Health inspection·March 12, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to protect a resident from the misappropriation of resident property when a credit card was stolen from a resident's room for 1 of 2 residents (R2) reviewed for the misappropriation of resident property in the sample of 3. Residents Affected - Few The findings include: The Final Incident Report dated 12/20/24 for R2 showed, Incident category: Resident misappropriation of property/theft. Summary of Incident: The resident is a long-term resident of the facility and is alert and oriented x 3 (person, time, & place); she is forgetful at times. On 12/17/24 the unit manager received an email from the police department detective. He was seeking assistance to identify a photo of the person within the email. The individual in the picture is presumed to be the individual who used the credit card of R2 at a store. The unit manager immediately reported to the interim administrator regarding the email received. The unit manager and ADON (Assistant Director of Nursing) reached out to POA (Power of Attorney), daughter of the resident. The POA stated that she realized that the credit card was not in the possession of the resident because she reviewed the monthly statement and that is when she saw a purchase made at a store. On 12/18/24 the unit manager was able to speak with the detective. The unit manager relayed to the detective that the individual in the picture did not work at the facility. The unit manager informed the detective of the CNA (Certified Nursing Assistant) who provided care to the resident during the same day when the credit card was used. The POA - daughter reached out to the credit card company was able to reverse the charges that were incurred. The POA then reached out to the police and filed a complaint. This is an ongoing investigation with the police. The facility will continue to assist law enforcement however we can. On 3/11/25 at 11:42 AM, V10 (R2's POA/daughter) stated, R2 wanted the credit card for incidentals. V10 stated she gets the credit card statements. V10 stated she reviewed the credit card statement and looked at it a few weeks later. She saw a charge dated 10/1/24 for a gaming system at a store for $500.00. V10 stated she notified the manager; she left a message. V10 stated she talked to R2 to see if she wanted the police involved and she did. V10 stated she contacted the police, and the detective has the dates. V10 stated the detective has been keeping in contact with the facility. V10 stated the police suspect that the person that used the credit card was someone that knew someone at the facility. They think an employee gave the card to someone else that used it. On 3/11/25 at 12:12 PM, V6 (Executive Director), V9 (Social Services), and V5 (Registered Nurse/Unit Manager) were presented information together and stated that theft should not occur at the facility. On 3/11/25 at 2:56 PM, R2 was sitting in a wheelchair in her room. R2's cell phone had a case around it with a card holder built into the case. R2 stated her credit card was stolen and had been in Page 1 of 6 145341 145341 03/12/2025 Encore Village 350 West Schaumburg Road Schaumburg, IL 60194

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the wallet on her phone. R2 stated the police were contacted and thought that it was a friend of someone that worked at the facility that used the credit card. The credit card was used at a store for a large amount. R2 stated she would like to see someone arrested because stealing isn't right. The Face Sheet dated 3/11/25 for R2 showed diagnoses including congestive heart failure, pneumonia, acute respiratory failure with hypoxia, atrial fibrillation, chronic obstructive pulmonary disease, dysphagia, type 2 diabetes mellitus, colostomy, retention of urine, polyneuropathy, transient ischemic attack, insomnia, hypomagnesemia, hypokalemia, anorexia, macular degeneration, constipation, hyperlipidemia, dependence on supplemental oxygen, vitamin D deficiency, hyperparathyroidism, and hypothyroidism. The MDS (Minimum Data Set) dated 12/12/24 for R2 showed a BIMS (brief interview of mental status) score of 15 - no cognitive impairment. The facility's Abuse, Neglect, Exploitation and Misappropriation Prevention policy (April 2021) showed, residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives: 1. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: a. facility staff; b. other residents; c. consultants; d. volunteers; e. staff from other agencies; f. family members; g. legal representatives; h. friends; i. visitors; and/or j. any other individual. 145341 Page 2 of 6 145341 03/12/2025 Encore Village 350 West Schaumburg Road Schaumburg, IL 60194

