Inspection·July 14, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete moderate amount of serous exudate, no odor, attached edges, surrounding tissue dark reddish brown, black/blue discoloration, fragile skin. Changed treatment: Treatment, normal saline cleansing, primary dressing calcium alginate, film/membrane, silicone, improving. Measurements, 2.9 cm. long by 3.5 cm. wide, by 0.2 cm. deep. The facility does not have documentation to show V6 or any facility staff member notified R1's representative/responsible party of the change in R1's pressure ulcer treatment. The facility does not have documentation to show R1 instructed the facility not to notify R1's representative/responsible party.On April 29, 2025, at 12:12 AM, V5 (RN) documented, [R1] with large blister to right heel, applied dry dressing and elevated right heel with pillows. Informed [V8] (Physician) to see resident tomorrow. Endorsed to next shift. The facility does not have documentation to show V5 or any facility staff member notified R1's representative/responsible party of the change in R1's skin condition. The facility does not have documentation to show R1 instructed the facility not to notify R1's representative/responsible party.On April 29, 2025, V7 (Wound Care Doctor) documented multiple wound assessments, including: Stage 2 pressure wound of the left heel, 4 cm. (centimeters) long by 3 cm. wide by not measureable depth and Unstageable DTI of the right heel, 2 cm. long by 1 cm. wide, by not measureable depth.On July 9, 2025, at 4:09 PM, V5 (RN) said, If a resident's wound is worse, or if the resident develops a new wound, it is not up to me to call and tell the doctor or family, that is the wound care nurse's job. I did not notify [R1's] family regarding the new wound on her heel.On July 10, 2025 at 10:09 AM, V8 (Physician) said, I don't really remember hearing about [R1's] pressure ulcer, but it came to my radar when I saw her and the wound was not in great shape, and that was the time I found out, just before she was going out to the hospital on May 1, 2025. I got a call that afternoon, and the family wanted [R1] sent to the hospital. With any wounds not doing well, we want the wound care doctor to see the patient. It is not okay that no doctor laid eyes on this wound from April 16 to April 29, 2025. It did not come to my radar until April 29, and then two days later we sent [R1] out. I would have examined the wound had I known about it before that.The facility's policy entitled Change in a Resident's Condition or Status, dated February 2021 shows: Policy Statement: Our community promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status (e.g., changes in level of care, billing/payments, resident rights, etc.). Policy Interpretation and Implementation: .4. Unless otherwise instructed by the resident, a nurse will notify the resident's representative when: .b. There is a significant change in the resident's physical, mental, or psychosocial status. Event ID: Facility ID: 145522 If continuation sheet Page 2 of 4 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 07/14/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 administer wound care treatments as ordered by the physician, and failed to ensure care plan interventions were followed for residents with pressure ulcers. This applies to 2 of 3 residents (R1, R3) reviewed for pressure ulcers in the sample of 5. The findings include: 1. The EMR (Electronic Medical Record) shows R1 was admitted to the facility on [DATE], and transferred to the local hospital on May 1, 2025. R1 did not return to the facility. R1 had multiple diagnoses including, atrial fibrillation, COPD (Chronic Obstructive Pulmonary Disease), pneumonia, unsteadiness on feet, need for assistance with personal care, cognitive communication deficit, repeated falls, urine retention, spinal stenosis, abdominal aortic aneurysm, depression, personal history of TIA (Transient ischemic Attack) and cerebral infarction, and hypertension. R1's MDS (Minimum Data Set) dated April 21, 2025 shows R1 had moderate cognitive impairment, required set up assistance with eating, oral hygiene, and personal hygiene, and was dependent on facility staff for all other ADLs (Activities of Daily Living). R1 had an indwelling urinary catheter and was frequently incontinent of stool. R1's MDS continues to show R1 had an unstageable DTI (Deep Tissue Injury) upon admission to the facility.R1's admission skin assessment, dated April 15, 2025, at 11:04 PM, by V5 (RN-Registered Nurse) shows the location of R1's skin condition was R1's coccyx, with DTI (Deep Tissue Injury)/dark discoloration, present on admission, right antecubital space with bruising, right inner forearm