Inspection·October 31, 2024

F 0677 of the shower/bath. Level of Harm - Minimal harm or potential for actual harm Review of R6's nursing progress notes, dated 9/1/24 to 10/28/24, showed no documentation that R6 refused showers. Residents Affected - Few On 10/31/24 at 8:43 AM, V1 (Administrator) stated it was her expectation that all residents were offered a shower/bath twice weekly at the facility. Resident Shower or Bed Bath Policy/Procedure, dated 11/2015, shows If not contra-indicated, shower is to be given to residents at the facility at least twice a week and as needed If the resident refused to have a shower or bed bath, inform the nurse 2. Face sheet, dated 10/30/24, shows R3's diagnoses included osteoarthritis, seizures, anxiety, depression, morbid obesity, idiopathic and hereditary neuropathy, artificial hips, overactive bladder, and hypertension. MDS, dated [DATE], shows R3's cognition was moderately impaired and R3 required substantial/maximal assistance from staff for bathing. Care plan, as of 10/28/24, failed to show R3 had any history of refusing showers/baths on scheduled days. On 10/29/24 at 12:50 PM with R4 (Roommate), R3 stated she felt like she had to fight to get her showers because the staff were too busy. R4 stated she was not receiving her showers/baths on her scheduled bathing days. On 10/30/24 at 10:30 AM, R3 stated she never refused her baths/showers on her scheduled bathing days. R3 stated she always asked for her showers on her scheduled shower days but the staff told R3 they were too busy to provide her with the showers. R4 stated R3 never refused any of her showers on her scheduled shower days. R4 stated, If anyone refuses, it is the staff! R4 stated on R3's scheduled shower days, the staff tell R3 they have no time to provide her scheduled showers or tell R3 it was not her scheduled day to receive a shower. Review of R3's nursing progress notes, dated 9/1/24 to 10/28/24, shows no documentation of R3 refusing offers of baths/showers. Review of R3's bathing documentation, dated 9/1/24 to 10/28/24, shows R3 was documented as refusing showers/baths on the following dates: 9/2/24, 9/5/24, 9/9/24, 9/12/24, 9/23/24, 9/26/24, 9/30/24, 10/24/24, and 10/28/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145329 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 145329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norridge Gardens 7001 West Cullom Norridge, IL 60634 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on interview and record review, the facility failed to ensure nursing staff remained with a resident until all of the resident's medications were administered per facility policy. This applies to 1 of 6 residents (R2) reviewed for medications left at bedside in a sample of 7. Findings include: Facility Incident report, dated 8/25/24, shows on R1's family observed medications at R2's bedside. The report shows R2 denied that they were her medications and stated she already took her medications. The report shows the medications were removed immediately and the resident was assessed with no concerns. The report shows R2 was monitored for changes in condition on 8/25/24. The incident investigation shows a re-education regarding medication storage and administration was given to facility nursing staff. On 10/29/24 at 10:41 AM with V2 (Director of Nursing), V3 (Infection Peventionist Nurse / Manager on Duty) stated she was the Manager on Duty on 9/25/24 when a nurse supervisor informed her a family found medications inside a resident room. V3 stated she investigated and spoke with the nurse and supervisor on duty at the time the medications were found. V3 stated there were approximately 14 medications and no narcotics. V3 stated the medications included vitamins, supplements, and other typical morning medications. V3 stated when she spoke with the residents in the room, R1 stated she already received and took her morning medications, and R2 stated she also took her medications V3 stated when she further questioned R2, R2 stated she may have forgotten to take her mediations she was provided earlier that mourning by the nurse. V3 stated V5 (Registered Nurse) was on duty and caring for R1 and R2 at the times the medications were found in the residents' room and denied leaving the medications not taken by R2 in R2's room. V3 stated V5 insisted she watched R2 take her medications that morning and stated she did not leave the medication at the bedside. Manager on Duty Statement, dated 8/25/24, shows medications were left on R2's bedside table. The statement shows R2 stated she put the medications on the bedside table intending to take them and forgot to do so. On 10/30/24 at 11:29 AM, V4 (Registered Nurse Supervisor) stated on 8/25/24 she was informed that medications were found at R2's bedside. V4 stated R2 stated the medications were hers and R2 forgot to take the medications. V4 stated she verified that the medications were R2's AM doses of medications and then destroyed the medications. V4 stated the medications should never have been left with the resident and the administering nurse should visualize the residents taking their mediations when medications are administered. MDS (Minimum Data Set), dated 9/6/24, shows R2's cognition was moderately impaired. On 10/29/24 at 1:30 PM, R2 stated on 8/25/24 she forgot to take her morning medications when the nurse handed her the medications. R2 stated she left the medications sitting on the dresser in her room. On 10/30/24 at 1:46 PM, V5 (Registered Nurse) stated she provided R2 with her AM medications on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145329 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 145329 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norridge Gardens 7001 West Cullom Norridge, IL 60634 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 0761 8/25/24 and watched R2 take her medications that morning. Level of Harm - Minimal harm or potential for actual harm MAR (Medication Administration Record), dated 8/25/24, shows R2's AM medications included cholecalciferol 5000 Units, duloxetine 60 mg (milligrams), glipizide 10 mg, lamotrigine 24 mg, miralax 17 grams, multivitamin 1 tablet, venlafaxine extended release 75 mg, Vitamin E-400, memantine 10 mg, sennosides-docusate sodium 8.6-50 mg, and tramadol 50 mg. Residents Affected - Few Facility document Administering Oral Medications, revised 3/2020, shows, Remain with the resident until all medications have been taken. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145329 If continuation sheet Page 4 of 4