions. The facility presented a revised abatement plan on 2/19/25, and the survey team accepted the abatement plan on 2/19/25. The Immediate Jeopardy that began on 2/16/25 was removed on 2/20/25 when the facility took the following actions to remove the immediacy. - On 2/20/2025 R5 was given an immediate discharge to St [NAME] Hospital, R5 no longer a resident of River View. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 9 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0600 - On 2/26/25, R6 was reassessed on Screening Assessment for Ind[TRUNCATED] Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 10 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to report and thoroughly investigate resident allegations of abuse per facility policy. Residents Affected - Few This applies to 2 of 5 residents (R1 and R7) reviewed for abuse in a sample of 16. The findings include: 1. On 2/20/25 at 1:15 PM, R1 stated on 2/17/25 she told V23 (R1's Daughter) that on 2/16/25 V8 made verbal and written inappropriate comments regarding her body and also inappropriately washed her periarea and buttocks while showering R1. R1 stated V8 did not wash any other parts of her body and stated she should be washing herself. R1 stated she spoke with V26 (CNA) the next day about V8 washing her peri area and buttocks and R1 stated V26 told R1 did not require any staff to wash her body because R1 could do that independently. On 2/20/25, V23 (R1's Daughter) stated R1 reported to her on 2/17/25 that while in the shower, V8 allowed R1 to wash all of her body but when R1 began to wash her peri area and buttocks, V8 insisted on touching her and washing R1. V23 stated R1 told V23 that V8 also made several verbal comments regarding her breasts and buttocks and began messaging R1 sexual messages via her phone. V23 stated she spoke to R1 and R1 told her V8 touched her inappropriately in the shower in addition to verbalizing/messaging R1 sexual messages. V23 stated she called the facility at approximately 2:25 PM on 2/17/25 and spoke with V4 (PRSC- Psychiatric Rehabilitation Services Coordinator). V23 stated she asked if V4 was aware V8 inappropriately messaged and touched R1 inappropriately in the shower and also asked if the police were informed. V23 stated V8 told V23 that the facility was aware of the messages and the shower allegation and the facility was going to handle it in house. V23 stated she contacted the police herself on 2/17/25 at 2:30 PM to report R1 was inappropriately touched in the shower and the police told her no one had yet reported R1 was touched inappropriately in the shower. V23 stated she asked the police to go to the facility and investigate because she did not want the investigation handled in house at the facility. V23 stated R1 was not sent to the hospital by the facility after her allegation or sexual abuse in the shower and V23 removed R1 from the facility on 2/18/25 AMA (Against Medical Advice) and sent R1 to the hospital with a friend to be examined related to her allegations.V23 stated, After seeing this, I sent my mom to the hospital - I pulled her out and she went to the hositpal. On 2/20/25, V9 (Police Officer) stated it was V23 (R1's Daughter) who informed the police regarding the allegation R1 was touched inappropriately in the shower by V8 on 2/17/25 at 2:35 PM. V23 stated the facility called the police prior on 2/17/25 regarding R1 being harassed by V8 via phone messages, but no mention was made regarding V8 touching R1 inappropriately in the shower the time the facility called the police. Preliminary Incident Investigation Report Form, submitted to IDPH (Illinois Department of Public Health) on 2/17/25 at 1:16 PM, shows the facility reported an allegation of Verbal or Mental Abuse of R1 committed by V8 (CNA- Certified Nursing Assistant). The report shows, It was reported that a CNA was flirting with [R1] through text messages. There were no injuries, and a full investigation is to follow. The report shows the date of the alleged incident was 2/17/25, the time of the alleged incident was 1:00 PM, and the time of the report was 2:40 PM. Preliminary Incident Investigation Report Form, submitted to IDPH on 2/20/25, shows the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 11 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0610 Level of Harm - Minimal harm or potential for actual harm reported an allegation of Sexual Abuse of R1 committed by V8. The report shows, Addendum 2/20/25: Resident later reported that she was helped by CNA [V8] in the shower, she reported that CNA [V8] inappropriately touched her while assisting with the shower. The report shows the date of the alleged incident was 2/17/25, the time of the alleged incident was 12:00 PM, and the time of the report was 1:30 PM. Residents Affected - Few On 2/20/25 at 9:15 AM, V1 (Administrator) stated on 2/17/25 he received an allegation that on 2/16/25 R1 was receiving messages sexual in nature via her phone from V8 (CNA- Certified Nursing Assistant). V1 stated at the time of R1's initial allegation, R1 denied that any physical in nature occurred between R1 and V8. V1 stated later in the day on 2/17/25, R1 contacted V1 and informed V1 that V8 sexually abused her while he was assisting her with her shower on 2/16/25. V1 stated R1 reported she did not require any physical assistance to clean herself in the shower and V8 unnecessarily wiped R1's periarea and buttocks during her shower. On 2/20/25 at 2:25 PM, V1 stated he submitted his initial abuse allegation report regarding the