Inspection·August 29, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R6 who is R2's roommate stated that their call light is broke. R6 stated it is supposed to have a string attached to the switch through a hole in the switch, but the hole is worn open, so the string does not stay attached to it. R6 stated the string is not running through the middle of the switch. R6 stated his roommate (R2) asks him to trigger the call light for him when he needs help and R6 does it for him (R2). R6 said, I don't know what he does if he needs help and I'm not in the room.On 08/26/25 at 12:25 PM, observed R5 lying in bed with the call light switch on the wall behind R5's bed. There was no string attached to the call light switch. The call light switch was too far away from R5 to be able for her to push it down. R5 stated she uses her call light buzzer when she needs help from staff. R5 looked around her bed and stated she cannot find the call light cord. R5 asked surveyor, where is it? R5 stated she does not have any way of letting the staff know she needs help. R5 said, I just have to wait. R5 stated she does have a cell phone that she keeps in her bag, but she does not know where the bag is right now. Did not observe bag in R5's room or within reach of R5. On 08/26/25 at 12:33 PM, V1 (Administrator) observed R2's call light system and noted there is no string attached to the call light switch. V1 stated all residents should have call lights within their reach so the staff can address their needs. On 08/26/25 at 12:41 PM, V1 observed R5's call light switch on the wall located behind R5's bed with no string attached to the call light switch. V1 stated the call light should be within R5's reach and there should be a string attached to the call light switch. V1 stated the string must have broken off. V1 stated it is important for residents to have access to the call light because the facility wants to make sure the resident needs are taken care of. On 08/26/25 at 2:34 PM, V10 stated R2 likes to get up out of bed and get put into his electric wheelchair because he usually leaves the building on pass. V10 stated she was the CNA taking care of R2 on 08/18/25 on the (7-3 shift). V10 stated she changed R2 and dressed him in street clothes and placed the mechanical lift sling underneath him, but she was not able to transfer R2 out of the bed because she was pulled off the floor to be an escort for another resident's appointment. V10 stated this was around 1:30 PM. V10 stated she told the nurse on duty that R2 was clean and dressed but needed to be transferred out of the bed and the other CNAs on the floor said they were going to cover her residents since she was getting pulled off the unit. V10 stated when she returned to the building around 4:00-4:30 PM she went to check on R2 and R2 was still lying in bed. V10 stated R2 looked annoyed and seemed upset that he was still in bed. V10 stated she cannot remember if R2's call light was on or not. V10 stated at that time she did not see V22, the CNA assigned to him on the 3-11 shift on the unit. V10 stated R2 should have been transferred out of bed and into his electric wheelchair earlier because that is what he wanted and is part of his regular routine. V10 stated R2 should not have had to wait that long to receive the care he wanted. On 08/26/25 at 2:22 PM, V20 (Licensed Practical Nurse) stated there is a get up list kept on the unit, so the CNAs know which residents are supposed to be up out of bed on which days. V20 stated she is familiar with R2, and she was covering R2 on 08/18/25 on the 7-3 shift. V20 stated R2's routine is that he likes to sleep in, waking up late in the morning and then gets out of bed around lunch time and is transferred into an motorized wheelchair and then he is out and about. V20 stated R2 likes to get out of bed every day. V20 stated on 08/18/25, the CNA assigned to R2 on the 7-3 shift had dressed him and had placed the mechanical lift sling underneath R2, but she was not able to transfer him out of bed because she could not find another CNA to assist her with transferring him before the change of shift. V20 stated when she checked on R2 toward the end of her shift sometime between 2:30 - 3:00 PM and R2 was still in bed and he was upset because he wanted to get out of bed. V20 stated she then told one of the 3-11 shift nurses that R2 needed to be transferred out of bed. V20 does not remember if R2's call light was on or not when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 2 of 5 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 08/29/2025 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 she checked on him. V20 stated she thinks the staff got R2 up that day because she thinks she saw him outside around 3:30 PM. On 08/27/25 at 3:55 PM, observed daily