Inspection·January 5, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not familiar with R1. V6 said that right before R1 eloped, she saw R1 talking to V11 (Psychiatric Nurse Practitioner). V6 said that she was passing medications and V8 called her and said that R1 was on the first floor. V6 said that she is not sure how R1 got to the first floor. On 1/5/26 at 10:55 AM, V9 (Certified Nursing Assistant) said that on 12/12/25, she brought R1 and another resident down to the first floor to smoke but they both did not have any cigarettes, so she brought them back up to the second floor and continued taking care of other residents. V9 said that she then heard that R1 had left the facility. V9 said that she does not know how R1 got to the first floor on her own. On 1/5/26 at 11:00 AM, V10 (Licensed Practical Nurse) said that R1 is only allowed to go off of the second floor with a staff member. V10 said that the elevator requires a fob to be used from the second floor. V10 said that there is usually a staff member at the nurse's station watching to ensure that residents do not enter the elevator without a staff member. V10 said that if she has to leave the nurse's station, she will get another staff member to sit at the station to watch the elevator. V10 said that R1 is at risk for elopement and is not in touch with reality.On 1/5/26 at 12:54 PM, V2 (Director of Nursing) said that all residents have an elopement assessment done upon admission and if they are at risk for elopement, they place them on the second floor. V2 said that the second floor is a locked unit, and residents should not be able to exit the unit without staff assistance. V2 said that a staff member should be present at the nurse's station at all times to ensure that residents do not get on the elevator unattended. On 1/5/26 at 1:01 PM, V3 (Assistant Director of Nursing) said that the second floor is the locked unit, and residents should not be able to exit the floor without a staff member. V3 said that she is not sure how R1 got on the elevator on her own. V10 said that they try and have a staff member watching the elevator and keep the residents who are at risk for elopement away from the elevator and involved in an activity. At 2:11 PM, V10 said that after an elopement, the resident's care plan should be updated by social services. V10 reviewed R1's Care Plan and said that she did not see an update after R1 eloped. V10 said that an in-service was not done after R1's elopement.On 1/5/26 at 1:34 PM, V11 (Psychiatric Nurse Practitioner) said that R1 is at risk for elopement. V11 said that on 12/12/25 she saw R1 and was walking the unit and talking with her. V11 said that after she was done on the second floor, a nurse used their fob to open the elevator, and she went to the third floor. V11 said that R1 was in the common area near the elevator when she left the second floor. V11 said that she was on the third floor for some time before she heard that R1 had left the facility. R1's Elopement Risk Evaluation dated 12/2/25 shows that she is at risk for elopement.R1's Care Plan printed on 1/5/26 shows that R1 is an elopement risk/wanderer related to history of attempts to leave facility unattended, impaired safety awareness, wanders aimlessly and is extremely unhappy being in a nursing home. R1's elopement interventions include disguise exits, distract resident from wandering by offering pleasant diversion, structured activities, food, conversation, television, book. All interventions were initiated on 12/2/25. No additional interventions were added after her elopement on 12/12/25.The list titled Residents with Risk for Elopement/Wandering was provided. The list was last updated on 11/19/25 and had 13 residents listed. R1 was not listed on the list. The facility's undated Missing Person/Elopement Policy shows, Safety of all residents is the primary care standard at [Facility]. Precautions, procedures, staff and visitor education have been put in place to maximize resident safety. A Resident Elopement form and a thorough investigation will be completed by the Nurse Manager. He or she is responsible to instruct staff on precautions and safety measures to be taken. The responsible nurse manager will attend the committee meeting to further review the incident and to develop a plan to prevent recurrence. In-service will be conducted on the day of the elopement occurrence to implement safeguards against repeated occurrences.The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145434 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145434 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Claridge Healthcare Center 700 Jenkisson Lake Bluff, IL 60044 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete facility's Elopement/Missing Resident Policy revised on 9/12/25 shows, The elopement risk assessment will be competed upon admission, quarterly and with change of condition by social service department. A care plan will be developed and updated upon admission, quarterly and with change of condition by the social service department. Social Services or their designee will In-service and inform all staff members of any residents at risk for elopement and will be updated on any new interventions and any new residents added to the elopement book. Event ID: Facility ID: 145434 If continuation sheet Page 3 of 3