Inspection·May 15, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The (05/14/2025) email correspondence with V2 upon the request of EBP (Enhanced Barrier Precautions) policy and procedure in reference to where to store or keep piston syringe and container, documented, in part We do not have a policy on this. The (05/15/2025) email correspondence with V43 (Assistant Administrator) documented, in part The expectation is that the piston syringe should be stored within the irrigation bottle and/or storage bag if irrigation bottle is not used in the resident room at the bedside. The (undated) Residents' Rights for People in Long-Term Care Facilities documented, in part As a long-term care resident in the State, you are guaranteed certain privileges according to rights, protections and State and Federal law. You have the right to . privacy. Your medical and personal care are private. Your facility may not give information about you or your care to any unauthorized person(s) without your permission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 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 ensure the call light device was within reach for two residents (R42, R203). This failure affected R42 and R203 in the sample size of 61. Residents Affected - Few Findings include: R203 has a diagnosis of but not limited to Fracture of Lower End of Right Femur, Subsequent Encounter for Closed Fracture with Routine Healing, End Stage Renal Disease, Dependence on Renal Dialysis, Hemiplegia and Hemiparesis Following Cerebral, Infarction Affecting Right Dominant Side, and Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease. R203 has a Brief Interview of Mental Status score of 05, but resident responded to surveyor's questions appropriately. Care plan focus for falls dated 5/07/2025 documents, in part, encourage resident to call, don't fall and promote placement of call light within reach. On 5/12/2025 at 11:40am R203's call light cord was hanging down to the floor behind the bed and not within reach of resident. Findings include: On 05/12/2025 at 11:27am, R42's call light was on the nightstand, not within R42's reach. R42 stated I cannot reach it. On 05/12/2025 at 11:28am, this observation was pointed out to V2 (Director of Nursing). V2 stated his call device is on the nightstand, not within his reach. R42 stated I don't know who put it there. R42's (Active Order as Of: 05/12/2025) Order Summary Report documented, in part Diagnoses: (include but not limited to) essential primary hypertension, venous insufficiency, hypertensive heart disease and hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. R42's (04/11/2025) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 11. Indicating R42's mental status as moderately impaired. Section GG. Functional Abilities - OBRA/Interim. GG0130. C. Toileting Hygiene, E. Shower/Bathe, F. Upper Body Dressing, G. Lower Body Dressing H. Putting On/Taking Off Footwear, I. Personal Hygiene: 1 - Dependent. R42's (Target Date: 07/12/2025) care plan documented, in part is at risk for falls due to history of Falls. Will remain free of falls. Promote placement of call light within reach. The (05/14/2025) email correspondence with V2 upon the request of R42's call device assessment documented, in part we do not have an assessment for call device. The (03/2023) Certified Nursing Assistant Job Description documented, in part Job Summary: Provides residents with daily nursing care in accordance with current federal, state and local standards, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few guidelines and regulations, facility policies and as may be directed by the Charge Nurse, Supervisor, assistant Director of Nursing, Director of Nursing or Administrator to ensure that the highest degree of quality care is maintained at all times. IV. Essential functions. AA. Keeps the nurse's call system within easy reach of the resident. The (undated) Facility Expected key ideas for Privacy, Dignity & Respect documented, in part Keep call cords within reach. The (09/20) Use of Call Light documented, in part Purpose: 1. To respond promptly to resident's call for assistance. Procedure: 7. Be sure call lights are placed within resident reach at all times. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to obtain and document the code status in the resident's electronic medical record for one resident (R132) reviewed for advanced directives in the sample of 61 residents. Findings Include: R132's admission Record documents, in part, diagnoses of chronic respiratory failure, anoxic brain damage, type 2 diabetes mellitus, dependence of respiratory, and a blank space is noted under R132's Advance Directive section of the profile screen (admission Record). R132's Minimum Data Set (MDS) dated [DATE] has a Cognitive Skills for Daily Decision Making Score of 3, which indicate R132's cognition is severely impaired. R132's Order Summary Report with active orders as of 05/13/25, documents that no physician's order for advance directives (full code or DNR status) for R132. On 05/13/25 at 10:21am V2 (Director of Nursing/DON) stated that a resident's code status should be entered on admission. V2 stated that the resident's code status can be found on the resident's face sheet and their care profile. Facility's policy titled Advance Directives dated 11/22 documents in part, Policy: A Social Service Director and/or designee will assess, care plan and implement Advance Directives .Procedure: .9. The resident will have a code status order entered in their physician orders in accordance with advance directives on file. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to provide a homelike environment by not supplying a resident (R36) with a television, personal light source and not assisting with putting away personal belongings. This failure affected one resident (R36) reviewed in the final sample of 61 residents. Findings include: Minimum Data Sheet (MDS) dated [DATE], in Section C- Cognitive Patterns documents Brief Interview for Mental Status (BIMS) Summary Score of 15 which indicates intact cognitive function. On 5/12/2025 at 12:24 PM observed R36's room without a television or a night lamp. Also observed in the resident's room, a dresser in a corner of the room with a suitcase positioned on the top. The dresser was positioned with the drawers facing the wall, away from resident's reach. Resident was not in the room at the time of observation. On 5/12/2025 at 12:24 PM, V30, (Licensed Practical Nurse/LPN), stated that R36 is out on pass and should return to facility later. On 5/13/2025 at 12:47 PM, R36 complained of facility not having a table lamp. R36 would like to use a comfortable lighting when walking to a restroom at night. R36 uses a walker when ambulating. R36 stated that ceiling light is big and very bright and the only light source available in the room. R36 further stated that at night, the room is too dark and R36 has a hard time seeing the way to the restroom. Observed the dresser in the room with the belongings bag which appeared to be in the same position from previous day, facing towards the wall and away from resident. R36 would like the belongings placed into the dresser and facing toward the resident instead of the wall. R36 furthermore complained that there is not a TV in the room and R36 would like to watch the news. R36 stated, that since she was admitted to the facility, she did not watch the news. R36 stated that she told the staff about these concerns since in facility, but nothing changed. On 5/13/2025 at 1:00 PM, V29, (Certified Nurse Aide/CNA), was not aware of specific reason why R36's dresser was positioned facing the wall and that the luggage bag with belongings has been on top of the dresser since R36 came to facility. V29 also stated that R36 could be somewhat difficult and stated that unpacking of resident's belongings could be anybody's responsibility. V29 furthermore stated that R36 does need assistance with ambulating and activities of daily living (ADL). On 5/13/2025 at 1:19 PM, V19 (Assistant of Director of Nursing/ADON) stated, that V19 was not aware of the dresser and the luggage problems for R36 and that the lamp and TV would be maintenance's responsibility to provide for residents. On 5/13/2025 at 2:05PM, V28 (Maintenance Coordinator), stated that the facility does provide TVs and was