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. Based on interview and record review the facility failed to report to the state surveying agency an allegation of misappropriation of resident property immediately, but not later than 24 hours when a credit card was stolen from a resident's room for 1 of 2 residents (R2) reviewed for the misappropriation of resident property in the sample of 3. The findings include: The Social Service Note dated 11/19/24 at 9:30 AM for R2 showed, the social worker spoke with resident's daughter (V10) regarding the stolen credit card. V10 shares that the credit card has been reported as stolen, and a police report has been filed. V10 shares that the credit card was located in the resident's phone wallet. V10 reports that charges were made on the credit card on 10/1/24. Social worker filed a concern form and endorsed to the administrator. The facility did not have an Initial Incident Report dated 11/19/24. On 3/11/24 at 11:03 AM, V9 (Social Services) stated, she reported to V2 (previous Administrator) that a resident's credit card was missing in October 2024 when V10 (R2's POA - Power of Attorney/daughter) reported it to her. V9 stated V2 didn't follow up on reporting it so it was not investigated until December 2024. V9 stated the last administrator was overwhelmed. Anyone that is an administrator knows that this needs to be reported. V10 stated she documented about it in the resident's record. On 3/11/25 at 11:42 AM, V10 (R2's POA/daughter) stated, R2 wanted the credit card for incidentals. V10 stated she gets the credit card statements. V10 stated she reviewed the credit card statement and looked at it a few weeks later. She saw a charge dated 10/1/24 for a gaming system at a store for $500.00. V10 stated she notified the manager; she left a message. V10 stated she thought she reported it to the facility sometime in November 2025 after she had received and reviewed the credit card statement. V10 stated she talked to R2 to see if she wanted the police involved and she did. V10 stated she contacted the police, and the detective has the dates. V10 stated the detective has been keeping in contact with the facility. V10 stated the police suspect that the person that used the credit card was someone that knew someone at the facility. They think an employee gave the card to someone else that used it. On 3/11/25 at 12:12 PM, V6 (Executive Director), V9 (Social Services), and V5 (Registered Nurse/Unit Manager) presented information together and V6 stated when the administrator is made aware of an allegation it must be reported to state surveying agency immediately. V5 stated the day she found out about the stolen credit card was on 12/17/24 and that is the date she reported it. The facility's Initial Incident Report dated 12/17/24 for R2 showed, Incident category: Resident misappropriation of property/theft. Summary of incident: Today on 12/17/24 at approximately 2:15 PM, V5 (Registered Nurse/Unit Manager), reported receiving an email from the police asking for assistance in the case that was being investigated involving the resident, R2's stolen credit card. In the email there was an image of an individual at the store whom they believe was involved in the theft of the credit card. Investigation initiated and ongoing. The Face Sheet dated 3/11/25 for R2 showed diagnoses including congestive heart failure, pneumonia, acute respiratory failure with hypoxia, atrial fibrillation, chronic obstructive pulmonary disease, dysphagia, type 2 diabetes mellitus, colostomy, retention of urine, polyneuropathy, transient 145341 Page 3 of 6 145341 03/12/2025 Encore Village 350 West Schaumburg Road Schaumburg, IL 60194

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ischemic attack, insomnia, hypomagnesemia, hypokalemia, anorexia, macular degeneration, constipation, hyperlipidemia, dependence on supplemental oxygen, vitamin D deficiency, hyperparathyroidism, and hypothyroidism. The MDS (Minimum Data Set) dated 12/12/24 for R2 showed a BIMS (brief interview of mental status) score of 15 - no cognitive impairment. The facility's Abuse, Neglect, Exploitation and Misappropriation Prevention Program (April 2021) showed, residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. Investigate and report any allegations within timeframes required by federal requirements. 145341 Page 4 of 6 145341 03/12/2025 Encore Village 350 West Schaumburg Road Schaumburg, IL 60194