inappropriate messages to R1 within two hours of receiving the allegation. V1 stated when he received the allegation R1 was inappropriately touched in the shower, he intended to put that information in his final report regarding the initial allegation of verbal/mental abuse he submitted on 2/17/25. On 2/20/25, V5 (PRSD- Psychiatric Rehabilitation Services Director) stated she spoke with R1 on 2/18/25 and R1 stated in addition to receiving inappropriate sexual messages via phone from V8, R1 stated she was sexually abused by V8 because she only required supervision in the shower and V8 washed her inappropriately. On 2/22/25, V1 stated in informed the police regarding R1's sexual abuse allegation on 2/20/25 at approximately 4:00 PM and informed R1's physician on 2/21/25 at approximately 12:00 PM. Facility Final Incident Investigation Report Form, provided 2/22/25, shows Based on the investigation, it is substantiated that [V8] touched [R1] inappropriately. The report fails to show record of R1 alleging that V8 inappropriately touched her periarea and buttocks while he showered R1 and that R1 did not require assistance to wash her body in the shower. The report fails to show V3 (Assistant Administrator) and V4 both personally witnessed the inappropriate phone messages on R1's phone sent by V8. On 2/20/25 at 1:13 PM, R1 stated she showed V8's sexually inappropriate phone messages to V3 and V4 on 2/18/25. On 2/20/25 at 10:38 AM, V4 stated she witnessed sexually inappropriate sexual messages on R1's phone from V8 before V8 deleted the messages. On 2/20/25 at 9:56 AM, V3 stated she witnessed sexually inappropriate sexual messages on R1's phone from V8 before V8 deleted the messages. Review of R1's clinical record shows the facility did not send R1 to the hospital after R1 alleged she was sexually abused in the shower by V8 on 2/16/25. 2. On 2/25/25 at 2:59 PM, R7 stated he had a previous altercation with R5 and in the most recent altercation a few weeks prior R5 hit him in the head several times. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 12 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Facility Final Incident Investigation Report Form, dated 2/10/25, shows on 2/5/25 R5 stood up and attempted to hit [R7] in the face. The report shows the facility did not substantiate the abuse because R5 stood up from his wheelchair and attempted to hit [R7], but has an unsteady gait, which caused him to lose balance and fall into [R7]. Abuse investigation witness statement provided by the facility shows R7 reported R5 repeatedly came into R7's room and when R7 asked if R5 had a problem, R5 stood up and started punching R7. The statement shows R7 covered his head while R5 swung but R5 missed which caused R7 to fall. Abuse investigation witness statement provided by the facility shows V17 (RN- Registered Nurse) reported R5 stood, leaned into R7 and hit him in the left side of the face. The statement shows R7 pushed R5 off of him and R5 lost his balance and fell. Abuse investigation witness statement provided by the facility shows V11 (RN) saw R7 and R5 arguing and R5 stood and hit R7. POS (Physician Order Sheet), dated 2/5/25 shows a physician order for R5 to Send to ER for physical aggression Nursing note, dated 2/5/25, shows R5 stood up, leaned into co-resident and was physically aggressive. Social Services note, dated 2/5/25, shows the PRSD was informed that R5 and another co-resident got into a physical altercation and R5 hit another co-resident. Social Services note, dated 2/5/25, shows R5 got in a physical altercation with co-resident as resident claimed that this co-resident had insulted him. PRSC explained to resident that he cannot get physical with co-residents whatsoever. PRSC explained to resident that if he has an issue with co-resident, he must find a PRSC to intervene. Resident was therefore educated on facility policy and proper communication. Will continue to monitor. Facility Abuse Prevention Training Program, dated 11/22/17, shows, . The resident's physician and representative, if necessary, shall be notified of any incident or allegation of abuse, neglect, exploitation, mistreatment or misappropriation of resident property Physicians will be notified of any incident and any medical treatment will be done as ordered Reporting & Response - .The administrator or designee will notify the resident's representative and physician of the alleged incident and the investigation The administrator or designee shall notify the local police of any suspicion of a crime or in the event of resident death other than by disease process An initial report to the State licensing agency, Illinois Department of Public Health, shall be made immediately after the resident has been assessed and the alleged perpetrator has been removed Final Report & Follow Up. Within five days after the report of the occurrence, a complete written report of the conclusion of the investigation, including steps the facility has taken to respond to the allegation, will be sent to the Department of Public Health. i. Report Contents. The final report shall include the following, as appropriate: .the original allegation (note day, time, location, the specific allegation, the alleged perpetrator, witnesses to the occurrence, circumstances surrounding the occurrence and any noted injuries); a summary of facts determined during the process of the investigation, review of the medical record and interview of witnesses; and conclusion of the investigation based on known fact The document