Health inspection·December 13, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to have call lights accessible to dependent residents. Residents Affected - Few This applies to 1of 1 residents (R63) reviewed for accommodation of needs in a sample of 32. The findings include: On 12/10/24 at 11:48 AM, R63 was sitting in recliner chair in her room. R63's call light was attached to her bed by the side rail. R63's bed was by the window, while R63 was sitting closer to door. When asked about her call light, R63 said, I cannot reach it from here, I do use it and it irritates me when it does not follow me across the room. I do need it; I can use it. Surveyor pushed R63's call light at 11:51 AM, V7 (Minimum Data Set/MDS Coordinator) came to R63's room. V7 said the call light should be close to the residents and within their reach all the time so they can us it when they need assistance. R63's MDS of 10/8/24 shows that R63's cognition is moderately impaired; R63 is dependent on staff for toileting hygiene and partial/moderate assistance with personal hygiene. R63's care plan (initiated 12/27/22) shows that R63 is at risk for falls with interventions for resident to call for assistance. On 12/12/24 at 9:58 AM, V2 (Director of Nursing/DON) said the call light should be within resident's reach when they are in their rooms, so it can be easily accessible to them. The facility's Call Light System policy (undated) states that the facility will provide a means of communication to meet the needs of each resident; assure the call light is within easy reach of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 2 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide a resident and/or their family/POA (POA/Power of Attorney) in writing for the reason of transfer to the hospital. The facility also failed to notify the ombudsman of the transfer. This applies to 5 of 5 residents (R9, R25 R58, R63, and R84) reviewed for discharge in a sample of 32. The findings include: 1. R63's After Visit Summary shows that R63 was admitted to the hospital from [DATE] to 9/16/24 with the diagnosis of acute cystitis without hematuria. R63's progress notes of 9/13/24 at 9:36 PM states that resident was observed sitting in her recliner chair with head and body jerking/shaking; resident's vitals were taken, and resident noted with elevated blood pressure of 242/108. Resident was sent to the hospital/emergency room via 911. 2. R58's After Visit Summary shows that R58 was admitted to the hospital from [DATE] to 10/18/24 with the diagnosis of wound infection. R58's progress notes of 10/11/24 states that resident was seen by the wound doctor. The wound doctor recommended that the resident should be sent to the hospital for possible debridement of the left heel/ankle wound. 3. R9's After Visit Summary shows that R9 was admitted to the hospital from [DATE] to 10/25/24 with the diagnosis of sepsis due to undetermined organism. R9's progress notes of 10/21/24 at 9:03 PM states that the nurse went into R9's room and noted that R9 was in distress and could not breath; vitals were taken and R9's heart rate was 145 and oxygen saturation level was 86%. The physician was notified, and they received order to send R9 to hospital; resident was sent to the hospital via 911. 4. R84's After Visit Summary shows that R84 was admitted to the hospital from [DATE] to 12/6/24 and was treated for acute on chronic abdominal pain. R84's progress notes of 11/27/28 at 5:47 PM states that resident's colostomy bag had pinkish/reddish watery fluid. Resident was sent to the hospital per resident request. On 12/11/24 at 1:34 PM, V5 (Assistant Director of Nursing/ADON) said we provide written documentation of bed hold policy to residents who are alert. We do not give written documentation of bed hold policy. We notify resident's family via phone of their transfer to the hospital. We only notify the ombudsman when residents are discharged from the facility, we do not notify them when residents are hospitalized . On 12/12/24 V5 said, the facility only has bed hold policy form, they do not have a bed hold policy. The facility's Necessity of Transfer form/Notice of Bed Hold Policy form (undated) states that a bed hold is an agreement between the community and you to keep your bed available while you are in the hospital or on therapeutic leave. If you are transferred to the hospital or take a therapeutic leave, you will receive this form and will be asked to notify us of your intent to return or be discharged from the community. A copy of policy provided to resident representative at time of transfer; copy of policy provided to the resident/included in transfer paperwork at time of transfer. 5. R25's face sheet showed R25 was admitted to the facility on [DATE], with diagnoses including cerebral infarction, hemiplegia and hemiparesis, polyneuropathy, atrial fibrillation, congestive heart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 3 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some failure, type 2 diabetes mellitus, dementia, hypothyroidism, hyperlipidemia, gout, hypertension, and osteoarthritis. R25's progress notes showed the following: On December 6, 2024, at 1:50 AM: Resident started having a feeling of being anxious [approximately] around 8 PM. She called her husband and came in the unit. [Name] stayed a while then left, verbalize it's late already. The resident becoming worse, she wants to get up and be lifted up from bed via [mechanical] lift, and her wish to be move out of bed to a wheelchair. About to move her, changed her mind but feeling anxious is getting worse. Contacted NP (Nurse Practitioner) [Name] NP explained the situation BP (Blood Pressure) 117/54 HR (Heart Rate) 52 BS (Blood Sugar) 116 O2 (Oxygen) 945 (sic) RA (Room Air). No facial drooping, no slurred speech, no neuro deficits noted. NP order to continue to monitor. Can give a hydroxyzine 25 mg (milligram) one time may calm her. New order administered. Condition worsened. Vitals become unstable resident desaturated 46 O2 administered at 4 L (Liters) went up at 55 then O2 boost up to 8 L NC (Nasal Cannula), saturation went up to 86%. NP ordered to send out EMH ER (Emergency Medical Hospital Emergency Room) via 911 called [At] 9:30 PM. Vitals taken BP 120/63 HR 53 O2 Sat 86% at 8 L via NC. Paramedics arrived and left the facility [at] 10:45 PM. Spouse contacted multiple times, no answers and son emergency contact, no answer. Endorsed to next NOD (Nurse on Duty) to follow up the status of the resident. On December 6, 2024, at 3:42 AM, Resident admitted to EMH for acute chronic respiratory distress. The facility was unable to provide documentation of written notification of transfer to the hospital to the family or to the ombudsman. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 4 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide in writing to the residents and/or their POA (POA/Power of Attorney) information regarding bed hold and return at the time of discharge to the hospital. This applies to 5 of 5 residents (R9, R25 R58, R63, and R84) reviewed for discharge in a sample of 32. The findings include: 1. R63's After Visit Summary shows that R63 was admitted to the hospital from [DATE] to 9/16/24 with the diagnosis of acute cystitis without hematuria. R63's progress notes of 9/13/24 at 9:36 PM states that resident was observed sitting in her recliner chair with head and body jerking/shaking; resident's vitals were taken, and resident noted with elevated blood pressure of 242/108. Resident was sent to the hospital/emergency room via 911. No bed hold documentation uploaded into the medical record. The facility was unable to provide documentation of bed hold given to the resident and/or the POA. 2. R58's After Visit Summary shows that R58 was admitted to the hospital from [DATE] to 10/18/24 with the diagnosis of wound infection. R58's progress notes of 10/11/24 states that resident was seen by the wound doctor. The wound doctor recommended that the resident should be sent to the hospital for possible debridement of the left heel/ankle wound. No bed hold documentation uploaded into the medical record. The facility was unable to provide documentation of bed hold given to the resident and/or the POA. 3. R9's After Visit Summary shows that R9 was admitted to the hospital from [DATE] to 10/25/24 with the diagnosis of sepsis due to undetermined organism. R9's progress notes of 10/21/24 at 9:03 PM states that the nurse went into R9's room and noted that R9 was in distress and could not breath; vitals were taken and R9's heart rate was 145 and oxygen saturation level was 86%. The physician was notified, and they received order to send R9 to hospital; resident was sent to the hospital via 911. No bed hold documentation uploaded into the medical record. The facility was unable to provide documentation of bed hold given to the resident and/or the POA. 4. R84's After Visit Summary shows that R84 was admitted to the hospital