Health inspection·July 19, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that night, I was at the nurse's station charting and (V7 and R1) were walking around and were towards the service elevator and then I heard a smack and a cry. I immediately got up and saw they were there and escorted them to (R1's) room and told (V7) to leave the facility immediately. I told her we needed to assess her mom and she did agree to leave and left the facility. I assessed (R1) for injuries, and she had some redness on her left cheek otherwise nothing else. (R1) is very confused, she didn't seem like anything had happened and already didn't remember what happened. (V7) is here all the time and brings (R1) food and is normally very caring. She came in the same as she always does and happy and not angry. I am completely shocked by this behavior from (V7).On 7/19/25 at 2:22PM, V6 (Certified Nursing Assistant) stated, We could hear a noise that sounded like a slap, but it was weird to hear. I looked down the hallway and (R1) was holding her face and her daughter (V7) was turning her chair around really fast and (V7's) face was red and she looked angry. She proceeded to push (R1) towards the nurse's station and the nurse intervened.The facility's policy titled, Abuse Prevention and Reporting-Illinois, reviewed on 12/17/21, showed, 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.this will be done by establishing an environment that promotes resident sensitivity, resident security, and prevention of mistreatment.abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish to a resident. Physical abuse is the infliction of injury on a resident that occurs other than by accidental means and that requires medical attention. Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment . 2. R2's electronic face sheet, printed on 7/19/25, showed R2 has diagnoses including but not limited to hypertensive heart and chronic kidney disease, alcoholic cirrhosis of the liver, esophageal varices, and liver transplant.R2's facility assessment, dated 5/20/25, showed R2 has no cognitive impairment and no behaviors.R2's care plan, dated 5/20/25, showed, (R2) may voice allegations of mistreatment or exploitation. This behavior appears to be related to: difficulty controlling anger and depression.R2's care plan, dated 6/26/25, showed, (R2) has either experienced or may be at risk for: verbal abuse and has the following risk factors: Low self-esteem/self-worth, Confusion/ disorientation, Aggression/combativeness. On 6.25.25 (R2) alleged verbal abuse from a visitor at the facility.On 7/19/25 at 1:32PM, R2 stated, A gentleman came out of the elevator, and he looked like he was searching for something, and I asked if I could help him and he said to me, Do you work here? I said no I don't but if there's anything I can help you with or the girls can help you with. He then cut me off and said 'if you don't work here then shut the f*ck up.he said do you work here and I again said no and then he said if you don't work here then shut the f*ck up or I will f*ck you up'. I then told him to keep walking and he said, 'I swear to God I will f*ck you up if I come over there.' I told him to go ahead and then he left the area. I was upset because I was trying to be helpful, and I wasn't trying to do anything but help him.On 7/19/25 at 1:50PM, R4 stated, I saw something happen with (R2) and some random guy. The guy came off the elevator and all I caught was what (R2) said. I heard him say Well sir, I'd be glad to help you or someone else could if you ask them I didn't catch everything the gentleman said but he was swearing at (R2) when (R2) did nothing except offer to help him.On 7/19/25 at 1:54PM, V5 (Licensed Practical Nurse) stated, I was working the day (R2) got into it with one of the visitors. I saw a family member walk past (R2) and (R2) asked if he needed help with something. I didn't hear all of it because I was having a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145669 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 145669 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Waukegan 2222 Audrey Nixon Boulevard Waukegan, IL 60085 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 FORM CMS-2567 (02/99) Previous Versions Obsolete conversation at the nurse's cart. I heard the guy say to him I don't need your help. I did hear him say he was going to beat (R2's) ass and seemed really mad. The guy went right into the bathroom, and I called (V2, Director of Nursing). We were looking around for him, and by the time we figured out where he was, he had left the facility because we saw it on the cameras. (R2) didn't do anything to instigate the situation, the guy was completely rude and seemed really irritated. I'm glad he backed off because I was afraid he would do something to (R2).The facility's policy titled, Abuse Prevention and Reporting-Illinois, reviewed on 12/17/21, showed, verbal abuse may be considered to be a type of mental abuse. Verbal abuse incudes the use of oral, written, or gestured communication, or sounds, to residents within hearing distance, regardless of age, ability to comprehend, or disability. Examples of mental and verbal abuse include yelling or hovering over a resident, with the intent to intimidate, threatening residents. Event ID: Facility ID: 145669 If continuation sheet Page 3 of 3