staffing assignment and V22 was listed as a CNA working on the 3-11 shift. V22 was not on her assigned nursing unit at this time. On 08/27/25 at 4:00 PM, V22 came onto the nursing unit carrying her personal items and stated she was delayed because she was downstair talking to the administrator because she was having difficulty logging onto the electronic health record system. On 08/27/25 at 4:10 PM, V22 (CNA) stated she works two jobs either before the 3-11 shift or afterwards. V22 stated if she gets to the facility later than 3:00 PM she calls ahead to let them know so they can alert the floor nurse and other CNAs so they can cover her residents until she arrives. V22 stated when she comes on shift, she rounds on her residents to see who needs care. V22 stated it is important for her to get eyes on all her residents initially and after that she checks on her residents at least every two hours. V22 stated R2 requires full assist with all care, and he cannot get himself up out of bed; requires two-person mechanical lift assist. V22 stated usually when she comes in R2 is not in the room because he is out on pass, but he usually returns to the facility by 8:00-9:00 PM. V22 stated she with the help of another staff member is the one who transfers R2 from his electric wheelchair back to bed in the evening. V22 stated it would be unusual for R2 to be lying in his bed earlier in her shift. V22 stated she does not remember anything out of the ordinary or unusual with R2 on 08/18/25. V22 stated she does not think she was late coming into work that day. V22 stated she does not remember seeing R2's call light on. V22 stated she does not remember him being in bed. V22 stated she does not remember if he was up in his motorized wheelchair. V22 stated she does not remember if she transferred him from his motorized wheelchair into bed that night. V22 said, I just cannot remember.On 08/27/25 at 10:34 AM, V2 (Director of Nursing) stated there is a Maintenance Log Binder on each unit that the nurses document any issues/concerns of items that are broken or need repair. V2 stated a broken call light is a high priority because the residents need to be able to reach the staff. V2 stated some of the residents cannot get up on their own and the call light is their only means of communicating with the staff. V2 stated call lights should be within resident's reach. V2 stated not having access to a call light is a safety issue and could put a resident at risk for a fall. V2 stated if a resident is waiting too long, they may try to get up by themselves and we do not want them to do that, we want them to call us. V2 stated this could potentially cause an injury if they try to get up on their own. V2 stated it is everyone's responsibility to respond to a call light; it does not matter which room staff is assigned to. V2 stated there is get up list for each unit. V2 stated it is important to get residents out of bed to minimize falls and improve socialization, so they do not feel isolated. V2 stated it is the resident's right to be able to get out of bed every day and the staff should be accommodating that. V2 stated if a CNA gets pulled to go out on an appointment last minute, then the CNA assignment should be adjusted, and the other CNAs should pitch in to cover those residents. V2 stated when staff comes in to work the nurse and CNAs should round on each of their residents to get a visual check on them and to make sure they are clean/dry and to see if they need anything. V2 stated the situation with R2 was caused by a combination of lack of communication between the staff and monitoring because someone should have checked on him at the start of the shift, and the CNAs should be rounding on the residents every two hours. V2 stated someone should have responded to his call light as soon as possible, within 5-10 minutes. V2 stated the facility should be accommodating R2's preference to get out of bed. V2 stated R2 was probably sad and frustrated that no one responded to his call light especially if he has a routine of getting out of bed every day. R2 has diagnosis which includes but not limited to Spinal Muscular Atrophy, Paraplegia, Bilateral Lower Extremities, Scoliosis, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 3 of 5 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 08/29/2025 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 Hypertension, Major Depressive Disorder, Anemia, Hyperlipidemia, Hypokalemia, Constipation, Seborrheic Dermatitis, Epistaxis, Other Muscle Spasm, Gastro-Esophageal Reflux Disease Without Esophagitis, Dysphagia, Oropharyngeal Phase.R2's MDS (Minimum Data Set) dated 08/13/25 documents in part, intact cognitive function based on Brief Interview for Mental Status score of 15/15. R2 has functional limitation impairments in range of motion to both sides of upper and lower extremities and uses a motorized wheelchair. R2 is dependent for activities of daily living including toileting hygiene, showering/bathing, upper/lower body dressing, and putting on/off footwear. R2 is dependent for mobility including sitting to lying, chair/bed to chair transfers, and tub/shower transfer. R2 is always incontinent of urine and bowel. R2's restorative care plans include but not limited to:1.) R2 has an ADL functional performance deficit due to weakness, impaired balance, poor posture related to spinal muscular atrophy, paraplegia, scoliosis with interventions including but not limited to encourage use of call light for assistance when needed. 