Inspection·December 8, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few responsible to do the wound treatments for the residents on Saturday and Sunday and if V2 gives instruction that they need to be done.On 12/8/25 at 8:37 AM, a phone interview was conducted with V23 (Licensed Practical Nurse) and stated that R1 came in the facility on 11/25/25 at 1:45 PM and she was the nurse who was assigned to R1. V23 said that R1's wound treatments were not entered in the orders because she did not do the assessment for her [R1]. V23 said that R1 came in so late and V23 only did the note and verified the medication from the office of V25 (R1's Physician). V23 said V25's office was closed so she had to call the on-call doctor to verify medication. V23 stated that R1 came in around 1:45 PM and their cut off is 2:00 PM. Surveyor asked what V23 means by cut off. V2 stated cut off means that any patient admitted on the 7-3 shift after 2:00 PM she just writes the note, put the resident in the system, and verify the medications. V23 stated she did not do R1's body assessment and she endorsed it to the evening shift nurse. V23 said she did not enter any orders in the system. On 12/8/25 at 1:41 PM, a phone interview was conducted with V26 (Licensed Practical Nurse) and V26 stated that she did the full body assessment for R1 upon admission. V26 said that she completed the admission assessment and entered the medication orders in the electronic health records, but did not enter wound treatment orders. V26 stated that the medications orders were verified with V25 (R1's Physician) and V26 notified V2 (Director of Nursing) and V24 (Wound Care Nurse/LPN) about R1's wounds. V26 stated R1 had left leg amputation that was freshly done in the hospital and came in the facility for wound care. V26 stated that when she notified V2 and V24, they both assessed R1's wounds right away the day of admission [DATE]).On 12/8/25 at 9:14 AM, a phone interview was conducted with V24 (Wound Care Coordinator/LPN) and V24 stated that she's been working in the facility since March 2025 as the full-time wound care nurse. V24 said that when a resident is admitted in the facility, the process is that as soon as the resident comes in the facility, the admitting nurse is supposed to do a full body assessment. They are to call the primary care physician and verify admission orders that include but not limited to medication orders and skin treatments as necessary. These need to be done as soon as the resident comes in the facility so that the appropriate treatments and care are provided to the resident, and to address anything that the resident needs. V24 said that the admission packet includes full assessment of the resident, and the admitting nurse is expected to complete the entire process. V24 said that if the resident is assessed with wounds, the admitting nurse will verify treatment orders, call the PCP [Primary Care Physician] and enter orders in the system. V24 said if treatment orders are not ordered, the treatments are not going to be done. V24 said, The treatments are documented or signed off in the TAR that it's done. If the TAR has holes, it means the treatments were not done. The nursing rule is if it's not documented, it's not done. I was on vacation from 11/22/25 to 12/1/25. If I'm on vacation, [V2] will take over or she can delegate the task. V24 said that she was not in the facility when R1 admitted on [DATE].The facility's Skin Condition Assessment & Monitoring- Pressure and Non-Pressure policy and procedure dated 6/8/18 documents in part: A skin condition assessment and pressure ulcer risk assessment (Braden) will be completed at the time of admission/readmission. Physician ordered treatments shall be initialed by the staff on the electronic Treatment Administration Record after each administration. Other nursing measures not involving medications shall be documented in the weekly wound assessment or nurses note. A licensed nurse shall observe condition of wound incision daily, or with dressing changes as ordered. Observations such as drainage, dehiscence, redness, swelling, or pain will be documented in the nurse's notes. If observations are acute, physician and responsible party will be notified by charge nurse. Notification will be documented in the resident's clinical record.The facility's Dressing Change policy and procedures dated 1/9/18 documents in part: Sign the Treatment Administration Record.The facility's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145591 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 145591 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Wesley 1415 West Foster Avenue 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Medication Administration General Guidelines (no date) documents in part: Medications are administered only by licensed nursing, medical, pharmacy or other personnel authorized by state laws and regulations to administer medications. Medications are administered in accordance with written orders of the prescriber. The individual who administers the medication dose records the administration on the resident's MAR directly after the medication is given. At the end of each medication pass, the person administering the medications reviews the MAR to ensure necessary doses were administered and documented. In no case should the individual who administered the medications report off duty without first recording the administration of any medications. Current medications, except topicals used for treatments, are listed on the medication administration record (MAR). Event ID: Facility ID: 145591 If continuation sheet Page 3 of 3