not sure about bedside lamp's availability, but will double check. V28 stated that the facility uses a sheet for maintenance requests and is not aware of TV or a table lamp request for R36. V28 stated that the request for a TV usually comes from Admission's office or from the maintenance sheet that the nurses or aides fill out. On 5/14/2025 at 12:27 PM, Observed in R36's room a TV on the dresser, a table lamp on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0584 nightstand table and the dresser turned facing the resident, luggage bag was not on top of the dresser. Level of Harm - Minimal harm or potential for actual harm On 5/14/2025 at 1:43 PM V2 (Director of Nursing), stated that V2 couldn't find policy for homelike environment and does not think that the facility has or uses a policy for homelike environment. Residents Affected - Few Care Plan Report's Focus, initiated on 4/23/2025, showed in part R36 demonstrates an ADL self-care performance deficit and needs assistance with ADL tasks. Care Plan interventions, initiated on 4/19/2025, shows in part staff to ensure resident is acclimated to the new living environment. The Facility provided a log sheet of Maintenance requests for the fourth floor that does not have R36's requests documented. Also requested from the facility a Homelike Environment policy, but the facility was not able to provide one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on Observation, interview, and record review, the facility failed to thoroughly implement communication/translation interventions for this resident on the individualized care plan. This failure affected one resident (R111) reviewed for Alternative communication/translation interventions in a sample of 61 residents. Findings include: On 05/12/25 at 11:57 AM, R111 was observed in the bed during interview, R111 stated he needed a Spanish translator to assist with communication because he (R111) spoke very little English. There was no communication board or communication contact number observed in R111's room at time of interview. V16 and V17, certified nursing assistants (CNAs), were in the room but neither were able to communicate with R111 because of the language barrier. On 05/12/25 at 11:59 AM, V16 (CNA), stated she normally tries to figure out what R111 is saying by gestures but R111 becomes frustrated at times because his (R111) needs aren't met because of the language barrier. On 05/12/25 at 12:00 PM, V17 (CNA), stated she stated she does not speak Spanish and tries her best to communicate with R111 but sometimes she is unable to figure out exactly what he needs. R111's Face sheet dated May 14, 2025, documents that R111 was admitted to facility June 24,2024 with diagnosis including Muscle weakness, end stage renal disease, hypertensive chronic kidney disease, diabetes mellitus, anemia, constipation, pain in knee, morbid obesity, lack of coordination. R111's MDS (Minimum Data Set) dated April 8,2025 section C, shows R111 has a score of 15 which means R111 has moderate cognitive impairment; section GG Functional Abilities shows R111 has a score of 3 which means R111 requires Partial/moderate assistance for hygiene care. R111's care plans dated January 24,2025 does not show that R111 has a care plan specific to his communication barrier or interventions/task for staff to implement and meet R111's clinical care needs. On 05/13/25 at 12:40 PM, V19 Assistant Director of Nursing, Registered Nurse (ADON) stated that most staff are aware to use Goggle translator to communicate with R111, and that staff were given communication board sheets but that she was not aware of any in-service documented that was available to show that staff was in-serviced. On 05/14/25 at 12:14PM, V13 Social worker stated that the communication board is used in room if resident can use it, a completed assessment on how well the resident is able to communicate and respond cognitively determines if the communication board is used. V13 stated staff may use a translator app or translation company utilized by facility. She (V13) stated if a resident requires communication/translation assistance this would be displayed on the front page of profile for resident so all staff would be able to view and be aware of how to communicate with the resident. On 05/14/25 at 12:16 PM, V13 reviewed the front page of R111's profile and was unable to display that R111 required communication/translator assistance. V13 stated that R111 does not require communication/translator assistance and is able to make all needs known to staff in English. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm On 05/14/25 at 12:20 PM, This surveyor and V13 went to R111's room and when R111 was asked a question he stated he can only speak very little English, V13 confirmed that R111 does not speak enough English to make his (R111) needs known to staff. V13 then stated that staff is aware to use Google translate and should. Residents Affected - Few use it. On 05/14/25 at 12:22 PM, A sign above the bed of R111 displayed Communication board and communication/translator phone call line for assistance with communication with R111. Facility policy titled: Communication Strategies dated 8/11 documents in part: The Activity Department, with assistance from the Social Service Department and/or Restorative Nursing Department when needed or in the absence of an Activity Director, will be responsible for assessing, documenting, care planning and providing, communication needs of the residents. In addition, they will be in-servicing staff that, are working with residents on appropriate communication skills to effectively,communicate with persons with communication deficits, including, but not limited to, non-English speaking residents, etc. In-servicing will occur annually and during new employee orientation, or more if deemed necessary. PROCEDURE: 1. The Activity Director/Aide will assess and document any resident's communication deficits on the Comprehensive Activity Assessment: Leisure and Preferences, the MDS assessment and the care plan. 2. The Activity Director, with assistance of the inter-disciplinary team (IDT), resident, staff and/or family will develop a communication care plan with individualized, approaches that help address the resident's needs to reach the care plan goal and will, re-assess progress quarterly, or more if needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure that a restorative rehabilitation program was being thoroughly implemented for a resident (R53) as documented in the plan of care. This failure affected one resident (R53) reviewed for Restorative Nursing program in a sample of 61 residents. Residents Affected - Few Findings include: R53's Face sheet dated May 14, 2025, documents in part that R53 was admitted to facility on June 24, 2024 with diagnosis including End stage renal disease, hypertensive chronic kidney disease, diabetes mellitus, anemia, hyperlipidemia, diverticulosis, morbid obesity, glaucoma, muscle weakness. R53's MDS (Minimum Data Set) dated March 13,2025 section C, shows R53 has a score 15 of which means R53 is cognitively intact; section GG Functional abilities, shows R53 has a score of 2 which means R53 requires substantial/maximal assistance for care. R53's care plan dated June 12,2024 shows that R53 has limitation in range of motion due to weakness and pain. Interventions/Tasks: Staff to provide active range of motion to R53, exercises to bilateral upper extremities and bilateral lower extremities for at least 5-10 reps x 2 sets for at least 15 mins daily for 5-7 days per week as tolerated. On 05/13/25 at 10:16 AM, V32 Restorative Aide stated via telephone interview that R53 refuses rehab often and that she (V32) informed her director but never documented refusals of restorative rehab. V32 stated R53 complains of stomach pain and doesn't do programs and just wants to lay down most of the time. On 05/14/25 at 01:26 PM, V31 Restorative Nurse Coordinator stated that there are no refusals that have been documented for R53 and that she was not made aware that R53 was not receiving her restorative rehabilitation. V31 stated if a resident isn't feeling well V32 would inform me but I was not made aware that R53 was not feeing well or did not receive her rehabilitation. V31 expects the restorative aides to complete their restorative programs, she (V32) should have informed me (V31) that R53 refuses treatments so she (V31) could speak with her. Facility policy titled: Restorative Aide dated 01/2015 documents in part: Job Summary: Responsible for Carrying out and documenting the activities of the Restorative program to ensure the highest degree of quality care is always maintained. Essential Functions: Record daily participation of residents in Restorative programs; aid with activities of daily living; recommend to clinical support supervisor the equipment and supplies needed for resident. Facility policy titled: Restorative Nursing program dated 3/10/2022 documents in part: It is the policy of the facility that a resident is given the appropriate treatment and services to enable residents to maintain or improve his or her abilities. Policy Interpretation: Activities provided by restorative nursing staff include Range of motion which Active or Passive, transfers, walking, bed mobility, dressing/grooming; Program goals will be documented in plan of care task section. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Findings include: Residents Affected - Some On 05/12/2025 at 11:06am, R144 was lying on a low air loss mattress Protekt Aire 6000 with a weight setting of 450lbs and alternating every 10mins. This observation was pointed out to V8 (Licensed Practice Nurse). V8 stated the setting is at 450lbs alternating every 10 minutes. On 05/12/2025 at 11:24am, V2 (Director of Nursing) stated I know the concern about (R144)'s low air loss mattress. The low air loss mattress' setting should be according to her weight. We are checking her weight right now. On 05/14/2025 at 9:57am, V2 (Director of Nursing) stated the setting of the low air loss mattress should be alternating and based on the resident's weight. The low air loss mattress effectually works if the setting is according to the resident's weight. If the setting is higher than the resident's weight, then it defeats the purpose of the low air loss mattress. R144's (Active Order as Of: 05/12/2025) Order Summary Report documented, in part Diagnoses: (include but not limited to) anoxic brain damage, moderate protein-calorie malnutrition, and acute embolism and thrombosis of deep veins of right upper extremity. Order summary. EBP (enhanced barrier precaution) for chronic wound. Low Air Loss Mattress. R144's (03/31/2025) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 03. Indicating R144's mental status as severely impaired. Section M - Skin Conditions. M0150. Risk of Pressure Ulcers/Injuries. 1. Yes. M1200. Skin and Ulcer/Injury Treatments. B. Pressure reducing device for bed. R144's Weights and Vitals Summary documented that R144's weight as of 05/05/2025 was 158.4lbs. R144's (03/20/2025) care plan documented, in part has an actual alteration in skin integrity R/T (related to) Anoxic brain damage. Pressure injury to back of head superior and back of head inferior. Comorbidities include CHF, anemia, and Acute respiratory failure. Intervention: Treatment as ordered. The (undated) Proactive Operation Manual for Protekt Aire 6000 documented, in part General. ProtektTM Aire 6000 pump and mattress is high quality and affordable air mattress system suitable for medium and high risk pressure ulcer treatment. They have been specifically designed for prevention of bedsores and offer affordable solution to 24-hour pressure area care. Intended use. Pressure Set Up. It is recommended to press Auto Firm on the panel when the mattress is first inflated. Users can then easily adjust the air mattress to a desired firmness according to the patient's weight and comfort. The (03/02/21) Prevention And Treatment Of Pressure Injury And Other Skin Alterations documented, in part Policy: 3. Implement preventive measures and appropriate treatment modalities for pressure injuries and/or other skin alterations through individualized care plan. The (03/2024) Management of Low Air Loss Mattress documented, in part Policy: low air loss mattresses will be set up, disinfected, maintained, and stored within the facility. Procedure: 2. Residents who have been assessed as in need of a low air loss mattress will have a mattress set up for their use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0686 Level of Harm - Minimal harm or potential for actual harm Based upon observation, interview and record review, the facility failed to ensure the Low Air Loss Mattress was set at the recommended setting and failed to ensure the Low Air Loss Mattresses were not layered with multiple linens. These failures affected 4 residents (R73, R116, R125, and 144) reviewed for prevention and treatment of pressure injury/ulcer in the sample of 61 residents. Residents Affected - Some Findings include: R73's admission record diagnoses include but not limited to quadriplegia, chronic respiratory failure, tracheostomy, gastrostomy, pressure ulcer of sacral stage 4, pressure ulcer of right upper back, pressure ulcer of right heel, cirrhosis of liver, hepatitis, and neuromuscular dysfunction of bladder. R73's (2/7/25) Brief Interview of Mental Status (BIMS) score is blank. R73's cognitive skills for daily decision making are severely impaired. On 5/12/25 at 10:40 am, R73 was lying on a low air loss mattress with multiple layers between R73 and the low air loss mattress. The layers observed under R73 consisted of a flat sheet, a mattress pad, and an incontinent brief. R73's POS (Physician Order Set) dated 1/2/25 documents in part low air loss mattress. R73's (5/7/25) care plan documents in part, Focus R73 has an actual alteration in skin integrity r/t (related/to) pressure injuries to sacrum . Interventions: pressure reduction support (low air loss) in bed. R116's admission record diagnoses include but not limited to anorexic brain damage, quadriplegia, chronic respiratory failure, tracheostomy, hypertension, vegetative state, and dysphagia. R116's (4/5/25) Brief Interview of Mental Status (BIMS) score is blank. On 5/12/25 at 10:50 am R116 was lying on a low air loss mattress with multiple layers between R116 and the low air loss mattress. The layers observed under R116 consisted of a flat sheet, a mattress pad, and an incontinent brief. R116's care plan dated 5/5/25 document in part, Focus: R116 has the potential for alteration in skin integrity. Comorbidities include diagnosis of quadriplegia . R125 admission record diagnoses include but not limited to tracheostomy, encephalopathy, subdural hemorrhage, vegetative state, pressure ulcer of sacral, diverticulosis, protein-calorie malnutrition, and hypokalemia. R125's (3/7/25) Brief Interview of Mental Status (BIMS) is blank. R125's cognitive skills for daily decision making are severely impaired. On 5/12/25 at 11:05 am R125 was lying on a low air loss mattress with multiple layers between R125 and the low air loss mattress. The layers observed under R125 consisted of a flat sheet, a mattress pad, and an incontinent brief. R125's POS (Physician Order Set) dated 4/11/25 documents in part, low air loss mattress. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some R125's (1/29/25) care plan documents in part, R125 has an actual alteration in skin integrity r/t traumatic subdural hemorrhage. Wounds include pressure injury to sacrum . On 5/12/25 at 11:13 am, V41 RN (Registered Nurse) stated there should only be 1 layer on an air loss mattress. The low air loss mattress is to help the wound and the wound circulation. To many layers is too much pressure on the skin and could cause skin breakdown. On 5/14/25 at 9:44 am, V2 DON (Director of Nursing) stated that layers on an low air loss mattress should only be 2 layers. It should be a sheet to cover the bed and a covering on the resident like a brief. We do not use incontinent pads. If more than 2 layers is used it can alter the effective process of relieving pressure and will not be effective to prevent pressure ulcers. Facility's job description titled Staff Nurse (Registered Nurse/License Practical Nurse) documents in part, Job Summary: Responsible to provide direct nursing care to the customer, and to supervise the day-to -day nursing activities performed by the nursing assistants. Such supervision must be in accordance with current Federal, State, and local standards, guidelines, and regulations facility policies. The objective is to ensure the highest degree of quality care is maintained at