2.) R2 requires use of a mechanical lift for transfers. 3.) Bowel and bladder support is required with intervention including but not limited to place call light within resident's reach when in room in order for resident to alert staff of need for toileting assistance.4.) R2 is at risk for falls due to weakness; impaired balance; poor posture related to spinal muscular atrophy, paraplegia, scoliosis with interventions including but not limited to encourage resident to call, don't fall and promote placement of call light within reach.R5 has diagnosis which includes but not limited to Chronic Obstructive Pulmonary Disease, , Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris, Chronic Kidney Disease, Stage 3b, Vascular Dementia, Unspecified Severity, Without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance, And Anxiety, Functional Quadriplegia, Other Recurrent Depressive Disorders, Chronic Diastolic (Congestive) Heart Failure, Hyperkalemia, Incontinence Without Sensory Awareness, Type 2 Diabetes Mellitus Without Complications, Other Osteoporosis Without Current Pathological Fracture, Polyosteoarthritis, Other Chronic Pain, Constipation, Age-Related Osteoporosis Without Current Pathological Fracture, Chronic Long Term (Current) Use Of Anticoagulants, Anemia, Presence Of Automatic (Implantable) Cardiac Defibrillator, Morbid (Severe) Obesity Due To Excess Calories.R5's MDS dated [DATE] documents in part moderate cognitive impairment based on BIMS score 09/15. R5 has functional limitation impairments in range of motion to both sides of upper and lower extremities. R5 is dependent for activities of daily living including toileting hygiene, showering/bathing, upper/lower body dressing, putting on/off footwear and personal hygiene. R5 is dependent for mobility including roll left/right, chair/bed to chair transfers, and tub/shower transfer. R5 is always incontinent of urine and bowel. R5's restorative care plans includes but not limited to:1.) R5 has difficulty sitting upright in a basic wheelchair and uses a recliner chair to maintain comfort and promote proper body alignment due to poor muscle control secondary to diagnosis of functional quadriplegia with interventions that include but not limited to place the call light within reach when in room.2.) R5 has an ADL (Activities of Daily Living) self-care performance deficit due to generalized weakness and interventions include but limited to encourage use of call light for assistance when needed.3.) R5 is at risk for falls due to impaired mobility, impaired cognition, use of narcotic & diuretic medications with interventions that include but not limited to promote placement of call light within reach.R6 has diagnosis which includes but not limited to Malignant Neoplasm of Cecum, Malignant Neoplasm of Colon, Vesicointestinal Fistula, Encounter For Attention To Colonoscopy, Encounter For Attention to Ileostomy, Iron Deficiency Anemia, Mild Protein Calorie Malnutrition, Schizoaffective Disorder, Constipation, Presence Of Right Artificial Hip Joint.R6's MDS dated [DATE] indicates intact cognitive function based on Brief Interview for Mental Status score of 15/15.Facility provided document titled, Get Up List Everyday. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145450 If continuation sheet Page 4 of 5 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 08/29/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete R2's name and room number is listed on the document. Facility provided document titled Residents' Rights for People in Long-Term Care Facilities undated which documents in part your facility must provide services to keep your physical and mental health, and sense of satisfaction and your facility must make reasonable arrangements to meet your needs and choices. Facility provided policy titled, Call Light, Use of dated 09/2020 which documents in part the purpose is to respond promptly to resident's call for assistance and be sure call lights are place within resident reach at all times. Event ID: Facility ID: 145450 If continuation sheet Page 5 of 5