shows, .Immediately is defined as as soon as possible after being made aware of an allegation of abuse, neglect, misappropriation of resident property or exploitation but is not more than 2 hours if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 13 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the events that cause the suspicion result in serious bodily injury or involve an allegation of abuse or not later than 24 hours if the events that cause the suspicion to don result in bodily injury Facility Abuse Policy Investigation and Reporting document, dated 11/22/17, shows, The Interview Process: Determine if written statements will be taken of the interviewee. If statements are taken, ensure that the statement is factual and not conclusatory (i.e. no assumptions, only facts observed or known to the interviewee) Physical Abuse Incident Response Guide - Definition Physical Abuse is the infliction on a resident that occurs other than by accidental means and that requires medical attention Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment Sexual Abuse Incident Response Guide - Definition: Sexual abuse is non-consensual sexual contact of any type with a resident Determine if the allegation involves verbal sexual harassment or physical sexual contact with or without penetration. If the allegation involves verbal sexual harassment, refer to the Verbal Abuse Investigative Path. If an allegation of sexual contact is involved: Immediately contact local law enforcement authorities (e.g. telephoning 911 where available) as required in Section 300.695 in the following situations: For sexual abuse - sexual penetration, intentional sexual touching or fondling, or sexual exploitation (i.e. use of an individual for another person's sexual gratification, arousal, advantage, or profit or For sexual abuse of a resident by a staff member, another resident, or a visitor. Call an ambulance provider and move the survivor, as quickly as possible, to a private environment to ensure privacy and ensure safety while waiting for emergency or law enforcement personnel to arrive. The facility will ensure the welfare and privacy of the survivor, including the use of an identity code to avoid embarrassment Take all reasonable steps to preserve evidence of alleged sexual assault Follow the directions and cooperate with law enforcement. If the facts indicate the sexual contact occurred, proceed with the investigation and interviews in cooperation/consultation with local law enforcement. Ensure notification to the Department of Public Health within 2 hours of the report Mental Abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation, or offensive physical contact by a licensee, employee or agent Mental abuse is also the use of verbal or nonverbal conduct which causes or has the potential to cause the resident to experience humiliation, intimidation, fear, shame, agitation or degradation. This includes,, but is not limited to, harassing a resident; mocking, insulting, or ridiculing; yelling or hovering over a resident, with the intent to intimidate; threats of deprivation; and isolation Event ID: Facility ID: 145308 If continuation sheet Page 14 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to permit a resident to return to the facility after he was transferred to the hospital. This applies to 1 of 3 residents (R5) reviewed for involuntary discharge in a sample of 16. The findings include: Face sheet, dated 2/22/25, shows R5's diagnoses included Huntington's disease and mood disorder. R5 was admitted to the facility on [DATE]. MDS, dated [DATE], shows R5 was cognitively intact and R5 was able to propel in a wheelchair once set up in the wheelchair. Care plan, dated 4/23/24, shows R5 was admitted to the facility on [DATE] with a criminal history of violating an order of protection and domestic battery. Approaches include, Review of my past behavior and evaluate the potential for me to engage in inappropriate / high risk behavior, provide R5 with supportive group intervention and/or 1:1 via a qualified provider, to promote safety intervene when I am observed to be engaging in inappropriate behavior, teach me impulse control strategies and communicate to me that I am responsible for all my actions/behavior and must therefore exercise control over my impulses and behavior. Care plan, dated 10/17/24, shows R5 had a history of a hit and run accident and may have flashbacks, become upset, and become aggressive verbally and physically with staff. Care plan, dated 11/4/24, shows R5 was observed with manipulative behaviors and approaches included providing educations to not fabricate stories, perform check-ins with residents, and providing 1:1 interactions with R5 to help find solutions towards issues. Behavioral care plan, initiated 2/10/25, shows R5 displayed verbal and physical aggressive behaviors toward others, uncontrolled behavior outbursts and requires the use of non-pharmacological and pharmacological interventions to address and mitigate behaviors. Interventions included Social Services will continue to educate resident on aggressive behaviors and encourage resident to utilize healthier ways to communicate thoughts and feelings. Social services will work with resident to establish better communication and mechanisms. Delusions/paranoia care plan, dated 2/14/25, shows R5 was diagnosed with Huntington's disease and believes everyone is making fun of his disability. Interventions include psychiatric management, minimizing risk factors through interventions such as assessment, team, consultation, supervision, observation, structured environment, peer-buddy system, contracting and medication management. Other interventions include teaching stress/anxiety management techniques, discussing benefits of therapy with physicians, encouraging resident to follow mental health treatment plans and encouraging resident to attend groups. Illinois State Police report, dated 1/2/24, shows R5 was convicted of domestic battery/bodily harm, revisiting a peace officer, criminal trespassing, possession of drug paraphernalia, manufacturing/delivering controlled substances. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 15 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of R5's clinical record shows R5 hit R6 on 2/20/25 and was sent to the hospital as a result of the aggressive behavior. Progress note, dated 2/20/25, shows no injuries were identified regarding either resident in the altercation, the physicians were notified, and R5 was sent to the hospital. Nursing progress note, dated 2/20/25 at 10:39 AM, shows R5 left the facility with paramedics and a bed hold policy was in place. Late entry social services note, dated 2/20/24 effective 10:57 AM and written 2/21/25 at 12:23 PM, shows staff provided the medical transportation staff petition forms for R5 and the marketing director dropped discharge papers to the hospital. Late entry progress note written by V1 (Administrator), dated 2/20/25 effective 2:31 PM and written 2/21/25 at 14:33, shows R5 was provided immediate discharge notice due to increased aggression towards other residents. Progress note written by V20 (RN), dated 2/20/25 at 6:00 PM, shows the hospital emergency department nurse stated R5 had a 30 day notice. The note shows, case worker and Admin were made aware, per 'immediate discharge form' was sent with the resident. Per Admin and case worker, [V12] was made aware of the incident and cannot accept the resident due to an increase in physical altercation incidents with co-residents and to reach out to [V12] for more. Per ER (Emergency Room) nurse, case worker from [hospital] would like to speak to Admin, left message. Per case worker, to arrange residents belongings to be picked up. Progress note, dated 2/20/25 at 11:34 PM, R5 was admitted to the hospital with a diagnosis of social case. Notice of Involuntary Transfer or Discharge and Opportunity for Hearing for Nursing Home Residents, dated 2/20/25, shows R5 was transferred or discharged to a psychiatric hospital due to The safety of individuals in this facility is endangered. On 2/22/25 at 3:25 PM, V22 (Hospital Case Manager) stated the hospital attempted to contact the facility to transfer R5 back to the facility and the facility refused to accept R5. V22 stated there was no medical necessity to admit R5. V22 stated R5 was sent to the hospital with no belongings, no identification, and no wheelchair. V22 stated the hospital previously admitted R5 for medication adjustments. V22 stated she attempted calling facility administration but she was unable to reach any staff. V22 stated R5 reported that facility staff frequently place R5 near a resident who constantly bullies and harasses R5 and R5 feels like he has to defend himself. V22 stated, While he has been at the hospital, he has been fine. Maybe they aren't moving him away from this person like he is asking! Hospital physician note, dated 2/20/25, shows, At the facility today, patient states he got into a fight with another resident who 'picks on me.' Patient was originally brought to [Hospital] for same and discharged back. Per [Facility], patient is kicked out and not welcome back Patient sent with paperwork 'notice of involuntary transfer or discharge and opportunity for hearing for nursing home residence.' The records show R5 did not meet the criteria for psychiatric or medical admission and case management was consulted. The note shows multiple attempts to call the facility were made and R5 was sent to the hospital with no belongings including no wheelchair, prescription medication, or identification. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 16 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Hospital Nurse Practitioner note, dated 2/21/25, shows, R5 was previously admitted to the inpatient psychiatric unit between 2/13/25 and 2/18/25. The note shows R5 was returned to the emergency room on 2/20/25 with the facility stating he was not welcome back to the facility. The note shows R5 was discharged previously from the facility to a different hospital for the same reason and returned to the facility at that time. During this admission, R5 was unable to be admitted to inpatient psychiatry due to not meeting criteria. The note shows the facility stated R5 was aggressive and injured six other residents and the facility would not allow him to return. The note shows [V12] (Psychiatrist) was consulted who was managing R5 on inpatient psychiatric floor and who gave medication modifications to manage R5's admission. Hospital note, dated 2/21/25, shows the hospital spoke to V3 who stated R5 became aggressive in the past 10 days and injured 6 residents. The note shows R5 returned from a psychiatric admission and again attacked another resident. The note shows the facility provided an involuntary discharge and would not accept the resident back at the facility. On 2/22/25, V1 stated R5 was sent to the hospital with the following paperwork: 1. Face sheet, 2 POS, and 3 petition. V1 provided additional document not provided on 2/21/25: Petition for