all times. Facility's Policy titled, Low Air Loss Mattresses, Management documents in part, Procedure: Installment: 6. Cover the mattress system with a sheet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review, the facility failed to ensure safe storage of compressed oxygen tanks in a holder (carrier). This failure has the potential to cause fire, explosive, or projectile hazards. This failure affected 2 residents (R54 and R503) and has the potential to affect all residents on the second and fourth floor in a sample of 98. Findings Include: R503's face sheet dated May 13, 2025, documents in part a diagnosis of Acute Respiratory Failure with Hypoxia, Interstitial Pulmonary Disease, Pulmonary Fibrosis, Seizure Disorder, Hypertension, and Dementia. On 5/12/2025 at 12:14 am, R503's compressed oxygen tank was observed sitting on the floor not contained in a holder (carrier) in front of R503's bed against the wall. On 5/12/2025 at 12:18, V12, (Licensed Practical Nurse-LPN) stated Oxygen tanks do not have to be stored in a holder when the tank is in the room. V12 stated oxygen tanks are only in an oxygen tank holder when residents are being transported to therapy or services. V12 removed the oxygen tank from the room. On 5/14/2025 at 10:04 am, V2, (Director of Nursing-DON), stated compressed oxygen tanks should always be stored in a holder (carrier). V2 stated the purpose of compressed oxygen tanks storage is to prevent it from falling and hurting somebody and preventing a fire. V2 verified the word restrained in the facilities policy means stored. On 5/14/2025 at 11:23 am, V37, (Registered Nurse-(RN), stated oxygen tanks should be always stored in a holder. V37 stated the nurses keep the oxygen tanks in the resident's room so they are there when the resident is transferred to therapy. V37 stated oxygen tanks can explode if they are not stored in a holder (carrier). On 5/14/2025 at 11:38 am, V36, (Respiratory Therapist-RT), stated oxygen tanks should always be maintained in a holder (carrier). V36 stated oxygen tanks can explode if they are not stored properly. Facility's Policy titled Oxygen Storage dated 09/20 documents in part: 1. All oxygen containers (compressed tanks and liquid cylinders) will be restrained while in storage. 2. A small amount of oxygen, not exceeding 300 cu. Feet (up to 12 E size tanks) may be kept at the nurse's station or in a corridor alcove for emergency use as long as it is properly restrained and protected against damage. On 5/12/2025 at 11:05 AM, in R54's room, observed an oxygen tank canister on the floor, tilted, not in upright position. Oxygen tank was not contained in an oxygen carrier. R54 stated that the oxygen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0689 tank has been in that position for few days. Level of Harm - Minimal harm or potential for actual harm On 5/14/2025 at 1:43 PM, V2 (Director of Nursing/DON) stated that the oxygen tanks should be contained in the oxygen carrier and stored in the oxygen storage room when not in use. V2 also stated that if not stored properly, there is risk of combustion, which could be dangerous for the residents and the facility. Residents Affected - Some The Facility's policy on Oxygen Storage, dated on 9/2020, lists in part that the oxygen containers should be restrained while in storage. The guidelines further list that the oxygen containers should be stored in a locked oxygen storage room. The document also lists in part the small size tanks may be kept at the nurse's station or in corridor alcove if it is properly restrained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** R202 has a diagnosis of but not limited to Malignant Neoplasm of Unspecified Part of Unspecified Bronchus or Lung, Specified Diseases of Upper Respiratory Tract, Chronic Obstructive Pulmonary Disease, Hypertension, and Chronic Systolic (Congestive) Heart Failure. Residents Affected - Some R202 has a Brief Interview of Mental Status score of 14. R202's Care plan focus (Oxygen Therapy) dated 5/01/2025 documents, in part, administer oxygen per MD orders (change weekly). On 5/12/2025 at 11:00am R202's nasal cannula was observed with a date of 4/29/2025. On 05/12/2025 at 10:57am, R18 was using a nasal cannula. The oxygen tubing was attached to a Concentrator. R18's humidifier bottle was dated 4/24/25 and R18's nasal cannula was not dated. On 05/12/2025 at 11:02am, V2 (Director of Nursing) checked the date on the humidifier bottle and stated it is dated 4/24/25 or 4/29/25, but no matter what the date is, the humidifier bottle is still not changed weekly. V2 also checked R18's nasal cannula and stated the nasal cannula is not dated. On 05/14/2025 at 10:01am, V2 stated the expectation is when we change the nasal cannula the staff is supposed to label it with the date it was changed to know when it was last changed. We change the nasal cannula every week and as needed. The purpose of labeling the nasal cannula is to keep track of when it was last changed. Humidifier bottle should be changed weekly. The purpose of changing the nasal cannula and humidifier bottle weekly is so we do not brew infection and to prevent spread of infection. R18's (Active Order as Of: 05/12/2025) Order Summary Report documented, in part Diagnoses: (include but not limited to) dependence on supplemental oxygen, asthma, angina pectoris, hypertensive heart disease, chronic obstructive respiratory disease, chronic respiratory failure, and atelectasis. Order Summary. Change 02 tubing monthly and PRN (as needed). Oxygen per nasal cannula @ 3liters per minute. R18's (04/15/2025) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 15. Indicating R18's mental status as cognitively intact. Section O - Special Treatments, Procedure, and Programs. C1 Oxygen therapy. B. while a resident. R18's (04/16/2025) care plan documented, in part requires oxygen therapy secondary to COPD, Asthma, chronic respiratory failure. Will maintain adequate O2 (oxygen) saturation. Administer oxygen per MD (medical doctor) orders. The (09/2020) Equipment Change Schedule documented, in part Policy: Equipment will be changed following established schedules to prevent cross contamination. Procedure: 1. Oxygen: a. Oxygen tubing, nasal cannula are changed every month and PRN (as needed). c. Change pre-filled humidifier when water level becomes low or weekly and prn. On 5/12/2025 at 11:30am observed R3's BIPAP (Bilevel Positive Airway Pressure) device with mask (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0695 sitting on R3's nightstand not in use by R3, the mask was not contained in a bag. Level of Harm - Minimal harm or potential for actual harm On 05/12/2025 at 11:39am V19 (ADON /Assistant Director of Nursing) walked into R3's room and surveyor pointed out to V19 the BIPAP mask on R3's nightstand. V19 stated the BIPAP mask should be stored in a bag when not in use by the resident. Residents Affected - Some On 5/14/2025 at 10:10am V2 (DON/Director of Nursing) stated for the resident's utilizing a nebulizer, BIPAP, or CPAP machine the mask should be stored in a bag when the mask is not in use by the resident. V2 stated the purpose for storing the mask in a bag is to prevent the spread of infection. R3's diagnosis includes but are not limited to, chronic obstructive pulmonary disease with (acute) exacerbation, acute and chronic respiratory failure with hypercapnia, morbid (severe) obesity with alveolar hypoventilation, obstructive sleep apnea (adult), and hypertensive heart disease with heart failure. R3's Physician Order Sheet (POS) with active orders as of 5/14/2025 documents in part, Respiratory: BIPAP: Apply at bedtime and PRN (as needed). Place BIPAP mask at bedtime for 8 hours. R3's Brief Interview for Mental Status (BIMS) dated 4/10/2025 documents R3 has a BIMS score of 15, which indicates R3 is cognitively intact. Findings include: R66's admission record diagnoses include but not limited to acute respiratory failure, tracheostomy, dependence on respiratory vent, dependence on oxygen supplement. R66's Brief Interview of Mental Status (BIMS) score is blank. R66's cognitive skills for daily decision making are severely impaired. On 5/12/25 at 11:20 am, observed R66's suction canister tubing lying over the suction canister uncontained. On 5/12/25 at 11:35 am, Surveyor inquired to (V9) Respiratory therapist should the suction tubing