Inspection·October 11, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10.9.2024, at 11:27 AM, V7 (Restorative Aide) said R2 approached V7 on 9.10.24. R2 asked if she could ask V7 a question. V7 said R2 asked her if a staff member told R2 to shut the f*** up, was that, okay? V7 said, I told R2 no, that's verbal abuse. I told her she needed to report it to V1 (Administrator). I notified V2 (Director of Nursing) of R2's allegation. 10.10.2024, at 10:18 AM via telephone, V10 (Certified Nursing Assistant) said, I was working on 9.10.2024. I was going out of the building, V3 (Former Receptionist) buzzed me out. I don't recall seeing any staff or residents in the reception area, I don't recall V3 saying anything. V10 said it's considered verbal abuse if a staff member swears at resident. 10.10.2024, at 11:35 AM V2 said, I wasn't in the facility when the incident (alleged staff to resident verbal abuse involving V3-Former Receptionist and (R2) happened. V7 (Restorative Aide) reported the incident to me when V7 could not reach V1 (Administrator).V2 said, I was able to reach V1. V2 said if there were witnesses, then it's considered abuse, if there are no witnesses then it's a he said, she said (argument or dispute where the truth is hard to determine due to conflicting accounts of those involved). R2 told me what happened the next day. R2 asked me if I heard what happened, that V3 told R2 to shut the f*** up. 10.10.2024, at 12:05 PM V11 (Social Service Coordinator) said, I was not present when incident happened. I was told by my supervisor to follow up with R2. R2 told me she was sitting at the front desk, that V3 (Former Receptionist) said something disrespectful to R2. I can't remember if R2 said V3 cursed at her, that's verbal abuse. If the statement was made, regardless of whether the resident said they felt safe in the facility or did not feel threatened, that's still abuse. 10.10.2024, at 12:42 PM V4 (Admissions Director) said if a staff member tells a resident to shut the f*** up that is verbal abuse regardless of whether that resident says they feel safe in the facility or do not feel threatened. 10.10.2024, at 1:41 PM, V1 (Administrator) said, I was made aware via phone by V2 (Director of Nursing) that R2 might have some concerns. I called the facility, I spoke with V3 (Former Receptionist). I asked V3 if she had any interactions with R2, she said yes. V3 told me R2 was sitting by the wall (reception area) and was giving the building code to other residents that were passing by or in the area. She (V3) said she told her (R2) to stop passing the code out. I told her that a resident stated that she used profanity, V3 denied it. She was suspended pending outcome of the investigation. I investigated incident. At the end of the investigation, I was not able to substantiate abuse but determined that V3 may have had an inappropriate communication with R2. I couldn't figure out what verbiage V3 used but determined that she most certainly made R2 feel uncomfortable. R2 said she felt safe, did not experience physical or emotional disturbance from the incident. If a staff member curses at a resident, it is considered verbal abuse. 10.9.2024, 6:52 PM Nursing Progress Note Late Entry documents in part: Writer was informed by administrator, that resident reported that staff was (inappropriate) towards. Resident immediately removed from the scene and assessed by clinical nurse with no injuries notes (noted). Resident denies pain, vitals (vital) signs are WNL (within normal limits). Per administrator resident did not want to notify 911. Resident is responsible party and MD (Medical Doctor) were notified with no new orders. Facility protocol implemented. Facility's Abuse Prevention Program policy (Revised 1.2029) documents in part: Policy: It is the policy of this facility to prohibit and prevent resident abuse, neglect, exploitation, mistreatment, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145654 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 145654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Lincoln Park Rehabilitation and Nursin 735 West Diversey Chicago, IL 60614 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 and misappropriation of resident property and a crime against a resident in the facility. Level of Harm - Minimal harm or potential for actual harm Abuse and Crime Reporting Policy: This facility will not tolerate resident abuse or mistreatment or crimes against a resident by anyone, including staff members, other residents, consultants, volunteers, and staff of other agencies, family member, legal guardians, friends, or other individuals. For the purposes of this policy, and to assist staff members in recognizing abuse, the following definitions shall pertain: 2. Verbal Abuse: Any use of oral, written, or gestured language that includes disparaging and derogatory terms to residents or their families, or within their hearing distance, to describe residents, regardless of their age, ability to comprehend or disability. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145654 If continuation sheet Page 3 of 3