Inspection·February 19, 2026

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few am, V15 (Registered Nurse, RN) stated that she has worked at the facility for about one year on the evening and night shift. V15 then stated that she recalls caring for R1 at the facility and explained that she came into R1's room on 1/12/26 around 4:00 - 5:00 am, after V8 (Certified Nursing Assistant, CNA) called her to R1's room. V8 further explained that V8 stated that R1 said she hit her. V15 then explained that she asked V8 what happen and V8 explained that she was just changing R1 and R1 said that V8 hit her head. V15 then explained that she then asked V8 if she hit R1's head and V8 stated, No. Not that I'm aware of. V15 further stated that she went into R1's room and asked R1 what happened and that R1 stated that V8 hit her head on the bed and on the right side of her face and that V8 also punched R1 in the face. V15 then explained that she assessed R1 head and did not find any bruising, swelling, bleeding or obvious injuries. V15 also explained that R1 did not complain of any pain to touch. V15 explain that she assessed R1 alone and that V7 (Registered Nurse, RN, Supervisor) was not present. V15 further explained that R1 explained that V8 was being rough while changing her (providing incontinence care) and then punched her (R1) in the face. V15 then stated that she informed R1 that she would report R1's allegations to V7 (RN, Nursing Supervisor). V15 explained that she then informed V7 of R1's allegations and instructed V8 to complete a report regarding R1's incident. V15 further explained that she completed a risk assessment reports, a physical injury incident report, and a pain assessment report. V15 was asked regarding R1's neurological assessment and monitoring and V15 stated that R1 did not lose consciousness and did not show any physical injury thus V15 did not complete a neurological assessment for R1. V15 then explained that neurological monitoring should be conducted anytime there is a report of a head injury or suspected head injury. V15 further explained that a neurological assessment is conducted for head injuries because there might be complications from a head injury and the resident may need to be sent to the hospital right away. V15 also explained that she informed R1's physician and the R1's family regarding R1's incident of alleged head injury and that she did not make a progress note regarding R1's incident with the details of the conversations because she was instructed by risk management at the facility not to complete a progress note and to only complete the risk assessment forms that V15 completed.On 2/18/26 at 11:41 am, V2 ( Director of Nursing, DON) stated that R1 is alert, oriented times three with dysphagia and was at the facility recovering from sub arachnoid hemorrhage stroke with right side weakness. V2 then stated that R1 required one person assist for her Activities of Daily Living (ADL's). V2 explained that on 1/12/26, R1 alleged that her head was hit on her bed while V8 (CNA) was providing care. V2 explained that V15 (Registered Nurse, RN) , V7 (RN) both conducted a pain, skin assessment, incident report and a post altercation allege abuse follow up form for R1's incident. V2 stated that when she spoke with R1, it was the next day and R1 stated that during care her head was hit but she did not feel it was intentional. V2 stated that she asked R1 if she felt safe and R1 stated that she has received good care and felt safe at the facility. V2 further stated that she assessed R1's head and she did not see any bumps or discoloration, and she told R1 to let staff know right away if she does not feel safe. V2 then stated that R1 did not have any further concerns after R1's allegation of her head being hit. V2 explained that a risk management form was completed. V2 explained that for a suspected head injury, the facility should check orientation, cognition, the residents vital signs, and pain. When V2 was asked regarding R1's neurological assessment monitoring from R1's 1/12/26 reported head injury V2 stated that she did not complete one. V2 then explained that a witness or unwitnessed head injury requires the residents neurological status to be monitored with neurological checks for 72 hours for change of condition and should be treated appropriately. V2 also explained that unwitnessed head injury should be especially monitored for a change of condition. V2 also explained that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145336 If continuation sheet Page 2 of 3 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 145336 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Warren Barr Gold Coast 66 West Oak Street Chicago, IL 60610 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete checking the residents vital signs is not the same as performing neurological checks. V2 stated that if a reported head injury does not receive neurological monitoring the resident could suffer complications and die.R1's Post Altercation/Alleged Abuse assessment dated [DATE] at 6:25 am, reviewed and shows assessment incomplete with no neurological checks conducted. R1's Accident/Incident Report dated 1/12/26 reviewed and shows no neurological checks conducted. R1's Risk Management dated 1/12/26 reviewed and shows no neurological checks conducted. R1's progress notes dated 01/12/26 through 1/15/26 with no documentation of neurological checks documented or performed. The facility's policy dated 07/2/25 and titled Neurocheck documents, in part: Procedures: The nurse will inform the physician of the incident and will follow physicians orders including a neurocheck on the resident. Event ID: Facility ID: 145336 If continuation sheet Page 3 of 3