bruising, left inner forearm bruising, left front axilla bruising.On April 29, 2025 at 12:12 AM, V5 (RN) documented, [R1] with large blister to right heel, applied dry dressing and elevated right heel with pillows. Informed [V8] (Physician) to see resident tomorrow. Endorsed to next shift. On April 29, 2025, V7 (Wound Care Physician) documented, a wound care assessment and evaluation of R1. V7's documentation shows the following wounds and wound measurements:Site 2: Unstageable DTI of the right ischium, undetermined thickness. Wound Size 1 cm. long by 1 cm. wide, by not measurable depth. Treatment plan: Zinc ointment apply once daily an as needed for 30 days. Gauze island with border, apply once daily an as needed.The facility does not have documentation to show the wound treatment for R1's right ischium DTI was entered into the EMR and administered as ordered by V7. Site 3: Stage 2 pressure wound of the left heel, partial thickness. Wound size 4 cm. long by 3 cm. wide, by not measurable depth. Blister: fluid filled. Treatment plan: Betadine apply once daily and as needed for 30 days.The facility does not have documentation to show the wound treatment for R1's facility-acquired Stage 2 pressure wound of the left heel was entered into the EMR and administered as ordered by V7.On July 9, 2025 at 9:37 AM, V7 (Wound Care Physician) said, It is my expectation the nursing staff administer my treatment orders immediately, and as ordered. If the treatment is ordered to be done daily, then they should be doing the treatment daily. 2. On July 8, 2025 at 4:31 PM, R3 was lying in bed in her room. R3's bilateral legs were covered by a blanket. R3 said she was not wearing foam boots on her feet. A foam boot was sitting on the floor of R3's room, next to the wall. V9 (CNA-Certified Nursing Assistant) entered R3's room with a dinner tray and assisted R3 with setting up her dinner meal. V9 pulled back R3's blanket. R3 had a gauze dressing over her entire left foot, up to her ankle. R3 was not wearing foam boots over her left or right foot. R3's bilateral feet were not offloaded from the mattress. V9 said R3 should have foam boots on her feet when she is in bed. V9 was able to find one foam boot in R3's room. V9 said she was unable to find the second foam boot.The EMR shows R3 was admitted to the facility on [DATE] with multiple diagnoses including, acute osteomyelitis of the left ankle and foot, peripheral vascular disease, unsteadiness on feet, non-pressure chronic ulcer of the left foot with necrosis of the bone, Type 2 diabetes, chronic kidney disease, anxiety Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145522 If continuation sheet Page 3 of 4 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 07/14/2025 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete disorder, and atrial fibrillationR3's MDS dated [DATE] shows R3 has moderate cognitive impairment, requires setup assistance with eating, supervision with oral hygiene and personal hygiene, substantial/maximal assistance with showering and bed mobility, and is dependent on facility staff for toilet hygiene, lower body dressing, and transfers between surfaces. R3 is frequently incontinent of bowel and bladder. R3's MDS continues to show R3 was admitted to the facility with one Stage 3 pressure ulcer. R3's care plan for actual impairment to skin integrity, initiated on June 25, 2025 shows multiple interventions created on June 25, 2025, including, Offload both feet/heels from the mattress.On July 1, 2025, V7 (Wound Care Physician) documented, Unstageable DTI of the right heel, 3 cm. long by 3 cm. wide by not measurable depth. Patient has [foam boots] provided, she is only wearing them at night. I recommend wearing them during the day as well since she is deconditioned foot surgery. Skin prep apply once daily and as needed. Recommendations: Reposition per facility protocol and offload wound(s).On July 9, 2025 at 3:06 PM, V3 (Wound Care RN) said, R3 should have her heels offloaded from the mattress and be wearing foam boots when R3 is lying in bed. The facility's policy entitled Wound Treatment Management, dated May 22, 2025 shows: Policy: To promote wound healing of various types of wounds, it is the policy of this community to provide evidence-based treatments in accordance with current standards of practice and physician orders. Policy Explanation and Compliance Guidelines: 1. Wound treatments will be provided in accordance with physician orders, including the cleansing method, type of dressing, and frequency of dressing change.7. Treatments will be documented on the Treatment Administration Record or in the electronic health record. Event ID: Facility ID: 145522 If continuation sheet Page 4 of 4