from [DATE] to 12/6/24 and was treated for acute on chronic abdominal pain. R84's progress notes of 11/27/28 at 5:47 PM states that resident's colostomy bag had pinkish/reddish watery fluid. Resident was sent to the hospital per resident request. No bed hold documentation uploaded into the medical record. The facility was unable to provide documentation of bed hold given to the resident and/or the POA. On 12/11/24 at 1:34 PM, V5 (Assistant Director of Nursing/ADON) said we provide written documentation of bed hold policy to residents who are alert. We do not give written documentation of bed hold policy. We notify resident's family via phone of their transfer to the hospital. We only notify the ombudsman when residents are discharged from the facility, we do not notify them when residents are hospitalized . On 12/12/24 V5 said, the facility only has bed hold policy form, they do not have a bed hold policy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 5 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The facility's Necessity of Transfer form/Notice of Bed Hold Policy form (undated) states that a bed hold is an agreement between the community and you to keep your bed available while you are in the hospital or on therapeutic leave. If you are transferred to the hospital or take a therapeutic leave, you will receive this form and will be asked to notify us of your intent to return or be discharged from the community. A copy of policy provided to resident representative at time of transfer; copy of policy provided to the resident/included in transfer paperwork at time of transfer. 5. R25's face sheet showed R25 was admitted to the facility on [DATE], with diagnoses including cerebral infarction, hemiplegia and hemiparesis, polyneuropathy, atrial fibrillation, congestive heart failure, type 2 diabetes mellitus, dementia, hypothyroidism, hyperlipidemia, gout, hypertension, and osteoarthritis. R25's progress notes showed she was admitted to the hospital on [DATE], at 1:50 AM with the admitting diagnosis of acute chronic respiratory distress. The facility was unable to provide documentation of written notification of the bed hold given to the family and/or the POA. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 6 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0657 Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to invite a resident to the care plan meetings. Residents Affected - Few This applies to 1 of 1 resident (R146) reviewed for care plan meetings in a sample of 32. The findings include: On December 10, 2024 at 11:01 AM, R146 said he wished somebody would tell him what he needed to do to go home. R146 said he was not told what the goals were or what he needed to do to be discharged home. R146 said he had never heard of a care plan meeting and had never been invited to one. R146 said he made his own goals up. On December 12, 2024 at 11:31 AM, V20 (Social Services Director) said R146 does not attend his meetings because he had never chosen to. V20 said she did not have documentation or progress notes to show she had invited R146 to the care plan meetings. V20 said R146's family was never there and had never scheduled to come to the meetings. V20 said she did not have documentation, including progress notes, to show the facility staff had invited the family to the care plan meetings. R146's Care Plan Meeting Attendance forms dated November 12, 2024, August 13, 2024, April 23, 2024, and January 23, 2024 showed R146 or family never attended any of the meetings. The facility's Care Plan policy revised in 2007 showed An Interdisciplinary Assessment Team, in coordination with the resident and his/her family or representative (sponsor), develops and maintains a comprehensive care plan for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 7 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to obtain residents' blood glucose levels appropriately and failed to follow physician order for administering insulin. This applies to 2 of 2 residents (R100 and R121) reviewed for blood glucose monitoring and insulin. Residents Affected - Few The findings include: 1. On 12/10/24 at 10:38 AM, V6 (Agency Registered Nurse/RN) checked R100's blood glucose level. R100's glucose level was 221. V6 said that R100 gets insulin per sliding scale. At 10:49 AM, V6 returned to R100's room and administered 4 units of insulin Aspart to R100's left upper arm. R100 said he had breakfast around 8:00 AM. The lunch trays were passed at 12:18 PM. Review of R120's Electronic Medical Record (EMR) shows the following diagnoses of chronic kidney disease, disorder of kidney and ureter and Type 2 diabetes mellitus without complication. R100 has a physician order for accucheck four times a day, Insulin Aspart injection solution 100 unit/ml, inject as per sliding scale. On 12/11/24 at 9:13 AM, V6 (Agency RN) said she took R100's 11 AM blood glucose level yesterday and does not know what time the lunch trays are passed in the unit. 2. On 12/11/24 at 8:35 AM, V8 (Licensed Practical Nurse/LPN) said they check resident's blood glucose levels around 7:45 AM- 8:00 AM and 11:00 AM- 11:15 AM, and the nurses administer insulin when they see the meal trays being served, right before the residents eat, so the resident's blood glucose level doesn't drop, or the resident gets hypoglycemic. On 12/11/24 at 11:27 AM, V9 (Licensed Practical Nurse /LPN) went to R120's room to check her blood glucose level. R120 was in her room eating rice. V9 checked R120's blood glucose level, it was 177. V9 said R120 gets insulin per sliding scale. V9 administered 2 units of Insulin Lispro to R120's right lower abdomen. Review of R120's EMR shows the following diagnoses of Type 2 diabetes mellitus with diabetic neuropathy and acquired absence of other right toes. R120 has a physician order for blood sugar via finger stick before meals and at bedtime, Humalog solution 100 unit/ml inject per sliding scale. On 12/12/24 at 10:00 AM, V2 (Director of Nursing/DON) said accuchecks are done before meals and insulin should be given after the accucheck so the nurse has accurate readings without the contribution of the food. V2 said that some nurses administer insulin when they see the meal trays so that the resident does not get hypoglycemic. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 8 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide ADL (Activities of Daily Living) care for 5 residents (R34, R5, R151, R139, & R38) who are dependent on care for activities of daily living in a sample of 32. Residents Affected - Some The findings include: 1. On 12/10/24 at 11:29 AM, R5 was observed with facial hair on her chin and around her mouth. R5 said that she was not aware that she had any facial hair on her face because she is not able to hold a mirror and the staff has never offered her one. R5 said that she had never been shaved and after touching her face and feeling the facial hair, R5 said that having the facial hair makes her feel bad and it is not a good feeling. On 12/11/24 at 11:12 AM, R5 was observed in her bed with facial hair on her chin and around her mouth. R5's EHR (Electronic Health Record) showed that she is a [AGE] year old female admitted on [DATE] with diagnoses including MS (multiple sclerosis) and osteoarthritis. R5's 11/4/24 MDS (Minimum Data Set) section GG showed that R5 is dependent on staff for personal hygiene. R5's 10/30/24 care plan showed she has an ADL self-care performance deficit related to quadriplegia and MS with interventions including personal hygiene requires staff's assistance. 2. On 12/10/24 10:39 AM, R34 was observed with facial hair and long jagged nails with a brown substance under her nails. R34 said that she wanted to be showered. R34's EHR showed that she is a [AGE] year old female admitted on [DATE] with diagnoses including parkinsonism, type 2 diabetes, Alzheimer's, and dementia. R34's 10/2/24 MDS section C. showed that her cognition is moderately impaired. Section GG showed that she needs staff supervision or touch assistance for personal hygiene. R34's 10/1/23 care plan showed R34 has an ADL Self-care deficiency related weakness, unsteady balance and multiple diagnoses that include Parkinson's Disease. The interventions include Shower/bathe R34 as scheduled and assist with dressing and personal hygiene needs. 3. On 12/10/24 12:29 PM, R38 was observed with facial hair on her chin and around her mouth. R38 said that the staff only shaves her once a month, then she rubbed the hair on her chin and around her mouth and said that the facial hair bothers her. R38 nails were observed with a brown substance under the nails and her hair was observed oily. R38's EHR showed that she is an [AGE] year old female admitted on [DATE] with diagnoses including Chronic Obstructive Pulmonary disease, type 2 diabetes, morbid severe obesity, and above the knee amputation. R38's 11/21/24 MDS section C showed that her cognition is severely impaired. Her 11/23/24 MDS section GG showed that she needs staff's supervision or touching assistance for personal hygiene. R38's 11/23/24 care plan showed that she has an ADL Self-care deficiency related to weakness, impaired mobility secondary to bilateral lower extremity amputations with interventions including staff assist resident with personal hygiene and dressing needs. 