Involuntary/Judicial Admission, dated 2/20/25, shows R5 was a person with mental illness who: because of his or her illness is reasonably expected, unless treated on an impatient bases, to engage in conduct placing such person or another in physical harm or in reasonable expectation of being physically harmed. The form shows R5 was petitioned for need of immediate hospitalization for the prevention of such harm. Nursing note, dated 2/5/25, shows R5 initiated a physical aggression toward another resident and was sent to the hospital for evaluation. Review of R5's progress notes show R5 was sent to the psychiatric hospital with an involuntary transfer petition and returned to the facility from the hospital on 2/6/25. R5's clinical record showed R5 was educated not to physically harm other residents. Nursing note, dated 2/9/25, shows R5 fought with another facility resident and R5 was sent to the psychiatric hospital for evaluation. Review of R5's progress notes show R5 was involuntarily petitioned to transfer to the hospital and returned to the facility on 2/9/25. R5's clinical record showed R5 was educated not to physically harm other residents. Nursing note, dated 2/13/25, shows R5 again fought with a facility resident and was involuntarily transferred to the hospital for psychiatric evaluation. POS shows a physician order, dated 2/13/25, for, Send to [Hospital] for involuntary admission. Progress note, dated 2/14/25, shows Bed hold policy in place for 10 days. Progress note, dated 2/14/25, shows the facility spoke with V12 (Psychiatrist) regarding placing R5 in a different nursing facility due to aggressive behaviors and that hospital caseworkers were working to find appropriate placement for R5. Social Services Note, dated 2/18/25, shows, The facility received a call from psychiatrist at [hospital] that stated this resident is not aggressive, but rather has a movement disorder due to his Huntington's diagnoses; resident has been educated on his disease and to stay in his wheelchair so he does not fall/use other residents to catch his balance as it can cause harm to other co-residents and staff . le R5 was admitted to the psychiatric hospital after fighting with another resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 17 of 18 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 145308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE River View Rehab Center 50 North Jane Elgin, IL 60123 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 0626 R5's clinical record shows R5 was readmitted to the facility on [DATE]. Level of Harm - Minimal harm or potential for actual harm Social Services Note, dated 2/18/25, shows R5 was readmitted to the facility and educated to not use physical violence at the facility. The note shows a behavior contract was to be created. R5's clinical record showed R5 was educated not to physically harm other residents. Residents Affected - Few As of 3/6/25, the facility was unable to provide a copy of a contract between the facility and R5 regarding R5's behavior. Facility Policy/Procedure, Involuntary Discharge or Transfer, undated, shows, Policy: The facility will provide proper procedure and notification of any involuntary transfer or discharge pursuant to the regulations A resident can be transferred or discharged from the facility based on one of the following reasons: a. The resident's welfare cannot be met at the facility C. The health and/or safety of individuals in the facility are endangered. This would include residents, facility staff, or facility visitors The resident's record must include the (1) reasons for the transfer/discharge (2) needs that cannot be met by the facility, steps taken to meet those needs, and needs that can be met by new facility as documented by resident's physician. Documentation in the notice must (1) demonstrate the condition which warrants the transfer (2) effective date of the discharge / transfer (3) location where the resident will be discharged / transferred, (4) name, mailing address and phone number of the person responsible for supervising the transfer (5) name, mailing address and phone number of the Office of the State Long Term Care Facility Ombudsman and (6) if the person has intellectual/developmental disabilities or serious mental illness, the name, mailing address, email address and phone number of Equip for Equality. B. The resident's physician must document in the record if the reason for discharge is either the resident's welfare cannot be met or the resident's health has improved sufficiently, or any physician can document in the resident's record when the safety or other individuals are endangered. The explanation and discussion of the transfer or discharge with the resident and his representative shall be summarized in the resident record REMINDERS 5. C. The resident's record must include descriptive ongoing documentation to demonstrate the need for transfer / discharge. D. The resident record should include descriptive documentation of all actions taken with dates and times. The record should include all attempts to assist the resident in the transfer/discharge. E. The resident's record should include all attempts made through care planning or other means to assess the resident's needs prior to issuing a thirty (30) day notice F. The facility shall assist the resident in the arranging alternative living arrangements. All assistance will be documented in the resident record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145308 If continuation sheet Page 18 of 18