for the suction canister be lying over the canister not contained? V9 stated that the suction tubing should not be like that. V9 stuck the tubing into the canister tube holder and stated it should be like this. It should be covered because it can get dirty and cause an infection. On 5/14/25 at 9:44 am, V2 DON (Director of Nursing) stated that the tubing for suctioning should be closed into the suction canister. If not closed bacteria can go into it and cause bacterial growth. R66's Physician Order Set (POS) documents in part, Suction every 4 hours and PRN (As Needed). R66's care plan documents in part, Focus: Potential for complications secondary to tracheostomy. Interventions: Suction per MD (Medical Director) order. Facility's job description titled Respiratory Therapist document in part, Adhere to the policies and procedures for the provision of respiratory services, in accordance with the goals of [NAME]. Based on observation, interview, and record review the facility failed to follow prescribed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0695 Level of Harm - Minimal harm or potential for actual harm physician Oxygen Therapy Orders for 4 residents (R101, R202, R502, R503), failed to ensure the humidifier bottle was changed per facility policy for 1 resident (R18) and failed to ensure (R3's) BiPap mask and (R66's) canister tubing was contained in a bag while not in use. These failures affected 7 residents (R3, R18, R66, R101, R202, R502, R503) in the sample of 61 residents. Residents Affected - Some Findings Include: On 5/12/2025 at 11:23am, R101 was observed in bed alert and oriented to person, place, time, and situation sitting in bed. R101's continuous oxygen was set at 2 liters per minute. On 5/12/2025 at 11:28am V11, (Registered Nurse-RN) stated R101 is on continuous oxygen 3 liters per minute. V11 stated the purpose of oxygen therapy is to prevent shortness of breath. V11 stated a resident can desaturate and have breathing problems or shortness of breath is the oxygen is not set as prescribed. R101's Face Sheet documents in part a diagnosis of but is not limited to Congestive Heart Failure, Anemia in Chronic Kidney Failure, Respiratory Failure with Hypercapnia, and Respiratory Failure with Hypoxia. R101's Physician's Order Sheet dated 5/12/2025 documents in part, Respiratory: Oxygen Per Nasal Cannula at 3 Liters Per Minute Continuous every shift. R101's Care Plan documents in part, R101 requires oxygen therapy PRN (as needed) related to Chronic Respiratory Failure. On 5/12/2025 at 12:16 pm, surveyor observed R503 receiving continuous oxygen set at 3.5 liters per minute via nasal cannula. On 5/13/2025 at 12:34 pm, surveyor observed R503 receiving continuous oxygen via nasal cannula at 2.5 liters/minute. V26, (Registered Nurse-(RN) stated that she is not for sure how many liters per minute R503's continuous oxygen is prescribed. V26 verified R503 currently does not have a prescribed physician's order for continuous oxygen but does have a physician's order DuoNeb Solution 0.5-2.5 (3) MG/ML(Ipratropium-Albuterol) to be inhaled via nebulizer. V26 stated R503 had an order for continuous oxygen therapy yesterday. V26 stated the nurses provide the resident's continuous oxygen setting during report. R503's Face Sheet dated May 13, 2025, documents in part a diagnosis of Acute Respiratory Failure with Hypoxia, Interstitial Pulmonary Disease, Pulmonary Fibrosis, Seizure Disorder, Hypertension, and Dementia. R503's Physician's Order Sheet dated 5/12/2025 documents in part, no prescribed physician's order for oxygen therapy. R503's Physician's Order Sheet dated 5/13/2025 documents an active order for Respiratory: Oxygen Per Nasal Cannula at 4 Liters Per Minute Continuous. R503's Care Plan does not document a care focus on respiratory therapy for continuous oxygen. On 5/13/2025 at 12:42 am, surveyor observed R502 receiving continuous oxygen via nasal cannula with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0695 Level of Harm - Minimal harm or potential for actual harm a setting of 8 liters/minute. V26 verified R502 has continuous oxygen in progress via nasal cannula at 8 liters/minute and R502 continuous oxygen physician order documents continuous oxygen therapy between 8-10 liters/minute. V26 verified R502 has an active order for continuous oxygen therapy 10 liters/minute via R502's Electronic Health Record. V26 stated that residents on oxygen therapy is to help with breathing. V26 stated a resident can experience desaturation if the oxygen is not set at the prescribed settings. Residents Affected - Some R502's Face Sheet dated 5/14/2025 documents in part a diagnosis of Chronic Obstructive Pulmonary Disease, Polyneuropathy, Chronic Respiratory Failure with Hypoxia, Asthma, and Centrilobular Emphysema. R502's Physician Order Sheet dated May 14, 2025, documents in part an active order for Oxygen per nasal cannula at 10 liters per minute continuous. R502's Care Plan dated May 14, 2025, documents in part a Focus for a potential for shortness of breath with a goal to demonstrate improved breathing post treatment. Facilities Policy Titled Oxygen Therapy Devices-Nasal Cannula documents the following: Purpose: Oxygen delivered per nasal cannula, will be used to prevent or reverse hypoxia and improve tissue oxygenation. Procedure: 1. Verify physician's order 2. A nasal cannula should be placed in resident's nostrils following the natural contour of nasal airway. 3. It should not be used at a liter flow that exceeds 6-lpm. 1. It is recommended that a humidifier be applied at liter flow greater than 2 lpm. A cannula can provide approximately FIO2 between 28-44%, depending on liter flow setting and resident's respiratory rate and ventilator pattern. 2. A nasal cannula will be changed monthly and prn. Equipment: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0695 1. Level of Harm - Minimal harm or potential for actual harm Oxygen source 2. Residents Affected - Some Nasal cannula 3. Humidifier if applicable 4. Oxygen-In-Use sign placed in the lobby area. Facilities Registered Nurse/Licensed Practical Nurse Job description in part, as follows: N. Place orders for medications and treatments as necessary following established budgetary guidelines. X. Prepare and administer medications and treatments if appropriate as ordered by the physician. Y. Review medication FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to provide immediate intervention for a resident (R36), complaining of unrelieved pain on reassessment. This failure affected one resident (R36) of the total sample of 61 residents. Residents Affected - Few Findings include: Face sheet documents R36 was transferred from acute care hospital to the facility on 4/16/2025 with the diagnosis included but not limited to Other Systemic Sclerosis, Other Venous Thrombosis and Embolism, Acquired Absence of Other Right Toe, and Lymphedema. Minimum Data Sheet (MDS) dated [DATE], in Section C- Cognitive Patterns documents Brief Interview for Mental Status (BIMS) Summary Score of 15 which indicates intact cognitive function. On 5/13/2025 at 12:47 PM, observed R36 in the room, sitting on the side of the bed with both legs touching the floor, with body tilted to the side. Both feet and legs were swollen, the right foot had a contracture of the toes and a missing toe. Resident was alert and oriented and well dressed. During observation, R36 was grimacing and looked physically distressed. R36 stated that after coming back from procedure on 5/12/2025, R36 has been experiencing lot of pain. The pain is mainly in her legs. R36 stated, that the pain medication given, does not work and that nurses take a long time bringing the medications. On 5/13/2025 at 1:19PM V30, (Licensed Practical Nurse/LPN) stated that R36 completed an invasive procedure called an angiogram of the legs the previous day (5/12/25). V30 said they gave R36 pain medication (tramadol 50 mg/milligrams) this morning around 11:30AM. V30 said when they went to re-evaluate R36 around 12:15PM, R36 asked for more medication as the pain was unrelieved. V30 informed R36 that there wasn't any other pain medication available to be given at that time, and instead offered R36 to elevate both legs, however, R36 keeps putting the legs down to the floor. V30 said they did not contact R36's physician for any further orders related to relieving