4. On 12/10/24 at 01:16 PM, R139 was observed with long nails with brown substances under the nails and long toenails about ½ inch over the top of her toes. R139's EHR showed that she is an [AGE] year old female admitted on [DATE] with diagnoses including (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 9 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hemiplegia, spinal stenosis, contracture of muscle, muscular degeneration, & vascular dementia. R139's 10/22/24 MDS section C showed that her cognition is moderately impaired and section GG showed that she needs substantial/maximal assistance from staff for personal hygiene. 5. On 12/10/24 at 02:06 PM, R151 was observed with a heavy/thick beard and mustache. R151 said that the staff tells him they are coming back to shave him every day, but they don't come back. R151 said that he doesn't like that they don't shave him. R151's EHR showed that he is a [AGE] year old male admitted on [DATE] with diagnoses including osteoarthritis, left artificial hip joint, and cerebral infarction. R151's 10/28/24 MDS section C showed that his cognition is intact. R151's 11/4/24 MDS section GG showed that he needs staff to supervise or touch assistance for personal hygiene. R151's 11/18/25 care plan showed a personal hygiene ADL self-care performance deficit with interventions including requires touch assistance with personal hygiene care. On 12/12/24 at 12:32 PM V2 (Director of Nursing) said that residents ADLs including personal nail care is to be provided as needed for infection control and for safety for nails that are long and jagged. V2 said that hair should be washed as needed. The facility was unable to provide an ADL policy. The facility's Resident Rights Statement dated December 2023 showed that all residents have a right to a dignified existence. The residents will be cared for in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life, dignity, and aspect in full recognition of his or her individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 10 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement a physician's order. This applies to 1 resident (R77) reviewed for quality of care in a sample of 32. Residents Affected - Few The findings include: On 12/10/24 at 12:39 PM R77 was in her room eating her lunch. The diet slip on her tray showed No Straws. At 12:54 PM V14 CNA (Certified Nurse's Assistant) brought a cup of water with a straw in the cup and placed it on R77's table and removed her lunch tray. On 12/12/24 at 01:09 PM V15 (CNA) said that she put a straw on R77's lunch tray and was bringing the tray to R77's room when V13 SLP (Speech Language Pathologist) took R77's tray from V15 and brought it into R77 room herself. On 12/12/24 at 01:15 PM V13 said that she did a bedside swallow study on R77 at that time, and she used the straw. V13 said that her evaluation determined that R77 is still not to use straws. V13 said that R77 last evaluation was in June of 2023, and it was determined that she was not to use straws, was to be on mechanical soft diet with nectar thick liquids and was to be on aspiration precautions related to her diagnosis of dysphagia. R77's EHR (Electronic Health Record) showed that she is a [AGE] year old female admitted on [DATE] with diagnosis including dysphasia, chronic obstructive pulmonary disease, and dementia. R77's 6/28/23 Physician's Order showed no straws every shift, and another physician's order again on 6/28/23 for Aspiration Precaution every shift. R77's 11/20/24 care plan showed altered diet related to dysphagia with interventions including aspiration precautions and no straws. R77's 12/12/2024 - 12/25/24 SLP Evaluation recommended No Straw. On 12/12/24 at 02:25 PM V3 ADON (Assistant Director of Nursing) said that staff should follow all physicians' orders including no straw and aspiration precautions. The facility was unable to provide a policy for following or implementing a physician's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 11 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide restorative services to a resident as recommended per ADL (Activities of Daily Living) Restorative Assessment. This applies to 1 resident (R128) reviewed for restorative services in a sample of 32. The findings include: R128's Face Sheet shows he is a [AGE] year old male with a history of Hemiplegia and Hemiparesis following cerebral infarction affecting right dominant side, aphasia following cerebral infarction, dysphagia following cerebral infarction, and repeated falls. R128's MDS (Minimum Data Set) dated 10/15/24 shows he has impairments on one side of both upper and lower extremities, and he uses a wheelchair for mobility. On 12/10/24 at 11:38 AM, R128 was interviewed by surveyor while sitting in his bed. R128 is unable to speak due to history of stroke and aphasia, but he was able to respond to yes or no questions by moving his head up and down and side to side. R128 said the facility staff did offer him a communication board, but he did not like it and preferred not to use it. R128 said he is not able to get out of bed on his own and he would like to get up to his wheelchair every day, but the staff do not ask him if he wants to get up. R128 said physical therapy, occupational therapy, and speech therapy are no longer working with him. R128 said he received those therapies when he first came to the facility, but he no longer receives them. R128 said he does not receive any restorative therapy and his right arm and right leg are weak due to his stroke. On 12/12/24 at 3:26 PM, V13 (Speech Therapist) said typically all long term patients get restorative therapy. V13 said R128 was referred to restorative therapy on 9/27/24 by physical therapy. On 12/12/24 at 11:06 AM, V8 (LPN/Licensed Practical Nurse) said R128 has received therapies in the past but is not currently receiving Physical Therapy, Occupational Therapy, or Speech Therapy. V8 said she has not seen R128 get any kind of restorative therapy. On 12/12/24 at 3:38 PM, V2 (DON/Director of Nursing) said R128 is on 3 restorative programs: Bed Mobility, Dressing, and Active Range of Motion for upper and lower extremities. V2 then looked for documentation that these programs are being carried out for R128 and V2 was unable to find any documentation showing that any kind of restorative therapy has been done over the last 30+ days. R128's ADL Restorative Assessment & Progress Note dated 10/15/24 shows R128 should have restorative programs for dressing, bed mobility, and active range of motion. Documentation forms for amount of minutes spent providing active range of motion and attempts at the dressing and bed mobility restorative programs have not been done over the past 30+ days. The forms show no data found. R128's Care Plan last revised 3/5/23 shows he has a bed mobility ADL self-care performance deficit related to limited range of motion to his right side secondary to history of stroke. Interventions include bed mobility program 6-7x's a week. Care Plan shows he has a dressing ADL Self- Care Performance Deficit related to limited range of motion. Interventions include he will participate with dressing upper body with extensive assistance and assist him to choose simple comfortable clothing that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 12 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete maximizes his ability to dress himself. Care Plan shows he has a range of motion ADL Self-Care Performance Deficit related to history of stroke with right sided weakness. Interventions include AROM (Active Range of Motion): he will participate with AROM to upper and lower extremities for at least 15 minutes 6-7 days a week, allow ample time to perform task, and no movement beyond point of resistance. The facility's undated policy titled, Restorative Nursing Policy states, Policy: It is the policy of this facility that residents will be assessed for restorative/rehabilitative needs and placed in nursing director programs. Each program purpose is directed toward assisting resident to achieve and maintain optimal levels of self-care and independence, thus enhancing self-esteem, promoting active participation in daily living and improving quality of life. Policy Specifications: To ensure that each resident's individual rehabilitative needs are identified, and appropriate nursing measures implemented to achieve a maximum level of independence. Responsibility: Director of Nursing, Licensed Nurses, Certified Nurse Assistants and Restorative Aides. Definition: Restorative Nursing Programs: a. Range of Motion .c. Bed