Health inspection·December 31, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record reviews, the facility failed to prevent live roaches from being in residents' rooms and crawling in bed with residents. This failure affected four residents (R2, R6, R18, and R21) in a sample of 10. This failure has the potential to affect all 250 residents residing in the facility.Findings include:a.R2's Face Sheet documents that R2 was admitted to the facility on [DATE] and R2's diagnosis includes Schizophrenia, Schizoaffective, Bipolar Disorder, Conduct Disorders, and Auditory Hallucinations. R2's last quarterly Minimum Data Sheet (MDS) documents a Brief Interview for Mental Status (BIMS) score of 15 indicating cognitively intact with little to no impairment.On 12/22/2025 at 2:32 PM, R2's family member (V6) stated R2's mattress was rotten and there were big cockroaches running throughout the mattress. V6 said that the mattress needed sterilizing. V6 added that roaches ran out of the clean sheets that were placed on R2's bed. V6 said the bug problems took place when R2 live on the second floor with R2's former roommates.b.R6's Face Sheet documents that R6 was admitted to the facility on [DATE] with a diagnosis of muscle wasting and atrophy, unsteadiness on feet, other lack of coordination, unspecified psychosis not due to a substance or known physiological condition, low vision right eye category one, low vision left eye category one, and neurocognitive disorder. R6's last quarterly Minimum Data Sheet (MDS) documents a Brief Interview for Mental Status (BIMS) score of 13 indicating cognitively intact with little to no impairment.On 12/22/2025 at 2:15 PM, V26 (Certified Nursing Assistant (CNA) stated that roaches on the second floor are usually seen during first shift sometimes on the second shift. V26 added that V26 sometimes work first shift, second shift and all four floors so V26 stated that the roaches are prevalent throughout the facility where residents reside. V26 said that the roaches appear on the floor when they order food for the residents from the kitchen. V26 stated that R6 attracts roaches because R6 likes to hide food especially sandwiches under the cushion of R6's wheelchair. V26 added that V26 saw roaches in V26's room last night as well as Thursday of last week. V26 provided other rooms where roaches usually crawl but the surveyor's data was lost.c.R18's Face Sheet documents that R18 was admitted to the facility on [DATE] with a diagnosis of muscle weakness, idiopathic peripheral autonomic neuropathy, simple chronic bronchitis, major depressive disorder, generalized anxiety disorder, and cognitive communication deficit.R18's last quarterly Minimum Data Sheet (MDS) documents a Brief Interview for Mental Status (BIMS) score of 15 indicating cognitively intact with little to no impairment.On 12/24/2025 at 10:39 AM, R18 stated that just last night R18's roommate killed a roach on their dresser by the television. At 10:30 AM, R21 said that R1's room had many roaches, and they were alive. While in R1's room, R1 had multiple devices that was purchased to trap and kill the roaches. R21 stated that the roaches hide and live behind the decorative wall trimming/band that was about waist-length above the wall. R21 then pulled open the trimming and a large black insect about one and half inches in diameter ran down the wall. R21 believe the roaches are embedded and live in the wall behind R21's bed and within the Residents Affected - Many Page 1 of 2 145625 145625 12/31/2025 California Terrace 2829 South California Blvd Chicago, IL 60608

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many decorative wall trimmings. Frontline staff of CNAs (V12, V26, V29, and V42) and housekeeping (V31, V32, and V33) interviewed on 12/24/2025 stated the residents have roaches in their rooms and they are told to report on the floor's maintenance request log. They all said that they have never seen the bugs on the residents though they appear in the corners of the rooms and when residents' beds are moved to clean or provide care. On 12/23/2025 at 11:55 AM, V14 (Licensed Practical Nurse) stated that bathrooms on the second floor more roaches than other floors.Record review of the first and second floor Maintenance Request Logs documents Lots of bed bugs (8/21/2025), roaches in the room (9/14/2025), roaches on the floor and in bed (11/1/2025) and list resident rooms that contain roaches. V1 (Administrator), V2 (Director of Nursing), V4 (Director of Housekeeping and Laundry), and V16 (Social Worker Director) interviewed during the investigation stated agreed that the facility has a roach problem, and their expectation is for the problem to be corrected as soon as possible. V4 stated that they implement regular exterminations to the building and resident rooms. V1 said that V1 is confident of the extermination capabilities from the same pest control company that they have employed for twenty years. V1 added that the bug problem is indicative of the resident population due to prior issues such as hoarding, homelessness, and visiting family members who may contribute to the concern and there is nothing they can about it outside of exterminating the facility.Policies:The facility failed to follow their Pest Control Policy dated 11/2014 which documents To prevent or control insects in the facility. 145625 Page 2 of 2