Health inspection·July 3, 2025

F 0803 Level of Harm - Minimal harm or potential for actual harm Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on interview and record review, the facility failed to provide six servings of Grains/Breads daily on the facility menu. Residents Affected - Many This applies to all 40 residents residing in the facility. The findings include: Facility Long Term Care Facility Application for Medicare and Medicaid, dated June 30, 2025, shows the facility census was 40 residents. Facility Diet Type Report, printed July 1, 2025, shows 39 residents receiving oral diets at the facility were receiving either General, Pureed, Mechanical Soft, Consistent Carbohydrate or Heart Healthy Diets. Review of facility Spring/Summer 2025 Diet Extensions diets, Week 1 Monday through Sunday, show the following number of Grain/Bread servings were missing from the planned facility diets on the respective days: Monday - missing 2 Grain/Bread servings (Mechanical Soft and Pureed diets missing 3 Grain/Bread) Tuesday - missing 1 Grain/Bread (Mechanical Soft and Pureed diets missing 2 Grain/Bread) Wednesday - missing 2 Grains/Breads Thursday - missing 2 Grain/Bread (Mechanical Soft diets missing 3 Grain/Bread) Friday - missing 2 Grain/Bread (Pureed diets missing 1 Grain/Bread) Saturday - missing 3 Grain/Bread (Mechanical Soft and Consistent Carbohydrate diets missing 4 Grain/Bread) Sunday - missing 1 Grain/Bread (Mechanical Soft, Consistent Carbohydrate and Heart Healthy diets missing 2 Grain/Bread) On July 1 at 2:00 PM, 2025, V4 (Director of Nutrition Systems) and V5 (Dietitian) stated the menus were planned using the United States Department of Agriculture My Plate and the Illinois long term care regulations for meal planning to plan the facility menus. V4 and V5 stated the bold items on the Diet Extensions were the food items given to residents if the residents did not personally select their menus. On July 1, 2025 at 2:30 PM, V4 and V5 reviewed the facility diet extensions and stated the menus were short servings of grains. V5 stated she follows the Section 300.2050 Meal Planning regulations to plan the facility menus. Facility Menu Nutritional Adequacy Audit Checklist, undated, shows the facility menu was expected to have six servings of grains daily. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145522 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 145522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beacon Hill 2400 South Finley Road Lombard, IL 60148 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 0803 Level of Harm - Minimal harm or potential for actual harm Facility policy/procedure Resident Menu Planning, Approval and Revision, revised January 2024, shows, Menus are written to meet the nutritional needs of the resident population in accordance with established national guidelines Menus are approved by the dietitian/or other clinically qualified nutrition professional for nutrition adequacy and include all diets Dietitian or qualified nutrition professional - Approves the menu nutritional adequacy in accordance with established national guidelines and refer to menu guidelines. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145522 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 145522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beacon Hill 2400 South Finley Road Lombard, IL 60148 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 interview and record review, the facility failed to have a complete water management plan for Legionella. The facility also failed to ensure the existing water management plan for Legionella was followed. Residents Affected - Many This applies to all 40 residents residing in the facility. The findings include: The facility's Long-term Care Application for Medicare and Medicaid dated June 30, 2025, showed the facility census was 40 residents. On July 2, 2025, at 12:13 PM, V9 (Director of Plant Operations) said the only monitoring conducted in the facility's water management plan for Legionella is testing the water for Legionella. V9 said the last time the facility tested for Legionella was June 24, 2024. V9 said the facility does not have a complete water management plan for Legionella. V9 said he has completed water management plans for Legionella in the past and this plan is missing multiple items like flow diagrams of water, risk areas for Legionella growth, and control measures. V9 said the facility's water management plan for Legionella does not contain the elements required by the federal regulation. On July 2, 2025, at 11:22 AM, V1 (Administrator) said the facility's water management plan for Legionella includes the two documents titled Health Center Prevention and Control for Legionella dated December 21, 2022, and Legionella Surveillance dated December 18, 2024. The facility's water management plan for Legionella does not show an assessment to identify where Legionella can grow and spread, control measures to prevent the growth of opportunistic waterborne pathogens, how to monitor control measures, or ways to intervene if control measures are not met. The facility does not have documentation to show monitoring of control measures. The facility's Legionella water testing results dated June 24, 2024, showed We do recommend continuing to monitor the water on a regular basis to help with the facilities water safety and adhere to CMS (Centers for Medicare and Medicaid Services) standard. The facility does not have documentation to show water testing has been conducted since June 24, 2024. The facility's policy titled Health Care Prevention and Control of Legionella dated December 21, 2022, showed Purpose: Legionnaire's disease is caused by the organism Legionella pneumophila. The bacterium Legionella can cause a serious type of pneumonia in persons at risk. Those at risk include persons who are at least [AGE] years old, smokers, or those with underlying medical conditions such as chronic lung disease or immunosuppression. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems including hospitals and long-term care facilities. Transmission can occur via aerosols from devices such as showerheads, cooling towers, hot tubs, and decorative fountains. Although uncommon in post-acute care facilities, Legionnaire's disease may occur and could be either facility or community acquired. The purpose of this policy and related procedures is to ensure specific actions are taken for prevention of Legionella and for investigation should a case occur . Procedures . The environmental services department will be responsible for maintenance of [the facility] water sources. They will also complete random testing of at least three water supply sources within the health centers and communities twice per year unless more frequent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145522 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 145522 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beacon Hill 2400 South Finley Road Lombard, IL 60148 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 testing is mandated by applicable law . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145522 If continuation sheet Page 5 of 5