Mobility .f. Dressing and Grooming . Event ID: Facility ID: 145420 If continuation sheet Page 13 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. On 12/11/24 at 11:12 AM, V10 (Wound Nurse) and V17 CNA (Certified Nurses' Assistant) were providing wound care and incontinence care for R5. V10 Picked up R5's catheter bag from the side of her bed raising the bag over the level of R5's bladder and then placed the catheter bag on R5's bed and proceeded to provide wound care to R5's 2 sacral wounds. After wound care and incontinence care was done, V17 picked up R5's catheter bag and put the bag back on the side of R5's bed. R5's EHR (Electronic Health Record) showed that R5 is a [AGE] year old female admitted on [DATE] with diagnoses including neuromuscular dysfunction of the bladder, quadriplegia, pressure ulcer of left buttock stage 4, and type 2 diabetes. R5's 6/20/24 care plan showed that R5 has a history of UTIs (Urinary Tract Infections). On 12/12/24 at 12:13 PM V2 (Director of Nursing) said that the catheter bag should not be over the level of the bladder. Based on observation, interview, and record review, the facility failed to properly position resident's indwelling catheter bag/drainage bag during wound care dressing change and incontinent care. This applies to 3 of 3 residents (R5, R84 and R155) reviewed for indwelling catheters and incontinent care in a sample of 32. The findings include: 1. On 12/11/24 at 8:37 AM, R84 was observed sitting in her motorized wheelchair going down the hallway. R84's indwelling catheter drainage bag was hanging on the arm rest of the motorized wheelchair above the bladder line. There was back flow of urine noted. On 12/12/24 at 10:30 AM, V10 (Wound Care Nurse) and V11 (Licensed Practical Nurse/LPN) completed wound care for R84. V10 informed R84 of her dressing change; at 10:34 AM, V11 approached R84's left side of the bed and unhooked her catheter drainage bag from the side of the bed, lifted it up and placed it on the bed, back flow of urine was noted in the tubing. V11 moved to right side of the bed and turned R84 on her right side, facing the window so that V10 could complete the wound care to R84's right and left buttocks. R84's catheter drainage bag was on the bed throughout the wound dressing change. Wound care was completed at 10:45 AM. After wound care V10 and V11 reposition R84 in bed, R84's catheter bag was still on the bed. Review of R84's Electronic Medical Record (EMR) shows the following diagnoses of paraplegia, acute embolism and thrombosis of unspecified deep veins of left lower extremity, neuromuscular dysfunction of bladder, urinary tract infection/UTI (12/6/24), extended spectrum beta lactamase (ESBL) resistance, pressure ulcer of left and right buttock stage 3. R84 has a physician order for indwelling catheter. R84's care plan (revised 11/15/24) shows that R84 was recently on antibiotics for UTI, and R84 has an indwelling catheter with history of UTI (revised 3/3/24). On 12/12/24 at 10:05 AM, V2 (Director of Nursing/DON) said catheter drainage bag should be positioned below the waist, so there will be no backflow of urine. The facility's Catheter Care, Urinary policy (revised 09/2005) states that the urinary drainage bag (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 14 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary bladder. 3. R155 has diagnoses that includes anemia, congestive heart failure, obstructive and reflux uropathy, male erectile dysfunction, anxiety, tremors, dementia and hypertension. R155's MDS (Minimum Data Set) dated 9/3/24 shows severe cognitive impairment. R155's current care plan states he was re-admitted with a catheter related to obstructive uropathy. Interventions include to use leg bag when out of bed. On 12/11/24 at 03:15 PM, V28 CNA (Certified Nursing Assistant) stated they only always use a leg bag for R155 and do not use a hanging bag for urine collection. On 12/11/24 at 03:43 PM, V27 LPN (Licensed Practical Nurse) stated they use a leg bag for R155 24 hour a day 7 days a week because he moves a lot. On 12/12/24 at 12:19 PM, V5 ADON (Assistant Director of Nursing) stated R155 should be switched to a large urine collection bag when he is in bed. When he is lying in bed urine can back flow and cause a urinary tract infection. There is no gravity when using the leg bag to keep it from back flowing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 15 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to post the current daily staffing. This effects all 159 residents in the facility. Residents Affected - Many Findings include: On 12/10/24 at 10:36 AM the Daily Staff Posting at the reception desk showed a date of 12/9/24 with a census of 160. On 12/11/24 at 02:02 PM V2 Director of Nursing (DON) said that the admission staff emails the current census in the morning between 930am and 10 am to the front desk, herself and all the managers. The receptionist will ask her, V2 or the scheduler, at the same time she is getting the email, for the census number. Then the receptionist is to fill in the number of staff for the day and the census and she posts it after 930 AM - 10:00 AM. V2 said that the receptionists' work schedules are 8am to 130pm and 1:00 PM to 8:00 PM. V2 said that the receptionist that works 8am - 130pm is the one that does the daily posting for that day. The facility's Posting Direct Care Daily Staffing Numbers policy dated August 2008 showed that facility will post on a daily basis for each shift, the number of nursing personnel responsible for providing direct care to resident. At the beginning of each shift the facility shall post the nurse staffing data as required by state and federal regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 16 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 - Some 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 6. On 12/10/24 at 11:01 AM, R109 was in her room and there were 10 Pills in a medication cup on her bedside table. R109 said that the nurse gave the medicine to her and then the nurse walked away. R109 said that she was not going to take her medications until her stomach felt better. R109 said that she had been throwing up since early morning and every time she drinks water she throws up. On 12/12/24 at 12:45 PM V2 (Director of Nursing) said that all residents need an assessment to self-medicate, and they also need an order from the physician. V2 then looks at R109 EHR (Electronic Health Record) and said that R109 did not have an order to self-medicate or an assessment. V2 said that the medications should not have been left there because the resident could throw away the medications and there is no guarantee the resident is taking the medications. V2 said she was not aware of the facility's policy on storage of medications. R109's EHR showed that she is a [AGE] year old female admitted on [DATE] with diagnoses including epilepsy and mild cognitive impairment. No self-medication assessment, physician orders to self-medicate or order to have medications at bed side were found in R109's EHR. The facility's Storage of Medication policy 10/27/14 showed that medications and biologicals are to be stored safely and securely. Facility's list of residents that can self-administer medications showed 5 residents and R109 was not on the list. Based on observation, interview, and record review, the facility failed to secure resident's medication during medication administration and failed to obtain a physician order for over-the-counter medications. The facility also allowed medications to be stored in residents' rooms without an order. This applies 8 of 8 residents (R63, R100, R109, R126, R127, R132, R136 and R146) reviewed for medications in a sample of 32. The findings include: 1. On 12/10/24 at 10:33 AM, R100, was resting in bed. V6 (Agency Registered Nurse/RN) came to R100's room to administer his medications. V6 said she needed to get the blood pressure cuff and the glucometer to check R100's blood pressure and blood glucose level. V6 left the medicine cup on top of R100's bedroom dresser. The medication cup had 9 unlabeled pills. Review of R100's Electronic Medical Record (EMR) shows the following diagnoses of chronic kidney disease, failure to thrive, diastolic (congestive) heart failure, dysphagia, and schizoaffective disorder, bipolar type. R100's Minimum Data Set (MDS)of 10/8/24 shows that his cognition is moderately impaired. 2. On 12/10/24 at 10:42 AM, R136 was sitting in his motorized wheelchair in his room. On R136's bedside table was a bottle of Dry Eyes Relief lubricating eye drops. R136 said he uses the eyedrops once in a while. Next to the eyedrops was a clear plastic cup that had 3 medication cups. Each medication cup had 5 small unlabeled pills (4 round brown pills and 1 yellow pill). R136 said the medications were his, they were ibuprofen for the pain in his foot. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 17 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 - Some Review of R136's EMR shows the following diagnoses multiple sclerosis, cardiomyopathy, fracture of lower end of right tibia, and fracture of unspecified lower leg. R136's MDS of 9/24/24 shows that his cognition is intact. Review of R136's current physician order was done, R136 did not have an order for Ibuprofen or that medications can be stored in resident's room. 3. On 12/10/24 at 11:09 AM, R127 was in bed in her room. R127 had Albuterol Sulfate HFA inhalation aerosol on her bedside table. R127 said she does not use the inhaler all the time, she has bronchitis, and she gets breathing treatments and other inhalers. Review of R127's EMR shows the following diagnosis of chronic obstructive pulmonary disease (COPD). R127's (MDS) of 10/15/24 shows that her cognition is moderately impaired. Review of R127's current physician order shows order for Ventolin HFA inhalation Aerosol solution 108 (90 base) mcg (Albuterol Sulfate) 2 puff inhale orally every 6 hours as needed for shortness of breath. R127 does not have an order that states medications can be stored in residents' rooms. 4. On 12/10/24 at 11:18 AM, R126 was sitting by the side of his bed. R126 was administering eye drops to his eyes. R126 said, I do not make tears, this helps. It is artificial tears, I have glaucoma R126 was administering Refresh lubricating eye drops. On R126's bedside table there was a tube of Triamcinolone Acetonide cream 0.1%. R126 said it was for his legs, he has eczema. Review of R126's EMR showed the following diagnoses of gout, glaucoma, chronic embolism and thrombosis of unspecified deep veins of bilateral lower extremity. R126's MDS of 11/5/24 shows that his cognition is intact. Review of R126's current physician order shows order for Triamcinolone Acetonide cream 0.025% apply to bilateral lower legs topically every day and evening shift for 14 days (order start date 11/28/24 end date 12/12/24). R126 did not have an order for Refresh Lubricating eye drops or an order that states medications can be stored in residents' rooms. 5. On 12/12/24 at 8:39 AM, there was a cup of unlabeled pills in medication cup on the medication cart in the D unit. There were 9 pills in the medication cup. The medication cart was between R63's room and R143's room. There was no nurse by the medication cart. R84 and R143 were in the hallway around the medication cart at that time. V6 (Agency RN) said V7 (MDS Coordinator) told her she had a phone call. V6 said she left her medications on the cart because V7 told her she would watch the medications while she was on the phone. V6 said the medications belonged to R63; V6 went to R63's room and administered the medications. On 12/11/24 at 9:14 AM, V7 (MDS Coordinator) said V6 (Agency RN) asked her to watch the medication cart while she was on the phone. V7 said she got distracted because she had to assist another nurse. V7 said the nurse should not have left the medications unattended. On 12/12/24 at 9:51 AM, V2 (Director of Nursing/DON) said there has to be an assessment in order for residents to self-administer or store medications at the bedside. There should also have a physician order as well. V2 said the nurse should not have left medications unattended in the resident's room; the nurse should be administering the medications. V2 said the nurse should not have left the medications unattended on the medication cart because other residents could accidentally take the medications. 7. On December 10, 2024, at 11:23 AM, during initial tour, R132 had nasal spray on her bedside table, a box for an albuterol sulfate inhaler, and a bin in her room contained Proair Respiclick albuterol sulfate inhaler. R132's bedside table also had an empty prescription bottle of meclizine 25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 18 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 Milligrams. Level of Harm - Minimal harm or potential for actual harm On December 12, 2024, at 9:05 AM, R132 was in the dining room with her albuterol sulfate inhaler next to her. Residents Affected - Some R132's face sheet showed diagnoses including acute respiratory failure, hyperlipidemia, chronic obstructive pulmonary disease, lack of coordination, dysphagia, peripheral vascular disease, heart failure, anxiety disorder, and gastro-esophageal reflux disease. R132's MDS (Minimum Data Set) dated October 15, 2024, showed R132 had moderate cognitive impairment. R132's POS (Physician Order Sheet) does not show orders for R132 to store medications at the bedside. R132's albuterol sulfate inhaler was ordered December 11, 2024 (during the survey) and did not show an order to self-medicate. R132's care plan did not show R132 was care planned to store medications at bedside. 8. On December 10, 2024, at 11:01 AM, during initial tour, R146 had albuterol sulfate inhaler and fluticasone spray on the bedside table. On December 12, 2024, at 2:51 PM, R146 said the medications have been on his desk for over a year. R146's face sheet showed diagnoses including chronic obstructive pulmonary disease, heart failure, dependence on supplemental oxygen, peripheral vascular disease, vitamin D deficiency, and right artificial hip joint. R146's MDS dated [DATE], showed R146 was cognitively intact. R146's POS On December 12, 2024, at 2:38 PM, V18 (RN/Registered Nurse) said she was R132 and R146's nurse and she did not have any residents who were allowed to keep medications at the bedside. V18 said if the medications were at the bedside, they should be removed. V18 said the residents should have orders for the medications and to keep the medication at the bedside. V18 said the staff should watch the residents take the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 19 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow recipes as instructed for palatability. This applies to all residents that receive regular diets, regular or pureed texture, prepared in the facility kitchen. Residents Affected - Many Findings include: The facility's Long-Term Care Facility Application for Medicare and Medicaid (Form CMS-Centers for Medicare and Medicaid Services-671) dated 12/10/24 documents that the total census was 159 residents. On 12/10/24 at 4:15 PM, V2 (Director of Nursing) said the facility has 3 NPO (Nothing by Mouth) residents and the facility provided resident diet list showed 137 residents receive regular diets of regular or pureed textures. R101's MDS (Minimum Data Set) dated 10/22/24 shows her cognition is intact. R101's POS (Physician Order Set) shows an order dated 6/8/24 for regular diet, regular texture. On 12/10/24 at 11:05 AM, R101 said the food is poor and it usually comes salty. R101 said she has her family bring her cans of soup and that is what she eats instead of the food from the facility kitchen. R28's MDS dated [DATE] shows her cognition is intact and her POS shows an order dated 8/22/24 for regular diet, regular texture. On 12/10/24 at 11:19 AM, R28 said the food is horrible and she can't eat a thing. R28 said she usually eats a peanut butter and jelly sandwich or a cheese sandwich instead of what is on the menu. R30's POS shows an order dated 11/9/24 for regular diet, regular texture. On 12/10/24 at 11:54 PM, R30 said she doesn't eat the food from the facility kitchen because it all has a certain awful taste like it was covered in a dirty dishrag. While interviewing R30, at 12:02 PM, her lunch tray was delivered, and a long black hair was found on her tray. When R30 looked at the food, she made a dismissive face and said she was not going to eat any of it. On 12/11/24 at 10:55 AM, V24 (Cook) was asked where the recipes were for the lunch she had prepared, and she asked V23 (Dietary Manager) where the recipes were kept. V23 responded telling her the recipes are in her stapled papers, behind the Production Sheet. V24 then found the recipes and handed them to surveyor. Surveyor reviewed the Production Sheet Lunch- Day: 11- Wednesday and the recipes for Pizza, Pureed Pizza, Side Salad with Dressing, and Strawberry Shortcake. V24 said she made cheese and sausage pizzas, and she used green peppers and onions but not a lot. The Pizza recipe shows to use 3 cups and 3 Tablespoons of both fresh chopped yellow onion and fresh chopped green bell pepper. The directions read, 4. Sprinkle pizzas with green pepper, onion, & cooked ground beef; top with shredded cheese, covering evenly. At 11:06 AM, V24 removed two pizzas from the oven to show surveyor she used red pepper (instead of green pepper) and onion on those two pizzas. V24 said she cut up about 8 onions and 4-6 red peppers and she did not know the measurement in cups of the vegetables. The recipe for pureed pizza states, place prepared pizza and tomato sauce in a sanitized food processor; blend until smooth. Therefore, the Pureed Pizza recipe was not followed either because the Pizza recipe was not followed. The Strawberry Shortcake recipe shows, 3. To serve: portion 4 ounce spoodle of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 20 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many strawberries over each biscuit. The dessert provided to the residents was a slice of pound cake with half of 1 strawberry on top. At 11:09 AM, V24 said for the strawberry shortcake they used sliced pound cake, not biscuits, and cut a strawberry in half and put that on top of the pound cake. Recipe not followed. The Side Salad with Dressing recipe shows ingredients of fresh tomatoes and shredded cheddar cheese, and the instructions say, 1. Wash, trim & dice tomatoes. Chill. 