Inspection·March 25, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm On 3/24/25 at 10: 58AM V6 (CNA) stated, Yes, I am aware that the light has been going off. It goes off all the time. Yes, this is my assigned room. I am just too busy right now. V6 (CNA) failed to answer the call light after being interviewed and alerted about the room nurse call activation. Facility policy and procedure titled Call Lights state including: Residents Affected - Few Procedure: 1. All facility personnel must be aware of call lights at all times. 2. Answer all call lights promptly whether or not the staff person is assigned to the resident. 3. Answer all call lights in a prompt, calm, courteous manner ; turn off the call light as soon as possible. 4. Never make the resident feel you are too busy to give assistance; offer further assistance before you leave the room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145654 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 145654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure the right to be free of abuse in 2 (R1, R2) of 4 residents resulting in minor injury to R1 and R2. Findings include: R1 is a [AGE] year old female with a diagnosis including Diabetes 2, Anxiety Disorder, Heart Disease and Pyoderma Gangrenosum. R1 was first admitted to the facility on [DATE]. R1 has a BIMS (Brief Interview for Mental Status) score of 15/15. R2 is a [AGE] year old female with a diagnosis including Diabetes 2, Chronic Respiratory Failure, Peripheral Vascular Disease and Congestive Heart Failure. R2 was first admitted to the facility on [DATE]. R2 has a BIMS (Brief Interview for Mental Status) score of 15/15. Facility Resident Abuse Investigation dated 2/21/25 shows R1 made contact with R2. Staff intervened and separated R1 and R2. Body assessment completed with no pain noted from both parties. R1 and R2 placed on increased monitoring and transferred out of facility for a psych evaluation. Family and MD notification made. R1 and R2 declined police involvement. Both parties feel safe in the facility. On 3/19/25 at 12:30PM R1 stated, Yes R2 and I were roommates. We were playing cards. I wanted the door left open and she didn't. We started arguing and we both made contact with each other. R2 scratched my forearm, and she got a small mark under her eye when I struck her in the face. The nurses came in right away and separated us. They assessed us and sent us both to the hospital for psych evaluations. We did not go to the hospital for any injuries. I was not afraid of her after it happened. I am not afraid now. We are good friends again and we play cards. They put us in different rooms. They also asked us if we wanted to file police reports and we both declined. I am safe here and the staff take good care of us. R1 progress note dated 2/22/25 shows R1 returned back from hospital in stable condition. Head to toe assessment completed with a superficial scratch to right arm, no active bleeding noted, no pain or swelling noted, area cleansed with NSS, and bacitracin ointment applied, resident expresses she feels safe at the facility. Resident denies emotional/mental distress at this time. Vitals wnl. Resident oriented to room [ROOM NUMBER] and remains on frequent monitoring. On 3/19/24 at 1PM R2 stated, I was roommates with R1. We were playing cards and we got into an argument over the doors to the room being closed. We had contact with each other. I got a very small mark under my eye when R1 hit my face. The staff quickly came in and separated us. We were both sent to the hospital with no injury. They sent us for a psych eval. We were both put in different rooms. The police didn't have to be involved. I never felt unsafe. We are friends now and I wish we were roommates again. We have not had any other issues and we still play cards. R2 progress note dated 2/22/25 shows R2 returned back from the hospital in stable condition. Head to Toe assessment completed with discoloration noted to the left eye. No swelling noted. No vision concerns. Slight redness under the left clavicle area. Denies pain. States that she feels safe in the facility. R2 expressed no mental distress at this time. MD updated and made aware of the residents return. Frequent monitoring remains implemented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145654 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 145654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 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 Level of Harm - Minimal harm or potential for actual harm On 3/24/25 at 10:16AM V4 (LPN) stated, I was charting and heard commotion coming from R1 and R2's room. I ran down and it was a physical altercation between R1 and R2. R1 was striking R2. I immediately separated R1 and R2. I called a code purple which is a behavior code. Other staff came in and took over. It was the end of my shift, and I left after the incident. Both R1 and R2 were sent to the hospital for a psych evaluation. Residents Affected - Few Facility Policy Titled Abuse Prevention Program shows: Policy: It is the policy of this facility to prohibit and prevent resident abuse, neglect, exploitation, mistreatment, and misappropriation of resident property and a crime against a resident in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145654 If continuation sheet Page 4 of 4