Inspection·April 1, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R14 repetitively said nothing happened to her. V1 continues to state I heard it over the phone, and I also interviewed R14. I had them give me the phone that night and I asked her the next day, was there any inappropriate stuff going on. R14 responded no. V1 states that R14 told him that she had a little bit of pain, and she (R14) asked him (R30) to rub her knee. V1 states that he then asked her two questions, do you feel safe, and she said yes. The second question was with him (R30) massaging her leg on the kneecap, was she ok with that, and she said yes. I am the one that asked him to do that. V1 states that R30 ended up being transferred out not due to that reason, but because he tended to wander around, so we transferred him to a sister facility with a secured unit just in case, since this facility is not a secured unit. V1 reports that he did speak to R14's guardian later and explained the whole situation and the guardian was ok with it. V1 states I did explain to him we should have contacted him the same day. We will do better next time. This surveyor asked V1 if he was aware that both R14 and R30 had diagnoses of dementia. V1 states I knew R30 did but not R14. There is no reportable done for this situation. When we spoke to everyone, there were no allegations of any type of abuse or anything like that. If there was, we would have submitted an initial and followed up. V1 states the was absolutely not reported or else we would have reported it. I don't think anything happened at all, based on our investigation. Yes she does have memory issues but I've worked with dementia patients all my life. She has periods of confusion and she is able to have a full conversation with you. She repetitively said to me that nothing happened. Every single day, I followed up with her, it was the same story each time. V1 states that he did not consider it an abuse allegation because what I was told by V40 is that R30 wandered into R14's room. V1 states V40 won't take any of our calls. I was not made aware of any hands being placed on R14. V1 reports that he does not know why R14 was transferred to a different nursing home per guardian request. V1 states I don't know who the family member is who reported to director of nursing. On 03/28/2025, 9:10 AM, via telephone V36 (Licensed Practical Nurse) states that he usually works 3:00 PM to 11:00 PM shift. V36 states that he was the nurse assigned to R14 the date when the family member of R25 reported that she saw R30 in R14's room. V36 states I remember someone had come to the nurse's station to report R30 being in R14's room and asked for someone to go and check what is going on. V36 reports that he went to R14's room and saw R30 standing next to R14's bed. R30's walker was in between R30 and R14's bed. V36 states that he did not observe R30 touching R14 in any way and R14 was laying on her bed in no distress. V36 states that he didn't document anything because he didn't find anything wrong except R30 was wandering and he needed to be redirected. V36 states that R30 is a wander. V36 reports that it was V37 (R25's sister) who was the family member who reported it to him. V36 states that he notified the former DON just so she knew. V36 states that the former DON went to speak to R14 and R30. V36 continues to state R14 is not the type of person you lay your hands on. If you want to change her gown or diaper she will give you a fight. V36 states that the family member didn't tell him that R30 touched R14. V36 states that there has not been any report before of R30 demonstrating any inappropriate behaviors towards others. V36 states that he did not witness any type of abuse. On 03/28/2025, 10:11 AM, via telephone V37 (R25's sister) states that she remembers what happened that day although she cannot remember the exact date, but it was sometime last month (February). V37 continues to state I am there almost every day, I'm walking down the hallway and I was looking for some linen for my brother's bed. I noticed R30, who would walk around with his walker. I noticed that he went into R14's room. I passed by and I walked by again. I saw she is on the bed, she had a gown on. She didn't have a diaper on, he was fondling her. I went to the nurse's station. At the time there happened to be several staff there. The nurses were there. V37 continues to state I told them you have to go check out (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 2 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R14's room. R30 is in her room. I don't know what is going on. I told them that I saw him touching her inner thigh inappropriately. V37 continues to state it was during the evening shift, around 4:00 PM. V37 states that no one reached out to ask her further questions of her observation. R14's face sheet documents that R14 is a [AGE] year-old female with diagnoses not limited to: unspecified dementia, moderate, with