2. Combine lettuce mix & tomatoes. Portions into 8 ounce spoodle (1 cup) servings onto salad plates or bowls . 3. Prior to serving, sprinkle 2 Tablespoons of shredded cheese on each salad. At 11:23 AM, V25 (Dietary Aide) said she prepared the side salads and there is no shredded cheese or fresh cut tomatoes in the salads. V25 said the salads are just bagged lettuce. Recipe not followed. At 11:14 AM V24 was observed plating pizza, and the crust was floppy and was ripping while V24 was trying to place slices on resident plates. The cheese and sausage was slipping off pizza slices as V24 was plating. On 12/11/24 at 12:04 PM a regular diet and regular texture test tray was received from the facility kitchen. The pizza crust was flimsy and gummy, and the cheese and toppings were sliding off slice when trying to eat with hands. The side salad did not have tomatoes or shredded cheese. The strawberry shortcake was dry and only had half of 1 strawberry on top. On 12/12/24 at 10:33 AM, V23 (Dietary Manager) said the kitchen staff are supposed to follow recipes because the recipes are designed to provide the necessary nutritional value and provide the best quality and taste of the food. V23 said every ingredient adds to the taste, whether that be onions, eggs, cheese, etc. V23 said the extra calories play a part. The facility's policy titled, Standardized Recipes dated 2020, states, Guideline: Standardized recipes will be used for all menu items, including pureed and therapeutic diets. Procedure: 1. Each standardized recipe will include the following: .c. Ingredients d. Measurement and/or weight of ingredients e. Procedures for assembling/method of production . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 21 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to properly label/date/seal/store items, wear hair restraints, and maintain safe food storage temperature of walk-in cooler in kitchen. This applies to all residents that receive oral nutrition and foods prepared in the facility kitchen. Findings include: The facility's Long-Term Care Facility Application for Medicare and Medicaid (Form CMS-Centers for Medicare and Medicaid Services-671) dated 12/10/24 documents that the total census was 159 residents. On 12/10/24 at 4:15 PM, V2 (Director of Nursing) said the facility has 3 NPO (Nothing by Mouth) residents. On 12/10/24 starting at 9:43 AM, the facility kitchen was toured in the presence of V23 (Dietary Manager). For the entirety of the tour, V23 did not wear a beard restraint in the facility kitchen. During the kitchen tour, the following was found: In the walk-in cooler: 1. The temperature inside the cooler on thermometer was reading 58 degrees Fahrenheit and inside the cooler did not feel cold enough. 2. A staff lunch of tortillas and what appeared to be ground beef was stored on shelf inside cooler. No label or date on the food items. V23 said staff lunch should not be stored in the kitchen walk-in cooler. In main kitchen area: 3. No garbage can be located by the handwashing sink to dispose of paper towels used to dry hands upon entering kitchen. 4. V30 (Dietary Aide) working in kitchen and not wearing hair or beard restraints. V30 has 2-3-inch hair on his head and mustache and chin hair. In Dry Storage: 5. A 36 ounce carton of Au Gratin potatoes opened, not sealed. 6. Five 5 pound boxes of expired muffin mix with expiration date 4/7/23. 7. Opened bag of cake mix, not sealed and no label or date. 8. 2 opened 6 pound cartons of expired rainbow sprinkles 8 color mix with best before date of 6/7/24. On 12/11/24 at 10:32 AM, during a return to kitchen tour the following was found: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 22 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 9. The walk-in cooler outside thermometer was showing 53 degrees. The thermometer inside the walk-in cooler was reading 58 degrees. V23 (Dietary Manager) said he removed all food from the walk-in cooler after he was told on 12/10/24 the temperature in walk-in cooler was elevated. V23 and surveyor then entered walk-in cooler together and surveyor noted there was still bread in the cooler as well as the following vegetables: tomatoes, potatoes, onions, cabbage, and spinach. The boxes the spinach and cabbage were stored in read on outside of box: Perishable, keep refrigerated between 33-38 degrees Fahrenheit. On 12/11/24 at 10:43 AM, V26 (Maintenance Director) came to walk-in cooler with infrared thermometer gun and showed the temperature near the fans blowing air in the cooler was 55 degrees Fahrenheit. 10. On 12/11/24 at 11:28 AM, V23 (Dietary Manager) and V30 (Dietary Aide) were both noted in the kitchen without wearing beard restraints. V30 was helping prepare lunch trays in the tray line. On 12/12/24 at 10:33 AM V23 (Dietary Manager) said all food items in the kitchen should be labeled and dated for food safety and to prevent foodborne illness of the residents. V23 said hair restraints should be worn in the kitchen to prevent cross contamination of food served to residents from staff hair falling into the food. V23 said the facility does have beard restraints and he thought they were only required if facial hair was over 2 inches. V23 said expired items should be discarded by their expiration date. V23 said opened food items need to be tightly resealed to prevent cross contamination of the food from pests, dust, or debris. V23 said staff knows they should store their personal food in the cafeteria break room, and not where resident food is kept. V23 said staff food is not monitored for food safety and if staff food is stored with resident food, there is a risk of cross contamination. V23 said the walk-in cooler/refrigerator temperature should be below 41 degrees. V23 said when walk-in cooler temperatures rise above 41 degrees, they enter a temperature danger zone where pathogens or bacteria can grow on the food and the facility risk resident illness from contaminated food items. The facility's policy titled, Hair Restraints dated 2020 states, Guideline: Hair restraints shall be worn by all Dining Services staff when in food production areas, dishwashing areas, or when serving food. Procedure: 1. Staff shall wear hair restraints in all food production, dishwashing, and serving areas. 2. Hair restraints, hats, and/or beard guards shall be used to prevent hair from contacting exposed food. Facial hair is discouraged. Any facial hair that is longer than the eyebrow shall require coverage with a beard guard in the production and dishwashing areas . The facility's policy titled Refrigerator and Freezer Temperatures dated 2020 states, Guideline: To ensure all perishable foods stay fresh and palatable, temperatures will be recorded on all refrigerators and freezers in use, including unit refrigerators located in nourishment rooms. Procedure: .2 The employee ensures that all cold storage units are 41 degrees Fahrenheit or below for refrigeration .5. If the temperature on the thermometer located inside the refrigerator or freezer is outside of the acceptable temperature range for safe food handling, the corrective action is: .c. If the food is at >41 degrees Fahrenheit, the unit will be emptied, and the foodstuff transferred to another refrigerator/freezer and the unit locked out/tagged out per facility policy . The facility's policy titled, Food Storage (Dry, Refrigerated, and Frozen) dated 2020 states, Guideline: Food shall be stored on shelves in a clean, dry area free from contaminants. Food shall be stored at appropriate temperatures and using appropriate methods to ensure the highest level of food safety. Procedure: 1. General storage guidelines to be followed: a. All food items will be labeled. The label must include the name of the food and the date by which it should be sold, consumed, or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 23 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0812 Level of Harm - Minimal harm or potential for actual harm discarded .c. Discard food that has passed the expiration date .d. Keep potentially hazardous foods out of the temperature danger zone (41 degrees Fahrenheit to 135 degrees Fahrenheit .) .2. Refrigerated storage guidelines to be followed: a. Set refrigerators to the proper temperature. The setting must ensure the internal temperature of the food is 41 degrees Fahrenheit or lower . g . Any food item at greater than 41 degrees Fahrenheit for an unknown duration of time, ., will be discarded immediately . Residents Affected - Many The facility's policy titled, Labeling and Dating Foods (Date Marking) dated 2020 states, Guideline: All foods stored will be properly labeled . Procedure: 1 . Once a case is opened, the individual food items from the case are dated with the date the item was received into the facility and placed in/on the proper storage unit .Expiration dated on commercially prepared, dry storage foods will be followed .4. Prepared food or opened food items should be discarded when: . The food item is older than the expiration date . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 24 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to maintain temperature logs, properly store and label food items, and discard potentially spoiled food items. This applies to 5 residents (R153, R5, R16, R8, and R109) reviewed for personal food storage in a sample of 32 residents. Residents Affected - Some The Findings include: 1. On 12/10/24 at 10:45 AM 153's personal refrigerator did not have a temperature log on it and there was no thermometer in the refrigerator. Inside of the refrigerator were 4 supplement drinks, 1 yogurt, several cups of jello, water and puddings. 2. On 12/10/24 at 11:29 AM, R5's personal refrigerator did not have a temperature log on it and there were 10 Peanut Butter and Jelly sandwiches in it, 3 cups of ice cream that was in a liquid form, 2 cups of sherbet that had also turned into a liquid form and the sherbert had separated, 1 of the sherbert cups was open without a lid and half full. 3. On 12/10/24 at 01:09 PM, R8's personal refrigerator was observed without having a temperature log and did not have a thermometer in it. In the freezer was ice cream and in the refrigerator was an uncovered unlabeled bowl of salad. 4. On 12/10/24 at 01:13 PM, R16's personal refrigerator had no temperature log and the thermometer showed Warm 42 F. There were pop and water in refrigerator. 5. On 12/10/24 at 11:01 AM, R109's refrigerator was observed filled with food. The was no observation of a temperature log and there was no thermometer in the refrigerator. On 12/12/24 at 12:28 PM V2 DON (Director of Nursing) said that the temperatures on the residents' personal refrigerators are to be checked and recorded daily but she was not sure what staff was responsible for ensuring this was done. V2 said that the temperature should be between 36 - 4 F and that staff should be disposing of expired food and food should be covered and dated so the residents don't eat spoiled food. On 12/12/24 at 03:46 PM V2 DON said that she found out that housekeeping staff are to be taking care of the residents' personal refrigerators and they are not doing it, or they are doing it sporadically. The facility's Food from Family, Visitor, Community policy dated 11/2010 showed that food stored for residents should be labeled and dated appropriately and discarded per safe food storage guidelines. The facility's Refrigerator and Freezer Temperatures Guidelines and Procedure manual 2020 showed that each refrigeration or freezer located outside kitchen is to be checked daily and recorded on the refrigerator/freezer temperature log. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 25 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. On 12/10/24 at 01:37 PM a red garbage container was observed outside R92's door. On R92's door showed a EBP (Enhanced Barrier Precaution) sign. V9 (Nurse) said that R92 had a wound and a catheter and the red garbage container in the hall was for staff to dispose their contaminated PPE (personal protective equipment) into after leaving the room. Residents Affected - Some On 12/12/24 at 12:22 PM V2 DON said that the soiled PPE is to be put in the red garbage containers in the room. V2 said that the red garbage can is to be in the room for staff to dispose of their PPE while still in the resident's room. V2 said that this is to be done for infection control, so they don't bring contaminated gowns outside of the room. R92's EHR (Electronic Health Record) showed 12/11/24 physician order EBP isolation due to foley catheter. The facility's EBP policy dated 4/1/24 showed that the trash can is to be inside the resident room for discarding PPE after removal prior to exit of the room or before providing care for another resident in the same room. 5. On 12/11/24 at 11:12 AM V10 (Wound Care Coordinator) & V17 CNA (Certified Nurse's Assistant) were providing wound care for R5. V10 with gloved hands, cleaned R5's sacral wound and then cleaned a new wound above the sacral wound. V10 then dried the wounds and put clean dressings on her wounds but she never removed her gloves and clean her hands after cleaning R5's wounds and between cleaning the two wounds. V17 had put on gloves, assisted V10 with wound care and provided incontinence care for R5 including removing the soiled brief that had drainage from the wound and moving R5's catheter from on her bed to the side of her bed with dirty gloved hands. V17 never removed her gloves, cleaned her hands and put on clean gloves one time. V17 acknowledge that R5's brief was soiled with the drainage from her wounds. On 12/12/24 at 12:13 PM, V2 (DON) said that V10 should have cleaned her hands and put on new gloves after cleaning the wounds for infection control, and so she doesn't soil the new dressings. V2 said that the CNA hands should be cleaned when going from dirty to clean during incontinence care and before touching the catheter bag. R5's EHR showed that she is a [AGE] year old female admitted to the facility on [DATE] with diagnoses including neuromuscular dysfunction of the bladder, quadriplegia, pressure ulcer of left buttock stage 4 and type 2 diabetes. R5's 10/30/24 care plan showed that she is at risk for additional skin breakdowns related to impaired mobility, incontinence of bowel and bladder and history of multiple pressure ulcers and the presence of multiple skin breakdowns. R5's care plans showed R5 is on Enhanced precautions, related to a history of urinary tract infections. R5's interventions included good hand washing techniques. The facility's Hand Hygiene policy dated 11/2013 showed that hand washing/hand hygiene procedures as a primary means to prevent the spread of infections among residents and visitors. The policy showed that staff must wash hands that are visibly dirty, when in contact with blood, body fluids secretion, non-intact skin, and after handling items potentially contaminated with blood, body fluids or secretions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 26 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0880 Level of Harm - Minimal harm or potential for actual harm 8. On 12/10/24 at 10:30 AM, R124 was sitting in his wheelchair in his room watching TV. R124's left foot was swollen and was wrapped in loose gauze dressing. R124 was elevated on the leg rest of the wheelchair. R124 said he has an infection, and he gets wound dressing changes daily. There was no EBP (Enhanced Barrier Precaution) sign or PPE (personal protective equipment) outside of his room. Residents Affected - Some On 12/11/24 at 10:36 AM, there was no EBP sign outside of R124's room. On 12/11/24 at 11:04 AM, V10 (Wound Care Coordinator) said R124 has vascular wound, his wounds drains, and he get dressing changes daily. Review of R124's Electronic Medical Record (EMR) shows the following diagnosis of non-pressure chronic ulcer of other part of left lower leg with layer exposed. R124's MDS (Minimum Data Set) of 10/15/24 shows that his cognition is moderately impaired. R124 has a physician order for venous wound of left lower leg: primary dressing alginate calcium with silver apply daily, secondary dressing ABD pad apply and wrap with kerlix daily. On 12/12/24 at 10:07 AM, V2 (Director of Nursing/DON) said residents with chronic pressure wounds, indwelling catheters, suprapubic catheter, G-tube (gastrostomy tube), tracheostomy, PICC (peripheral inserted central catheter) lines are placed on Enhanced Barrier Precautions (EBP). V2 said R124 has venous ulcer, and he is not currently on EBP, however according to the facility's policy, R124 should be on EBP. V2 said residents are placed on EBP to prevent transmission of MDROs (multi drug resistant organism). The facility's Policy and Procedure: Enhanced Barrier Precautions (effective 4/1/24) states to implement EBP for residents with wounds (chronic wounds such as pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and chronic venous stasis ulcers. EBP refers to the use of gown and gloves for using high contact resident care activities for residents. 