Health inspection·March 13, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and document review the facility failed to ensure the rights of residents to be free from abuse in one of four residents (R1, R7, R8 and R10) in a sample of 10 residents. This resulted in R7 sustaining a superficial scratch to left side of face near eye. Findings include: R7 is a [AGE] year-old male with diagnoses including Parkinsonism, COPD, Schizoaffective Disorder, Diabetes 2, and Alcohol Abuse. R7 was first admitted to the facility on [DATE]. R7 has a BIMS (Brief Interview for Mental Status) score of 15/15. R7 hospital record dated 3/8/25 shows R7 sustained superficial abrasion to the left bridge of nose/near eye. No other injuries sustained in the altercation. On 3/11/25 at 2PM R7 stated yes, I had an altercation with R8 out on the smoking patio. R8 started urinating out on patio and did it on my leg. I pushed him away and he pushed my face with his hand. My glasses fell off my face and broke on the ground. He poked my eye, and I had a small scratch on my eyebrow. I went in and told staff. Staff called the police and got R8 from the patio. The police came but I didn't want to press charges. I didn't get hurt. They sent us both to the hospital and I returned without any injury except the scratch. I haven't seen R8. I don't want to talk about this anymore. I am safe here. R8 didn't mean it he is just sick so it's not a big deal to me. On 3/11/25 at 1:56PM V2 (Assistant Administrator) stated we received a call that R7 allegedly received a scratch. We immediately separated both residents. Both were assessed. There was no serious injury just a tiny superficial scratch to the face of R7 with no significant injury. R7 was not in pain or distress. We reported to the State Agency immediately. Chicago Police called. R7 refused to press charges. R7 stated the patient is sick and no need to do anything. Both were sent to hospital. R7 was sent to hospital with no significant injury and returned the same day. On 3/12/25 at 1:40PM V8 (RN/Registered Nurse) stated R7 came in from patio and told me R8 scratched his face and broke his glasses. I assessed him with a small scratch below his eye. I notified other staff who came and provided 1:1 to both R7 and R8. The police arrived. Family and doctor was notified. Both residents were sent to the hospital. R7 3/11/25 Social Service note states this writer went to speak to R7 to see how he was doing in regard to an incident that allegedly happened this past Saturday. He (R7) told this writer, I'm fine, and there is nothing to talk about its over with and I don't want to talk about it anymore. Social Page 1 of 2 145507 145507 03/13/2025 Clark Manor 7433 North Clark Street Chicago, IL 60626

F 0600 services will continue to offer support as needed. Level of Harm - Minimal harm or potential for actual harm R8 is a [AGE] year-old male with diagnoses including Bipolar Disorder, Hepatitis C, Nicotine Dependence, Other Drug Induced Secondary Parkinsonism and Thrombocytopenia. R8 was first admitted to the facility on [DATE]. R8 has no BIMS (Brief Interview for Mental Status) score non scorable. R8 is care planned for including Verbally Physically Aggressive Behavior as the result of the 3/8/25 incident, R8 is care planned for Delusional Behavior. Residents Affected - Few Review of facility alleged abuse investigations show that on 3/8/25 at around 4:05 PM Administration received a call from V3 (RN), Nursing Supervisor who stated that resident R7 has alleged that R8 had scratched his face. R7 was assessed and had no significant injury. R8 has a diagnosis of Bipolar D/O and Mild Cognitive Impairment and other medical conditions. R7 was sent to hospital for medical and R8 was sent to hospital for psych eval. Chicago Police Department was notified, and officer responded, and a report was filed. NP/nurse practitioner and mother of R7 were both notified. This will serve as the facilities initial report. Investigation immediately initiated. R8 3/8/25 progress note states resident noted with verbal and physical aggression towards others. Un-redirectable, placed on 1:1 monitoring. DR/doctor notified with order to send resident to Hospital ER/emergency room on involuntary petition for psych evaluation. Order noted and carried out. Resident became uncontrollable, 911 was called and transferred him to Hospital. Doctor informed. Resident has no family contact. Report given to Hospital psych intake c/o. Resident face sheet, POS/physician order sheet, most recent lab results and medication list faxed to 773-xxx-xxxx. R8 3/8/25 progress note states in addition, resident was transferred to hospital with the assistance of Chicago Police, report filed. Facility policy titled Abuse and Neglect Revised 7/12/24 includes statement: Policy Statement: It is the policy of the facility to provide professional care and services in an environment that is free from any type of abuse, corporal punishment, misappropriation of property, exploitation, neglect, or mistreatment. 145507 Page 2 of 2