mood disturbance, adult failure to thrive, generalized anxiety disorder, Bipolar II disorder. R14's MDS/Minimum Data Set, dated [DATE] documents that R14 has a BIMS/Brief Interview for Mental Status score of 03/15, indicating that R14 is severely cognitively impaired. R14's care plan documents in part, R14 assessed to be at risk for abuse due to diagnosis bipolar disorder and Dementia. She has history of wandering into other residents' rooms. R14 will remain safe, calm, and free from abuse through next review. Advocate for the resident when needed. R30's face sheet documents that R30 is a [AGE] year-old male with diagnoses not limited to: dementia in other disease classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance mood disturbance, and anxiety, unspecified psychosis not due to a substance or known physiological condition. R30's MDS/Minimum Data Set, dated [DATE] documents that R30 has a BIMS/Brief Interview for Mental Status score of 07/15, indicating that R30 is severely cognitively impaired. Facility reported incidents reviewed from January 2025 to March 2025 and does not document a report of sexual abuse allegation for R14. Facility document dated 03/25, titled abuse policy documents in part, this facility affirms the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion. The This will be done by filing accurate and timely investigative reports. Sexual abuse is non-consensual sexual contact of any type with a resident. This includes, but is not limited to, sexual harassment, sexual coercion, or sexual assault. Initial reporting of allegations shall be completed immediately upon notification of the allegation. The written report shall be sent to the state agency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 3 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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** Based on interview and record review, the facility failed to perform urinary catheter care in a manner that would prevent a urinary tract infection/UTI. This failure affects one (R24) resident out of three residents reviewed for urinary catheter care in a total sample of 30 residents. Findings include: R24's facesheet documents that R24 was admitted to the facility on [DATE]. R24's facesheet documents that R24 has diagnoses not limited to: anoxic brain damage, quadriplegia, chronic respiratory failure, urinary tract infection, infection and inflammatory reaction due to indwelling urethral catheter, dysphagia, and bacteremia. On 03/26/2025, at 2:33 PM, R24 observed lying in bed with a gown on. G-tube (gastronomy tube) and tracheostomy were in place. The head of bed at 45 degrees. R24's urinary catheter observed intact and draining urine via gravity into a drainage bag. R24's drainage bag observed with 1100 milliliters of urine inside. R24 is not alert or oriented and is unable to make his needs known. R24's POS/physician order sheet documents the following orders: Start date 05/31/2024 to 02/18/2025- catheter: change catheter monthly every night shift every 1 month(s) starting on the last day of month. Start date 02/25/2025- catheter: indwelling urinary catheter care daily and prn (as needed) every night shift. Start date 02/28/2025- catheter: change catheter monthly every night shift every 1 month starting on the last day of the month. R24's care plan documents the following: Catheter care per orders. Change Foley according to facility protocol. Provide catheter care. Date Initiated: 11/09/2023. Record review of R24's treatment administration record/TAR dated 12/2024 to 02/2025 does not show that there is any documentation that R24's catheter was changed and R24 was provided with urinary catheter care. R24's hospital records dated 03/03/2025, documents that R24 was admitted to the hospital with diagnoses not limited to: catheter associated urinary tract infection/CAUTI. On 03/27/2025, at 1:39 PM, V34 (Registered Nurse) states the urinary catheter drainage bag holds a maximum of 2000 milliliter of urine. V34 states the certified nursing assistants/CNAs are responsible for emptying the urinary catheter drainage bags. V34 states if she performs rounds and notices that the bags need to be emptied, then V34 will empty them. V34 states once a urinary catheter drainage bag is filled with 1000 milliliters of urine, then she would expect the drainage bag to be emptied. V34 states if a urinary catheter drainage bag is not emptied in a timely manner, then it can cause reflux and backflow into the bladder. This could cause a urinary tract infection. V34 states there is a facility protocol to change the urinary foley catheters monthly and as needed/PRN. V34 states if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 4 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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 a residents' catheter is not changed timely or if catheter care is not provided, then a resident can be prone to getting a urinary tract infection. V34 