6. On 12/12/24 at 10:26 AM, V29 Assistant Engineer stated water temperatures and chlorine levels are to be checked monthly to prevent the growth of legionella. On 12/12/24 at 12:19 PM, V5 ADON (Assistant Director of Nursing) stated legionella testing and prevention is the responsibility of maintenance. On 12/12/24 at 03:42 PM, V26 Maintenance Director, stated there was missing documentation for testing water temperatures and chlorine levels to prevent the growth of legionella. V26 stated he was not able to find and policy and wasn't sure how frequently the testing should be done. On 12/12/24 at 04:17 PM, V1 Administrator stated he believed the water temperature and chlorine levels to prevent legionella should be done monthly. Review of the facility provided documentation of their water testing of temperatures and chlorine levels was missing for May, July and August 2024. The facility provided policy Water and Waste Management revised on 9/12/2024 does not state what water temperatures should be maintained, type of disinfectant or the level needed to be obtained to prevent the growth and spread of legionella. The policy does not indicate the frequency water temperatures and disinfectant levels evaluated to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 27 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0880 prevent legionella. Level of Harm - Minimal harm or potential for actual harm 7. The facility provided policy Infection Control Protocol for All Nursing Procedures revised date in August 2008. The facility provided policy Influenza Vaccine had a revised date of August 2007. The facility provided policy Pneumococcal Vaccine had a revised date of November 2009. The facility did not provide a policy related to Covid or Covid vaccination. Residents Affected - Some On 12/12/24 at 12:19 PM, V5 ADON (Assistant Director of Nursing) stated corporate updates and makes changes to the infection control policy. The policy is changed as regulations are changed and updated. On 12/12/24 at 04:17 PM, an updated complete infection control policy was requested from V1 Administrator. V1 stated the policy provided was their current infection control policy. Based on observation, interview, and record review, the facility failed to follow infection control practices. This applies to all 159 residents residing in the facility. The findings include: 1. On December 10, 2024, at 11:30 AM, R161's room did not have any EBP (Enhanced Barrier Precautions) signage or isolation bin with PPE (Personal Protective Equipment) outside of her room. On December 11, 2024, at 12:25 PM, V10 (Wound Care Coordinator/RN-Registered Nurse) and V31 (CNA/Certified Nurse Assistant) went to R161's room and only applied gloves before starting wound care treatment. At 12:31 PM, V10 and V31 touched R161's urinary catheter bag and placed it onto the bed. At 12:33 PM, V31 lowered R161's bed and the urinary catheter bag was resting on the ground. At 1:57 PM, V10 entered R161's room with only gloves on and began moving the urinary catheter bag and placed onto the bed. On December 12, 2024, at 9:29 AM, V10 and V11 (LPN/Licensed Practical Nurse) went to R161's room to provide wound care and only had gloves on. V31 then provided R161 a bed bath wearing only gloves. R161's face sheet showed she was admitted to the facility with diagnoses including neuromuscular dysfunction of bladder, major depressive disorder, anemia, hyperlipidemia, hypertension, and osteoarthritis. R161's POS (Physician Order Sheet) showed an order dated December 11, 2024 (during the survey) for EBP isolation due to wounds and foley. R161's care plan shows R161 had a stage 4 sacral ulcer and indwelling catheter. 2. On December 10, 2024, at 12:06 PM, R86's room did not have any EBP signage or isolation bin with PPE outside of his room. On December 11, 2024, at 12:18 PM, V10 (RN) provided wound care to R86 without wearing a gown. R86's face sheet showed he was admitted to the facility with diagnoses including cellulitis of right lower limb, venous insufficiency, peripheral vascular disease, and gout. R86's POS does not have an order for EBP. 3. On December 10, 2024, at 12:19 PM, R149's room did not have any EBP signage or isolation bin with PPE outside of her room. R149 had a PICC (Peripherally Inserted Central Catheter) line in her right upper arm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 28 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0880 Level of Harm - Minimal harm or potential for actual harm On December 11, 2024, at 11:58 AM, R149's room still did not have any precaution signage or PPE outside his room. On December 11, 2024, at 2:10 PM, V18 (RN) was in R149's room without a gown only, only gloves and assisted R149 in having her incontinence brief changed while she was on the toilet. Residents Affected - Some R149's face sheet showed he was admitted to the facility with diagnoses including abscess of tendon sheath, infection and inflammatory reaction due to internal leg prosthesis, congestive heart failure, osteoarthritis, type 2 diabetes mellitus, dementia, osteoporosis, and cardiac pacemaker. R149's POS showed an order dated December 12, 2024 (during the survey) for Enhanced Barrier Precautions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 29 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain the kitchen walk-in cooler in safe operating condition. This applies to all residents that receive oral nutrition and foods prepared in the facility kitchen. Residents Affected - Many Findings include: The facility's Long-Term Care Facility Application for Medicare and Medicaid (Form CMS-Centers for Medicare and Medicaid Services-671) dated 12/10/24 documents that the total census was 159 residents. On 12/10/24 at 4:15 PM, V2 (Director of Nursing) said the facility has 3 NPO (Nothing by Mouth) residents. On 12/10/24 at 10:08 AM during a kitchen tour with V23 (Dietary Manager), the walk-in cooler in the facility kitchen was noted to be 58 degrees Fahrenheit per the in unit thermometer and inside the cooler did not feel cold. On 12/11/24 at 10:32 AM during a return of kitchen tour with V23 (Dietary Manager), the walk-in cooler outside unit thermometer was showing 53 degrees Fahrenheit. V23 said he removed all of the food from the walk-in cooler on 12/10/24. V23 and surveyor then walked into walk-in cooler and surveyor observed the following food items: various packages of bread, tomatoes, potatoes, onions, cabbage, and spinach. The boxes that the spinach and cabbage were stored in had the following printed on the outside of the boxes: Perishable, keep refrigerated between 33-38 degrees Fahrenheit. The walk-in cooler in unit thermometer was showing 58 degrees Fahrenheit. On 12/11/24 at 10:43 V26 (Maintenance Director) tested the walk-in cooler temperature with an infrared thermometer gun, and it showed 55 degrees Fahrenheit near the fans blowing cool air into unit. On 12/12/24 at 10:33 AM, V23 (Dietary Manager) said the temperature of the cooler/refrigerator should be held below 41 degrees Fahrenheit. V23 said when cooler temperatures rise above 41 degrees Fahrenheit, they enter a temperature danger zone where pathogens and bacteria can grow on the food and, if consumed, residents risk illness from contaminated food. The facility's policy titled Refrigerator and Freezer Temperatures dated 2020 states, Guideline: To ensure all perishable foods stay fresh and palatable, temperatures will be recorded on all refrigerators and freezers in use, including unit refrigerators located in nourishment rooms. Procedure: .2 The employee ensures that all cold storage units are 41 degrees Fahrenheit or below for refrigeration .5. If the temperature on the thermometer located inside the refrigerator or freezer is outside of the acceptable temperature range for safe food handling, the corrective action is: .c. If the food is at >41 degrees Fahrenheit, the unit will be emptied, and the foodstuff transferred to another refrigerator/freezer and the unit locked out/tagged out per facility policy . The facility's policy titled, Food Storage (Dry, Refrigerated, and Frozen) dated 2020 states, Guideline: Food shall be stored on shelves in a clean, dry area free from contaminants. Food shall be stored at appropriate temperatures and using appropriate methods to ensure the highest level of food safety. Procedure: 1. General storage guidelines to be followed: .d. Keep potentially hazardous foods out of the temperature danger zone (41 degrees Fahrenheit to 135 degrees Fahrenheit .) .2. Refrigerated storage guidelines to be followed: a. Set refrigerators to the proper temperature. The setting must ensure the internal temperature of the food is 41 degrees Fahrenheit or lower . g . Any food (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 30 of 31 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 145420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeway Senior Living 111 East Washington Bensenville, IL 60106 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 0908 item at greater than 41 degrees Fahrenheit for an unknown duration of time, ., will be discarded immediately . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145420 If continuation sheet Page 31 of 31