R36's pain. On 5/13/2025 at 1:36 PM, V19 (Assistant Director of Nursing/ADON), stated that the nurse should call a doctor about the need for additional pain relief or change in the dosage of R36's pain medication, if current pain management is not working. R36's May 2025 Medication Administration Record (MAR) was reviewed on 5/13/2025 at 1:41PM and did not include a current pain assessment for R36. At the time of review, there were no pain medications documented as having been given. The following day on 5/14/25, the facility presented a revised MAR, which documented tramadol being given at 11:05AM for a pain level of 8 out of 10. Additionally, acetaminophen (dosage) was documented as administered at 1:07PM for a pain level of 7 out of 10. Care Plan Report, initiated on 4/2/2025 showed in part that R36 has chronic pain related to Other Systemic Sclerosis and Pain strategies should be administered according to medication administration record. Care plan report also lists to observe R36 for effectiveness of pain relief; assess the resident's pain every shift and to complete pain assessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Order Review History Report, reviewed by the physician on 5/10/2025, lists in part active orders dated, 4/16/2025, for Acetaminophen 325mg tablets every 6 hours as needed for pain, Lidocaine External Cream 3% to apply topically three times a day (ordered 4/17/2025), Tramadol 25mg tablets every 8 hours as need for pain management (ordered on 4/18/2025) The orders also include pain evaluation every shift. Facility's policy titled Pain Management, dated 4/22/2025, showed in part that the residents should be assessed for acute pain associated with surgery or acute illness as the condition arise. The policy also showed in part that residents should be assessed for chronic pain or persistent pain when symptoms present. Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to ensure two licensed personnel conducted a physical inventory of controlled substances at each change of shift. This failure has the potential to affect all 24 residents receiving medications from the 3rd Floor Vent Team #1 medication cart. The facility also failed to ensure the tablet count documented on the controlled drug receipt/record/disposition form matched the number of tablets contained in the medication bubble pack. The counts should match to prevent the loss and/or diversion of controlled substances. This failure had the potential to affect all 19 residents who receive medications from the 2nd floor LTC (long-term care) medication cart. Findings include: On 05/13/2025 at 12:50pm observed the controlled substance binder and controlled substance bubble packs/medication cards for the 2nd floor LTC medication cart with V25 (RN/Registered Nurse). Observed a bubble pack of controlled substance which contained seven tablets; observed the controlled drug receipt/record/disposition form for the bubble pack of medication which documented the number of tablets left in the bubble pack as eight. The number of tablets in the bubble pack/medication card of the controlled substance did not match the number of tablets documented on the controlled drug receipt/record/disposition form. On 5/13/2025 at 1:00pm V25 (RN/Registered Nurse) stated I should sign the medication out on the controlled drug receipt/record/disposition form right after I administer the controlled substance medication to the resident. On 5/13/2025 at 1:10pm V26 (RN/Registered Nurse) stated I administered that medication to the resident. V26 stated when I administered the medication to the resident, I was supposed to sign the medication out on the controlled drug receipt/record/disposition form and the medication administration record. V26 stated that is why the count of tablets in the medication card does not match what is documented on the controlled drug receipt/record/disposition form, I forgot to sign the controlled drug receipt/record/disposition form. On 5/14/2025 at 10:10am V2 (DON/Director of Nursing) stated the purpose of the individual controlled drug receipt/record/disposition form for each resident's-controlled substance is to keep count of the controlled substances and the nurses can know how many tablets/ how much liquid of a controlled substance is remaining. V2 stated the number of tablets listed on the individual controlled drug receipt/record/disposition form should match the number of tablets/ amount of liquid in the medication bubble pack and/or the bottle of controlled substance medication. V2 stated the controlled drug receipt/record/disposition form is to be documented on indicating that the medication was given. V2 stated in my professional opinion, the number of tablets in the bubble pack should match the number that is documented on the controlled drug receipt/record/disposition form for each resident's controlled substance. On 5/14/2025 reviewed the facility's policy (dated 06/2022) titled Controlled Drug Documentation which documents, in part, underneath C. Procedure: 1. For each controlled substance dispensed individually, pharmacy supplies a pink proof-of-use form (Controlled-Drug Receipt/Record/Disposition Form), pre-printed with resident and medication information. c. Proof-of-use forms should be used to document each time a dose of the medication is administered. 2. Controlled substances must be counted and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some verified every shift by authorized professionals, usually at shift change. Balances are documented on the Shift Count form and must be signed by both the incoming and outgoing staff. Any discrepancy between the number of controlled drugs on hand and the sheet's balance must be brought to the attention of the Resident Care/Nursing Director (or equivalent) immediately, following the facility's policy. On 5/14/2025 reviewed the facility's Staff Nurse (Registered Nurse/ Licensed Practical Nurse) job description which documents, in part, underneath Essential Functions: V. Perform routine charting duties as required and in accordance with our established Charting and Documentation Policies and Procedures. On 05/13/2025 at 1:30 pm, review of the 3rd Floor team #1 vent medication cart with V18 (LPN/Licensed Practical Nurse) surveyor observed the Controlled Substances Check Form for May 2025. The Nurse's Initials On box was left blank for May 4, 2025 (11-7 shift). The Nurse's Initials Off box was left blank for May 5, 2025 (11-7 shift). The Nurse's Initials Off box was left blank for May 6, 2025 (11-7 shift). The Nurse's Initials On box was left blank for May 7, 2025 (3-11 shift). The Nurse's Initials On box was left blank for May 8, 2025 (11-7 shift). The Nurse's Initials On box was left blank for May 9, 2025 (11-7 shift). The Nurse's Initials Off box was left blank for May 10, 2025 (11-7 shift). The Nurse's Initials On box was left blank for May 11, 2025 (11-7 shift). The Nurse's Initials On box was left blank for May 12, 2025 (11-7 shift). The blank spaces on the facility's-Controlled Substances Check Form indicate the controlled substances were not reconciled at the end and beginning of the shift on the specified days. On 5/13/2025 at 1:30pm V18 (LPN/Licensed Practical Nurse) stated the shift-to-shift controlled substances check form is used by the nurses to count the narcotics. V18 stated two nurses are to count the narcotics sheet together at the start and end of the shift. V18 stated both nurses are to make sure the count of the narcotics is correct and document their initials on the form if the narcotic count is correct. V18 was not aware why the nurses did not sign the shifts that have no signatures. On 5/14/2025 at 2:45pm V2 Director of Nursing (DON) stated the purpose of controlled drug documentation is to ensure accurate count of medication to decrease the risk of medication diversion per Drug Enforcement Agency guidelines, he (V2) stated that it is his expectation for two nurses to count off and sign off on the Controlled Substance Shift Count Documentation sheet. On 05/14/2025 reviewed the facility's policy dated 1/2015 titled: Registered Nurse/Licensed Practical Nurse job description which documents in part, underneath Essential Function: N. Place orders for medications and treatments as necessary following established budgetary guidelines; X. Prepare and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm administer medications and treatments if appropriate as ordered by the physician; Y. Review medication record for completeness of information, accuracy in the transcription of the, and adherence to stop orders policies. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 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. Based on observation, interview, and record review the facility failed to ensure that bottles of medication in the medication cart which are specifically prescribed for a resident and not considered a stock medication were properly labeled with the resident's information and expired medications were removed from the shelves used to store stock medications in the medication storage room. This deficient practice has the potential to affect 19 residents who receive their medications from the 2nd floor medication cart and 58 residents on the 3rd floor who may receive stock medications from the 3rd floor medication storage room. Findings include: On 5/13/2025 at 12:40pm, inspected the 2nd floor LTC medication cart with V25 (RN/Registered Nurse). The following was observed, 2 bottles of Velphoro 500mg (milligram) tablets were not labeled with a resident's name or directions for use. On 5/13/2025 at 12:45pm V25 (RN/Registered Nurse) stated these two bottles are not stock medication, this medication is for a specific resident. V25 stated the medication should be labeled with the resident's name, instructions for use, and the date the medication was opened. On 5/14/2025 at 10:10am V2 (DON/Director of Nursing) stated for residents with a specific medication prescribed for the resident, not a stock medication, the resident's name, and directions for use of the medication should be labeled on the resident's medication bottle. On 5/14/2025 at 10:27am inspected the 3rd floor medication storage room with V40 (LPN/Licensed Practical Nurse). Stored on a silver metal shelving unit in the storage room was 1 can of antifungal athlete's foot powder spray with an expiration date of 4/2025, 1 opened bottle of antacid tablets 500mg with an expiration date of 1/25, and 1 bottle of calcium carbonate oral suspension 1250mg(milligrams)/5ml(milliliters) antacid 16 Fl(fluid) oz(ounces)-437ml with an expiration date of 30 Apr (April) 2025. On 5/14/2025 at 10:35am V27 (ADON/Assistant Director of Nursing) stated the nurses are responsible for removing expired medications from the medication storage rooms. On 5/14/2025 at 11:45am V19 (ADON/Assistant Director of Nursing) stated the night shift nurses are supposed to check for expired medications. On 5/14/2025 reviewed the facility's policy dated 12/2023 and titled Storage/Labeling/Packaging of Medications which documents in part, underneath B. Policy: 7. Each resident's medications are stored in original containers and must be properly labeled. 10. Medication containers that are damaged, soiled, contaminated, or outdated are immediately removed and either returned or disposed of according to procedure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record reviews, the facility failed to discard expired food items from the dry storage area of the facility's kitchen and failed to label frozen food items in the freezer with an open date. These failures could potentially affect 113 residents consuming the facility's food out of 155 residents residing at the facility. Findings include: On 5/12/2025 at 09:34 AM, V1(Administrator) provided facility's current resident's census that showed a total of 155 residents. On 5/12/2025 at 11:00 AM, the facility provided a Diet Type Report of residents which showed a total of 42 residents with a nothing by mouth (NPO) diet. On 5/12/2025 at 09:35 AM, observed in the facility's kitchen freezer, five opened containers of 3-gallon size multiflavored ice scream, no open date. (Two containers of Vanilla, one container of Strawberry, one container of Mint Chip and one container of Chocolate flavor). V3 (Corporate Dietary Coordinator), stated, that the open ice scream containers should be dated when opened and when received. V3 also stated that the opened, unmarked containers of ice scream should be discarded. On 5/12/2025 at 09:55 AM observed in the Dry Food Storage Room, on the middle shelf, two plastic storage bins filled with brown rice labeled with Use by date of 4/22/2025. Also observed in the Dry Food Storage Room, 20 plastic containers filled with variety of condiments, individually wrapped, all labeled with dates 1/22/2025 - 4/22/2025 four large food storage bins filled with dry powdered substances labeled as follows: Breadcrumbs, [NAME] Sugar, Thickener, Flour. All the food storage bins were labeled with dates 1/22/2025 - 4/22/2025. On 5/12/2025 at 10:14 AM, V4 (Dietary Manager) and V3 (Corporate Dietary Coordinator), both affirmed that the meaning of the different dates, relates to when the food items were opened and stored in the bins (1/22/2025) and the second date is the last recommended date of use of the products (4/22/2025). V3 said, that the food inside of the bins was not expired, but there is no original package available that showed the expiration date. V3 furthermore stated, that the dietary aide must have forgotten to change the dates on the labels when filling the bins. V3 said, that the flour and thickener were poured into the bins on 5/11/2025 by V3 personally, but the dietary aide did not update the dates on the bins and that V3 did not realized it. V3 also stated that the dry substances should not be used and should be disposed of. The labels on all the affected containers should be removed and the items labeled correctly at the time of the transfer from the original packaging. Facility's policy titled Food Storage Guidelines, (dated 7/17, 8/18), showed in part, that the food should be stored and used in an acceptable amount of time and should be stored in a way that will keep the food safe. The policy further showed in part, that condiments could be held for 30 days; the use by date is the recommended freshness date and after that date the food should be discarded. Facility's policy titled Food Storage Dated 6/97 and revised 2/12 and 7/17 showed in part that food items should be marked with date prior to storage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 ensure midline catheter dressings were changed for 2 (R23 and R132) residents, failed to ensure staff don appropriate PPE (personal protective equipment) during transfer for 1 (R20) resident, and failed to ensure tube feeding equipment used for a resident (R81) on EBP (enhanced barrier precautions) were stored appropriately. These failures affected 4 (R20, R23, R81, and R132) residents and has the potential to affect all the residents on the 3rd floor. Residents Affected - Some Findings include: The (05/12/2025) 3rd floor census was 62. On 05/12/2025 at 10:40am, there was a half wall divider with railing in the dining/activity area. There was a container with piston irrigation syringe on top of the half wall. The container was labeled with R81's name, R81's room, and the current date. R60, R61, and R89 were seated close to the half wall divider. This observation was pointed out to V11 (Registered Nurse). V11 checked the label on the container of the piston irrigation syringe and stated it has (R81)'s name, room number, and today's date. We use it for a feeding tube. I don't know why these are here in the dining area. These should be in the resident's room. Residents with a feeding tube are on EBP (enhanced barrier precaution). The expectation is to keep the container and the piston syringe in the room to prevent the spread of infection and other stuff she (R81) may have. On 05/14/2025 at 9:58am, V2 (Director of Nursing) stated everything that is in direct contact with the resident should stay in the room to prevent the spread of germs. R81's (Active Order as Of: 05/12/2025) Order Summary Report documented, in part Diagnoses: (include but not limited to) encounter for attention to gastrostomy, candidiasis, streptococcus Group A and B, resistance to antifungal drugs, Methicillin susceptible Staphylococcus aureus, and diphtheria. Order summary. Enteral Feed Order. Flush enteral with 30ml of water before and after medications. EBP (enhanced barrier precaution) for device Care or use of Feeding tube. R81's (02/04/2025) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: no entry. C0700. Short-Term memory Ok: 1 memory problem. C0800. Long-Term Memory Ok: 1. Memory Problem. C1000. Cognitive Skills for daily decision making: 3 severely impaired. Section K - Swallowing/Nutritional Status. K0520. B. Feeding tube 3. While a resident. R81's (Target date: 05/05/2025) care plan documented, in part requires tube feeding and stoma site care related to dysphagia. Check placement and patency of feeding tube prior to administering meds, feedings and flushes. R81's (05/05/2025) care plan documented, in part has MDRO: CANDIDA AURIS, CRAB (Carbapenem-resistant Acinetobacter baumannii) IN SPUTUM, NDM (New Delhi [NAME]-beta-lactamase) RECTAL, KPC (Klebsiella pneumoniae carbapenemase) IN URINE, DIPTHEROIDS ON RIGHT 2ND TOE AND STAPHYLOCOCCUS AUREUS ON GTUBE SITE. Educate responsible party on Enhanced Barrier Precautions. The (05/14/2025) email correspondence with V2 upon the request of EBP policy and procedure in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some reference to where to store or keep piston syringe and container documented, in part We do not have a policy on this. The (05/15/2025) email correspondence with V43 (Assistant Administrator) documented, in part The expectation is that the piston syringe should be stored within the irrigation bottle and/or storage bag if irrigation bottle is not used in the resident room at the bedside. The (12/2024) Enhanced Barrier Precautions documented, in part Policy: EBP (enhanced barrier precaution) are an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDRO) in nursing homes. As well as to prevent multi-drug resistant organism acquisition of those with an increased risk of acquiring MDRO's including residents with chronic wound or an indwelling medical device. Procedure: 2. Residents that have indwelling medical devices, regardless of MDRO status, will be on EBP. A. Some examples may include feeding tube. R23's diagnoses include paraplegia, hypertensive heart disease without heart failure, schizoaffective disorder bipolar type, type 2 diabetes mellitus with diabetic neuropathy, pressure ulcer of right buttock stage 4, depression. R23's Minimum Data Set (MDS) dated [DATE] has a Brief Interview for Mental Status (BIMS) score of 15, which indicates R23's cognition is intact. R132's diagnoses include chronic respiratory failure, anoxic brain damage, type 2 diabetes, dependence on respirator, ventilator associated pneumonia. R132's Minimum Data Set (MDS) dated [DATE] has a Cognitive Skills for Daily Decision Making Score of 3, which indicate R132's cognition is severely impaired. On 05/12/25 at 10:47am R23 observed with midline to left upper arm dated 04/26/25. On 05/12/25 at 10:49am V5 (Registered Nurse/RN) stated that midline dressings should be changed once a week on night shift. V5 stated R23's date on the midline dressing is 04/26/25. V5 stated that it is important to change the midline dressings to prevent infections. R23's physician order dated 04/26/25 documents in part, May place IV (intravenous) midline for ABT (antibiotic) therapy. Review of R23's physician orders show no order for midline dressing change. R132's physician order dated 05/08/25 documents in part, IV midline: transparent sterile dressing change weekly ad PRN (as needed). On 05/12/25 at 11:38am observed R132 with a right upper arm midline. R132's midline observed with multiple layers of loose-fitting tape and no date on the midline dressing. On 05/12/25 at 11:38am V2 (Director of Nursing/DON) stated that R132 was readmitted to the facility on [DATE]. V2 stated that there should be a date on R132's midline dressing. V2 stated that the facility's policy is to do an initial dressing change on admission and then weekly and/or as needed. V2 stated that it is important to change the midline dressing to prevent infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Facility's job description titled Staff Nurse (Registered Nurse/Licensed Practical Nurse) dated 01/2015 documents in part, Job Summary: Responsible to provide direct nursing care to the customer, and to supervise the day-to-day nursing activities performed by the nursing assistants. Such supervision must be in accordance with current Federal, State, and local standards, guidelines and regulations, facility policies. The objective is to ensure the highest degree of quality care is maintained at all times .Physical Requirements .Z. Administer professional services such as: catheterization, tube feedings, suction, applying and changing dressings/bandages, packs, colostomy, and drainage bags, care of the dead dying, as required. Facility's policy titled IV Care Reference Guidelines dated 11/21/2021 documents in part, Dressing Change: Midline q (every) 7 days and PRN (as needed). On 05/12/25 at 12:06 PM, the entrance to the room of R20 displayed an EBP sign, R20 was observed in his bed and two staff members were preparing him (R20) to be transferred via mechanical lift into the Geri chair. V16 and V17, Certified Nursing Assistants (CNA) (V16, V17) were observed without appropriate PPE on. They were only wearing gloves. V16 took her gloves off after transferring R20 into chair and began to reposition R20 in the chair without any PPE on. On 05/13/25 at 11:03 AM, V16 (CNA) stated she was not aware what PPE to wear for EBP. V16 stated she doesn't feel that a gown should be worn during transfer of a resident from bed to chair and stated if she (V16) was providing Activity of daily living to R20 that she (V16) would then place on a gown. On 05/13/25 at 12:11 PM, V17 (CNA) stated for EBP she should wear gown and gloves, and it slipped her (V17) mind to put on a gown while providing care and transferring R20 into chair on yesterday. On 05/13/25 at 11:46 AM, V44 Registered Nurse Infection Prevention Nurse stated EBP sign states to wear PPE when providing care on residents with EBP precautions and that staff are informed and educated daily but staff do not comply with wearing PPE. V44 stated he doesn't know why staff choose not to wear appropriate PPE and by not wearing appropriate PPE it places resident and staff at risk. R20's Face sheet dated May 14, 2025, documents in part that R20 was admitted to facility on March 24,2023 with diagnosis including End stage renal disease, hypertensive chronic kidney disease, diabetes mellitus, anemia, convulsions, schizophrenia, visual loss, benign prostatic hyperplasia. R20's MDS (Minimum Data Set) dated May 5,2025 section C, shows R20 has a score 05 of which means R20 is severely cognitively impaired; section GG Functional abilities, shows R20 has a score of 1 which means R20 is dependent for all transfers and assistance for care. R20's care plan dated March 16,2023 shows that R20 receives dialysis Monday, Wednesday, and Friday. Interventions/Tasks: Staff to provide Enhanced barrier precautions during high contact resident care activities. R20's Physician Order summary report dated 4/8/2025 documents in part that R20 has an order for EBP for Candida auris (CA). On 5/14/25 review of facility policy dated 12/2024, titled Enhanced Barrier Precautions (EBP) documents in part; Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of multidrug- resistant organisms (MDRO) in nursing homes. Guidelines:3. A subset (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 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 145450 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/15/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete of targeted MDRO's is considered an extensively drug resistant organism (XDRO)All residents infected or colonized with XDRO will require EBP for the duration of their stay at the facility, a. Candida Auris (CA). Procedure:1. High contact resident care activities include the following: Transferring, dressing, bathing/showering. 4. Gown and gloves use prior to the high contact care activity. On 5/14/25 review of facility policy dated 3/2023, titled Certified nursing assistant job description documents in part; Provides residents with daily nursing care in accordance with current federal, state, and local standards, guidelines and regulations, facility policies. Essential functions: A. Ensure that all nursing procedures and protocols are followed in accordance with established policies, including dress code. Event ID: Facility ID: 145450 If continuation sheet Page 31 of 31