states there should be physician orders in the residents' electronic health record/EHR for catheter care. V34 states if catheter care is not documented in the residents' EHR then catheter care was not provided to the resident. On 03/28/2025, at 10:46 AM, V38 (Physician) states V38 states catheter care should be provided to resident according to the physician orders and the facility protocol. V38 states if there are physician orders for catheter care, then the facility should be following the physician orders for catheter care. V38 states keeping the residents' catheter clean is considered a standard of care. V38 states if catheter care is not provided to the residents, then it can cause an infection. On 03/28/2025, at 11:19 AM, V3 (Assistant Director of Nursing/ADON) states the protocol for changing the catheters in the facility is to change the residents' catheter every month and as needed. V3 states if a residents' catheter is noted with sediments, kinks, and improper urine flow, then the catheter would be changed prior to the one-month protocol. V3 states if catheter care is not provided, then infections such as UTIs/urinary tract infections or sepsis can happen. Facility policy dated 09/2020, titled Indwelling Catheter documents in part, 1. Obtain a physician's order for indwelling catheter. 6. Empty drainage bags at least once each shift and as needed. 7. Complete indwelling catheter care by cleansing catheter insertion site daily and as needed. 13. The interval between catheter changes should be determined by the individual resident's needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 5 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow policy and obtain a consent from a resident's representative for a psychotropic medication dosage increase. This failure affected 1 resident (R5) out of 5 residents reviewed for psychotropic medications in a total sample of 30 residents. Findings include: R5's face Sheet documents resident is a [AGE] year-old with diagnoses including but not limited to: Dysphagia following cerebral infarction, aphasia following cerebral infarction, other sequelae of cerebral infarction, chronic respiratory failure, encounter for attention to tracheostomy, type 2 diabetes with diabetic chronic kidney disease, history of falling, adjustment disorder. Minimum Data Set Section (MDS) section C (dated [DATE]) documents that R5 is severely impaired. Care plan (dated 01/29/2025) documents that R5 has the potential for pain related to presence of tracheostomy, vent dependence, and presence of G/tube. Also, R5 has hemiplegia due to CVA (cerebrovascular accident/stroke) and is currently in skilled therapy. On 03/26/2025, surveyor was conducting a complaint investigation survey pertaining to consents for psychotropic medications for R5. R5's Combined Medication Informed Consent was signed by V11 (R5's daughter/power of attorney) on 02/04/2025, consenting to the administration of Escitalopram Oxalate Oral Tablet 5 MG daily. Surveyor determined that the facility does not have an updated consent for a dose increase for Escitalopram Oxalate Oral Tablet 10 MG. R5's Physician Order (dated 02/14/2025) states: Escitalopram Oxalate Oral Tablet 5 MG (Escitalopram Oxalate). Give 10 mg via G-Tube (stomach tube) one time a day for GAD (generalized anxiety disorder). On 03/27/2025, at 2:10 PM, V3 (assistant director of nursing) stated, The nurse on duty is responsible for calling the responsible party/power of attorney to get consent if there was a dosage increase on a psychotropic medication. R5's current order for Escitalopram is 10 mg (milligrams) daily, prescribed for generalized anxiety disorder. There is a consent on file for Escitalopram 5 mg daily, but there is no consent for the dosage increase for Escitalopram 10 mg. Escitalopram is a medication that requires consent. When there is a dosage increase, we must get consent as well. On 03/27/2025, at 2:22 PM, V2 (director of nursing) stated, R5 was originally prescribed Escitalopram 5 mg daily, and the facility obtained consent from V11 (R5's daughter/power of attorney). The physician ordered a dosage increase on 02/14/2025, for Escitalopram 10 mg daily. This medication requires a consent and an increase in dosage also requires a consent from the resident and/or responsible party. There is a consent for Escitalopram 5 mg, but there is no consent for the Escitalopram 10 mg. Psychotropic Medications Policy (dated 09/2020) states in part: To establish a standardized system to inform residents and/or their responsible parties about psychotropic medications and their side effects. For each psychotropic medication ordered either a verbal or a written consent from the resident or the resident's responsible party will be obtained prior to initiation of the medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 6 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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 0758 Level of Harm - Minimal harm or potential for actual harm Consent will not be obtained for a dosage decrease. The resident and/or resident's responsible party will be notified regarding any changes in the medication dosage; this information will be documented in the resident's medical records. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 7 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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** Based on observation, interview, and record review the facility failed to keep one (R5) of 3 residents free from the risk of communicable disease transmission of 30 reviewed for infection control. Residents Affected - Few Findings include: 3/26/25, at 11:40 AM, writer observed R5 cohorted in room with R26. 3/26/25, at 1:42 PM, V12 (Licensed Practical Nurse) stated a resident with MDRO (multidrug resistant organism) and C. Auris (Candida auris) would not be in a room with a resident that does not have the same. To my knowledge R26 does not have anything to contaminate R5. 3/26/25, at 2:18 PM, V16 (Registered Nurse) stated a resident with MDRO and C. Auris needs to be on contact isolation and have to be roomed with someone with the same strain. If I see where residents cannot be roomed together due to infection, I will notify admissions, the Director of Nursing, and manager. Residents are cohorted according to the same organism. A resident with a microorganism is not roomed with a resident without a microorganism. 3/27/25, at 1:10 PM, V2 (Director of Nursing) stated we cohort based on the organism the resident has and the mechanism of transfer. Ideally, we want to cohort residents with the same organism. If we cannot, we reach out to CDPH (Chicago Department of Public Health) for guidance based on the numerous XDROs (extensively drug resistant organism) and MDROs (multidrug resistant organism) we have. Most XDROs are not active infections, they have a history of it and are placed on enhanced barrier precautions (EBP). With any direct care it is required to follow EBP for the protection of the staff and residents. For EBP, wear gloves and gown for direct care of the patient and follow standard precaution which is hand hygiene. EBP requirements includes, tracheostomy, ventilator, ostomy, intravenous, PICC (peripherally inserted central catheter) lines, catheters, wounds, and history of an MDRO. These qualify for EBP. R5 has tube feeding, tracheostomy, indwelling catheter, ventilator, and wounds. That's why R5 requires EBP. R26 has central line, history since 2023 of C. Auris (Candida auris) and CRE (Carbapenem-resistant Enterobacterales) in the groin. It is not active. It's a low risk for transmission of the C. Auris to the other resident. We maintain EBP precaution for both residents. They are both on a ventilator. There was no available room with piped in oxygen for the resident (R5) to go into. The resident (R5) was placed in a room with a resident (R26) with history of C. Auris. I'm going to move/cohort R5 into a room with a resident with no XDRO. According to R5 facesheet, R5 has diagnoses that include but not limited to chronic respiratory failure; encounter for attention to tracheostomy, gastronomy; hemiplegia and hemiparesis; dependence on respiratory ventilator. According to R5 census, R5 resided in room [ROOM NUMBER]-B from 12/2/2024 to 3/27/2025. On 3/27/2025 (during survey) R5 was transferred to a different room. According to R26 facesheet, R26 resides in room [ROOM NUMBER]-A and has diagnoses that include but not limited to candidiasis of skin and nail; klebsiella pneumoniae; other specified bacterial agents as the cause of diseases; resistance to other specified beta lactam antibiotics, multiple antibiotics, antifungal drugs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 8 of 9 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alden Lakeland Rehab & Hcc 820 West Lawrence Chicago, IL 60640 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 R26 census indicates R26 has resided in room [ROOM NUMBER]-A since 8/23/2022. Level of Harm - Minimal harm or potential for actual harm R26 is care planned for MDRO: EBP for candida auris in skin, candida in urine and crab in sputum, date initiated 10/11/2023. Residents Affected - Few Facility policy Infection Prevention and Control Program, 9/20/2024, documents in part: The primary mission is to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Cohorting: the practice of grouping residents infected or colonized with the same infectious agent together to confine their care to one area and prevent contact with susceptible residents (cohorting residents). According to Centers for Disease Control and Prevention, https://www.cdc.gov/candida-auris/prevention/index.html, Both infected and colonized patients can spread C. auris (Candida auris). Preventing the spread in healthcare facilities: Place patient with C. auris in a room separated from those at risk. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 9 of 9