Inspection·February 23, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm feet. V11 stated the television in R1 and R2's room was on, and it was loud. R2 was mad with R1 because the television was too loud. V11 stated after she saw R1 punching R2. She ran to the nursing station and informed the CNAs (Certified Nursing Assistants) (no names provided) and the nurses (no names provided) that R1 was punching R2 and both R1 and R2 were screaming at each other. V11 stated staff went to R1 and R2's room to check on the residents and took R1 out of the room. Residents Affected - Few On 02/22/2025, at 11:20 AM, V6 (Certified Nursing Assistant-CNA) stated he was assigned R1 and R2 on 02/05/2025. V6 was completing his hourly rounds and was on the other side of the unit when he heard code purple (which means resident altercation). By the time he got to R1 and R2's room, there were other staff members intervening. V6 stated R1 and R2 were arguing and shouting to each other about the television volume. R2 was stating R1's television volume was high, and that is what the argument was about. V6 stated the nurse (cannot remember the name) was already in the room talking to R1 and R2 and they were separated. On 02/22/2025, at 1:29 PM, V9 (Registered Nurse) via phone stated it was around 2:00 PM, when V9 was called by V11 (housekeeping) and informed that R1 and R2 were having a verbal argument. V9 stated she went to the room to check and when she got here, she found the residents separated. She checked to see if both residents were ok. V9 stated R1 stated R2 hit him and R2 stated R1 hit him. Both residents were placed on a 1:1 and V1 (Administrator), V2 (Director of Nursing-DON) and social services were notified. On 02/22/2025, at 12:21 PM, V10 (Social Services Director) stated R1 was brought to V10's office to get him off the floor after getting into a physical altercation with R2 (roommate) because R1's television was too loud. On 02/22/2025, at 2:33 PM, V1 (Administrator) stated V10 (Social Services Director) notified her of R1 and R2's altercation on 02/05/2025. R1 and R2 were separated. Physicians were notified, police were called, and family was notified. V1 stated the initial reportable to IDPH (Illinois Department of Public Health) on 02/05/2025. V1 stated if any time a resident hit another resident, it is a form of abuse. R1 was removed from the room and taken to the social services office. R1 was petitioned out for further assessment and treatment. V1 stated the police were called because of the allegation of physical abuse. After the police interviewed R1 and R2, the facility was given a case number that stated, simple battery. V1 stated any forms of abuse can affect the resident emotionally and mentally even when there are no physical injuries. On 02/22/2025, at 3:25 PM, V2 (Director of Nursing -DON) stated residents are not supposed to hit each other, because that's a form of abuse. To prevent the altercation, social services could have put interventions in place, such as offering both R1 and R2 earphones which could have prevented the altercation. Witness statements dated 2/5/2025 document R1 and R2 have verbal and physical confrontation regarding R1's TV being too loud. R1's progress notes dated 2/6/2025, document R1 had a physical altercation with R2. R1 continued to be agitated, verbally aggressive and threatening to cause harm to R2. R1 continued to be non- compliant and disrespectful. R1's progress notes dated 2/5/2025, document altercation between R1 and R2 was reported to police and case number #JJ139411 provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145479 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Atrium Health Care Center 1425 West Estes Avenue Chicago, IL 60626 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R2's progress notes dated 2/5/2025, document V9 (Registered Nurse-RN) was called to R2's room by staff (no name). Upon entering the room, R2 and R1 were engaged in a verbal altercation with R2 stating R1's TV (television) volume was too loud. When R2 asked R1 to reduce the volume, R1 hit R2 on the lap. V9 separated R1 and R2. R2's progress noted dated 2/6/2025, document R2 was in an alleged physical altercation with R1. R2's progress notes dated 2/11/2025, document R2 denied being the aggressor, but admitted his actions were a form of defense due to R1's demanding behavior. Police report dated 2/5/2025 #JJ139411 document simple battery. Policy titled Abuse Prevention Policy dated 10/24/2022 documents: -Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. Physical abuse is the infliction of injury on a resident that occurs other than by accidental means. Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment. Verbal abuse is the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or families or within hearing distance regardless of an individuals' age, ability to comprehend or ability. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145479 If continuation sheet Page 3 of 3