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 have evidence that an allegation of misappropriation of resident property was thoroughly investigated for 1 of 2 residents (R2) reviewed for the misappropriation of resident property in the sample of 3. Residents Affected - Few The findings include: The facility's Initial Incident Report dated 12/17/24 for R2 showed, Incident category: Resident misappropriation of property/theft. Summary of incident: Today on 12/17/24 at approximately 2:15 PM, V5 (Registered Nurse/Unit Manager), reported receiving an email from the police asking for assistance in the case that was being investigated involving the resident, R2's stolen credit card. In the email there was an image of an individual at the store whom they believe was involved in the theft of the credit card. Investigation initiated and ongoing. The report was signed by V4 (Assistant Executive Director). The Final Incident Report dated 12/20/24 for R2 showed, Incident category: Resident misappropriation of property/theft. Summary of Incident: The resident is a long-term resident of the facility and is alert and oriented x 3 (person, time, & place); she is forgetful at times. On 12/17/24 the unit manager received an email from the police department detective. He was seeking assistance to identify a photo of the person within the email. The individual in the picture is presumed to be the individual who used the credit card of R2 at a store. The unit manager immediately reported to the interim administrator regarding the email received. The ADON (Assistant Director of Nursing), spoke with nursing staff, and staffing coordinator to assist identifying the person in the email photo. They were not able to match any nursing staff. The unit manager and ADON (Assistant Director of Nursing) reached out to POA (Power of Attorney), daughter of the resident. The POA stated that she realized that the credit card was not in the possession of the resident because she reviewed the monthly statement and that is when she saw a purchase made at a store. On 12/18/24 the unit manager was able to speak with the detective. The unit manager relayed to the detective that the individual in the picture did not work at the facility. The unit manager informed the detective of the CNA (Certified Nursing Assistant) who provided care to the resident during the same day when the credit card was used. The POA - daughter reached out to the credit card company was able to reverse the charges that were incurred. The POA then reached out to the police and filed a complaint. This is an ongoing investigation with the police. The facility will continue to assist law enforcement however we can. On 3/11/25 at 11:42 AM, V10 (R2's POA/daughter) stated, R2 wanted the credit card for incidentals. V10 stated she gets the credit card statements. V10 stated she reviewed the credit card statement and looked at it a few weeks later. She saw a charge dated 10/1/24 for a gaming system at a store for $500.00. V10 stated she notified the manager; she left a message. V10 stated she thought she reported it to the facility sometime in November 2025 after she had received and reviewed the credit card statement. V10 stated she talked to R2 to see if she wanted the police involved and she did. V10 stated she contacted the police, and the detective has the dates. V10 stated the detective has been keeping in contact with the facility. V10 stated the police suspect that the person that used the credit card was someone that knew someone at the facility. They think an employee gave the card to someone else that used it. On 3/11/25 at 12:12 PM, V6 (Executive Director) stated the administrator should have initiated an investigation and to protect residents' rights they need to ensure the investigation is completed. 145341 Page 5 of 6 145341 03/12/2025 Encore Village 350 West Schaumburg Road Schaumburg, IL 60194

F 0610 Level of Harm - Minimal harm or potential for actual harm On 3/11/25 at 1:29 PM, V4 (Assistant Executive Director) stated V11 ADON (Assistant Director of Nursing) did the investigation for R2. V11 would have spoken to everyone and documented in the electronic medical record. V4 stated normally the internal documents and interviews are in the files. V4 stated staff should be interviewed and other residents in the area depending on what happened. V11 stated the interviews should be there for R2's credit card incident but they are not. Residents Affected - Few On 3/11/25 at 1:35 PM, V11 (ADON) stated V5 (Registered Nurse/Unit Manager) did the investigation for R2 and the theft of the credit card. V11 stated it was brought to their attention when the police called to talk to V5. V11 stated she did not personally interview anyone and did not recall who made the report. On 3/11/25 at 2:25 PM, V5 RN (Registered Nurse/Unit Manager) stated she did not do the investigation for R2's credit card theft and was not involved in the interviews. V5 stated she did not talk to R2 about it. V5 stated the only person she talked to about it was V10 (R2's POA/daughter). The Face Sheet dated 3/11/25 for R2 showed diagnoses including congestive heart failure, pneumonia, acute respiratory failure with hypoxia, atrial fibrillation, chronic obstructive pulmonary disease, dysphagia, type 2 diabetes mellitus, colostomy, retention of urine, polyneuropathy, transient ischemic attack, insomnia, hypomagnesemia, hypokalemia, anorexia, macular degeneration, constipation, hyperlipidemia, dependence on supplemental oxygen, vitamin D deficiency, hyperparathyroidism, and hypothyroidism. The MDS (Minimum Data Set) dated 12/12/24 for R2 showed a BIMS (brief interview of mental status) score of 15 - no cognitive impairment. The facility's Abuse, Neglect, Exploitation and Misappropriation Prevention Program (April 2021) showed, residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. Identify and investigate all possible incidents of abuse, neglect, mistreatment, or misappropriation of resident property. Investigate and report any allegations within timeframes required by federal requirements. 145341 Page 6 of 6