Inspection·July 20, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few addressing the situation. He pushed me away and that's when I think he hurt my chest, and I must have banged my elbow, but I was so angry that I can't really recall all the details. He's a nurse and should not treat patients this way so I told this when I was in the ER (emergency room.). R1 returned to the facility after treatment but expressed to staff the following day that he no longer felt safe and requested discharge against medical advice. R1 said he was being watched by V3 social worker and other staff and he was treated like an animal and wanted to go somewhere else instead where staff were kind. R1 stated R1 was trying to get another patient some help.On 7/18/25 at 3:30 PM, V3 (Social Service Director) said that he is involved in the orientation of new employees, but that part of his orientation does not include anything related to de-escalation of behaviors but more so a general summary of dementia and emphasis on elopement prevention. On 7/18/25 at 4:10 PM telephone interview, V4 (LPN) said that he did not have any physical contact with the resident and denied raising his voice to the resident. V4 said that R1 placed his chest against his chest and his arms were at his side and he tried to control himself. Surveyor asked what he meant by trying to control himself and asked if R1 made him angry, V4 said that he meant that he wanted to try to make the resident calm was what he meant to say but admits that he was unable to calm the resident down. Surveyor asked where his arms were when this altercation came about, V4 said that his arms were at his side all the time. Surveyor asked if he raised his voice, shout at the resident, or used any type of harsh language, V4 said that he told (R1) that the resident that was screaming was not his and that he had the resident to go back to his room numerous times, but the resident did not listen to him. V4 indicated he had past dementia training but not this current facility. V4 denied de-escalation training on resident behaviors. V4 indicated he was not shown the video. On 7/18/25 at 4:30 PM, V5 LPN said V5 was the other nurse on duty the night of the incident (7/16/25) did not witness the altercation between R1 and V4 as she was busy in another room attending to a different patient however heard a loud argument down the hall. V5 said she heard the resident (R1) screaming at V4 but did not hear V4 saying anything back to the resident. V5 said she heard an argument but only heard R1 shouting. V5 again said, that she heard R1 but said that V4 did not say anything to the resident. V5 stated V5 did not observe what was written in the note, No I was busy in another room. Review of V5's nursing note entry does not align with her statement to the surveyor. On 7/16/25 at 8:30 PM, V5 (LPN) wrote, R1 approached Nurse V4 (LPN) and requested that he check on another resident who was asking for help. Nurse V4 responded promptly and went to assist the other resident. Upon returning, Resident appeared upset and began yelling at Nurse (V4), demanding that he go back and check on the resident again. Resident became increasingly agitated and attempted to physically punch (V4). Nurse V4 raised his hand to block the punch. Nurse V4 then instructed R1 to return to his room and refrain from further aggressive behavior. Shortly after the incident, Resident alleged that Nurse V4 had struck him and requested that the police be contacted. Due to the escalation and the resident's emotional state, the decision was made to send R1 to the emergency room (ER) for further evaluation and safety assessment. Supervisor was notified.Facility abuse policy revised 2022 reads in part, This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this guidance is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff and mistreatment of residents.Physical Abuse is the infliction of injury on a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145626 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 145626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Generations Oakton Pavillion 1660 Oakton Place Des Plaines, IL 60018 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 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident that occurs other than by accidental means and that requires medical attention (77 Ill. Adm. Code 300.330). Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment. Verbal Abuse is the use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents or families, or within their hearing distance, regardless of an individuals' age, ability to comprehend, or disability. Event ID: Facility ID: 145626 If continuation sheet Page 3 of 3