Inspection·May 2, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few right cheek and a scratch on the left cheek, a rounded mark was noticeable on his left hand around the middle finger, a scrape on the left earlobe, a purplish discoloration on the upper lip, and a small scrape on left knee . Review of behavior note dated 04/20/2025 at 12:00 PM reads in part, per staff report, nursing staff was alerted of incident in resident's bedroom by peer; when nurse arrived, she reportedly observed the resident on the floor with one of his roommates [R2]; the resident's finger (R1) was reportedly in [R2's] mouth. Per nursing report, it was unclear what had instigated the incident, though the resident has a pattern of wandering into peers' rooms related to confusion which may startle or upset peers . R1's abuse/trauma screening dated 04/21/2025 indicated that resident is at high risk for the likelihood of abuse/trauma occurring. On 05/02/2025 at 10:40 AM, R1 was ambulating in the hallway throughout the locked unit. R1 was not interviewable. 2. R2's face sheet indicated resident admitted to facility on 03/03/2025 and has a past medical history not limited to Parkinson's Disease, Dementia, cerebrovascular accident, major depressive disorder, and anxiety disorder. Review of Minimum Data Set Section C - Cognitive Patterns dated 03/10/2025 showed R2 has severe cognitive impairment. R2's aggressive behavior assessment dated [DATE] indicted that resident has a history or recent episode of aggressive/agitated behavior and/or non-compliance with medications, treatment, regimen, resisting care and a history of agitation/aggressive behavior at previous [skilled nursing facility]. R2's care plan last reviewed on 03/17/2025 documented have the potential for aggressive behavior, per history, related to Dementia, may yell at staff or make loud vocalizations during care provision related to confusion (initiated 03/03/2025); have a behavior problem related to Dementia, occasionally will make hypersexualized comments and may touch staff inappropriately during activities of daily living (ADL) care provisions; am resistive to care (shower/ADL care refusal) related to Dementia and depression (last revised on 04/21/2025). R2's behavior note dated 04/20/2025 at 11:30 AM reads in part, per staff report, nursing staff was alerted of incident in resident's bedroom by peer; when nurse arrived, she reportedly observed the resident on the floor with one of his roommates [R1]; peer's finger was reportedly in the resident's (R2) mouth. Per nursing report, it was unclear what had instigated the incident, though [R1] has a pattern of wandering into peers' personal space related to confusion which may startle or upset peer . R2's active physician orders as of 05/02/2025 revealed orders for haloperidol lactate concentrate 2 milligram/milliliter (MG/ML) give 0.5 mg by mouth every 6 hours as needed for agitation, start on 04/18/2025; hydroxyzine hcl oral Tablet 50 MG by mouth in the evening for agitation, start on 04/04/2025; lorazepam oral tablet 0.5 MG give 1 tablet by mouth every 6 hours as needed for Anxiety, start on 04/18/2025. On 05/02/2025 at 10:45 AM, R2 was observed in locked unit activity room seated at a table. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145316 If continuation sheet Page 2 of 4 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 145316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481 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 - Actual harm Residents Affected - Few Regarding incident, R2 said he was in his room and fell. R2 added that nothing happened with my roommate, then added that he did not get into a fist fight with anyone or touch anyone. R2 indicated that he feels safe at the facility. On 05/02/2025 at 12:18 PM, V5 (Certified Nursing Assistant/CNA) indicated at time of incident, she was off the locked unit assisting with a resident transfer, and when she returned to the unit, a resident told her that, two people are on the floor. When V5 entered the room, she saw R1 and R2 lying on the floor and R2 had R1's right ring and middle fingers in his (R2) mouth and was biting down on them. V5 said she called out for help then ran towards R1 and R2. V5 added that when she attempted to separate the residents, R2 had let go of R1's hand but then slapped him (R1) on his left cheek with an opened hand. V5 (CNA) added that R1 was crying and was trying to push R2 away from him and that R1 looked scared. V5 indicated that R1 and R2 were roommates at the time of incident and R1 walks over to R2's side of the room to stare out the window, stares at R2, then R1 walks away. V5 then said after they were separated, the nurse (V7) came in and she took R1 into the shower room with V6 (CNA). V5 said she saw R1 had a scratch mark behind his ear that was bleeding, a light scratch to his chest, a scrape to his left knee, and a bite mark on his right hand. V5 said R1 was still crying at this time and looked upset. V5 also said that R2 had gotten angry at R1 that morning before breakfast because R1 had walked near R2 to look out the window in the dining room. V5 said that R2 stood up and started yelling at [R1] and R2 was trying to get to R1 who was just standing there and staring at him (R2). On 05/02/2025 at 01:22 PM, attempted to call V7 (Registered Nurse) regarding the incident with R1 & R2. No answer, and a detailed message was left. V7 did not return call upon exiting complaint survey. On 05/02/2025 at 01:29 PM, V6 (CNA) said regarding incident with R1 & R2, she heard V5 (CNA) yelling for help saying R1 and R2 were, fighting are the floor. V6 said when she entered the room, she saw R1 and R2 both on the floor and she saw R2 smack R1 on the face prior to being separated by staff and R2 was saying that R1 deserved it and R2 was laughing at R1. V6 added that R1 was crying, and she could see bite marks to his fingers, his ear was bleeding, and visible redness to R1's back. V6 added that it looked as if R2 had pushed R1 down to the floor because R1 had hand marks to his shoulders. V6 said that R2 would always be mean to R1, would try to kick [R1] out of the room and that R2 always seems to be saying stuff to [R1]. V6 indicated that R1 and R2 kind of have a history then said that R2 was the aggressor during this incident and R1 was the victim. V6 said after R1 and R2 were separated, she and V5 (CNA) took R1 to the shower room. R1 was still very emotional at this time. On 05/02/2025 at 1:51 PM, V1 (Administrator) said regarding the findings from her investigation, R1 and R2 were both on the ground, and staff were unable to determine if both residents fell. V1 added that R2 was upset at R1 for looking at him but could not determine who the aggressor was. V1 (Administrator) added that she was not made aware of the incident that occurred in the dining between R1 and R2 on the morning of incident. Abuse policy last reviewed 10/24/2022 reads in part: this facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145316 If continuation sheet Page 3 of 4 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 145316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Wilmington 555 West Kahler Wilmington, IL 60481 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 - Actual harm staff and mistreatment of residents. This will be done by .establishing an environment that promotes resident sensitivity, resident security and prevention of mistreatment, identifying occurrences and patterns of mistreatment .Resident-to-resident altercations that include any willful action that results in physical injury, mental anguish or pain must be reported in accordance with regulations. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145316 If continuation sheet Page 4 of 4