Health inspection·June 21, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to implement its abuse prevention policy by failure to report injury of unknown origin. This deficiency affects one (R3) of three residents reviewed for abuse prevention policy. Findings include: On 6/18/25 at 4:15PM, R3 was assessed by V4 (Restorative Nurse) and V2 (Director of Nursing) and surveyor present. R3 was observed with discoloration to bilateral side of breasts. On 6/18/25 at 4:30PM, V2 (Director of Nursing) said staff is aware to report any injuries of unknown origin to Administrator to complete an investigation and report to IDPH in a timely manner. V2 said it was not reported to IDPH. On 6/18/25 at 4:30PM, V4 (Restorative Nurse) said any unknown injury is reported immediately for follow up. On 6/21/25 at 10:44AM, V1 said she did not send the initial report to IDPH in a timely manner for an unknown injury incident. V1 said staff is aware to report immediately to V1 for follow up and investigation. V1 said she did not think it was an abuse case, however per facility policy failed to follow protocol. R3 was admitted on [DATE] with diagnosis in part but limited to cerebral infarction, other coronavirus, anemia, type 2 diabetes mellitus, hyperlipidemia, heart failure, essential hypertension. Progress note dated 6/13/25 indicates observation of bruising. Initial report of incident dated 6/18/25 reported to IDPH. Abuse Investigation and Reporting Policy Revised 11/2023. Policy Statement: All reports of resident abuse, neglect, exploitation, misappropriation of resident property, mistreatment, electronic mail, social media, videotaping, photographing, and other imaging of residents, and/or injuries of unknown source (abuse) shall be promptly reported to local, state and federal agencies (as defined by current regulations) and thoroughly investigated by community management. Conclusions of investigations will also be reported, as defined by the Ascension Living Abuse Prevention policy. Page 1 of 2 145324 145324 06/21/2025 Harmony Park Ridge 1001 North Greenwood Avenue Park Ridge, IL 60068

F 0609 Reporting: Level of Harm - Minimal harm or potential for actual harm A. All alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of an unknown source and misappropriation of property will be reported to the Administrator or designee and to the following other officials or agencies: Residents Affected - Few 1. The State licensing/certification agency responsible for surveying/licensing the community; 2. Other officials in accordance with State Law, including to Adult Protective Services where state law provides for jurisdiction in long term care facilities; 3. The Resident's Representative (Sponsor) of Record; 4. The resident's Attending Physician; and 5. The community Medical Director. B. Alleged violations involving abuse, neglect, exploitation or mistreatment (including injuries of unknown source and misappropriation of resident property) will be reported: 1. Abuse or Serious Bodily Harm - Immediately but not later than 2 hours. * If the alleged violation involves abuse or results in serious bodily injury. 2. No Serious Bodily Injury - As soon as practical, but not later than 24 hours*. If the alleged violation involves neglect, exploitation, mistreatment, or misappropriation of resident property; does not result in serious bodily injury. 145324 Page 2 of 2