Health inspection·April 28, 2023

F 0550 Nursing personnel assisting should be positioned/seated at eye level with the resident to provide a relaxed and comfortable environment, and to avoid a standing over image. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 2 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record reviews, the facility failed to apply a bilateral knee immobilizer to one resident (R93) of 3 residents reviewed for positioning devices listed in Restorative program. Residents Affected - Few Findings Include: On 4/25/23 at 11:00am, observed R93 in bed asleep, and breathing. R93's lower extremities covered with a blanket. List of restorative devices, R93 is on the list for bilateral knee immobilizer. Physician orders says bilateral knee immobilizer on at all times, may remove for inspection and hygiene every shift with an order date of 2/1/23. On 4/25/23 at 11:15 am Restorative Aide (V8) with surveyor and observed that R93 was not wearing the immobilizer. Immobilizer device by V8 found on wheelchair in plastic bag. Not in use. V8 stated, It was supposed to be on R93. On 4/25/23 at 11:45 am interviewed V23 (CNA) and V23 admitted that it was not put on that day due to they stopped and removed the immobilizer couple of days ago and have not seen the device in resident's room. On 4/27/23 at 12:25pm V27 (Physical Therapy Director) stated that R93 was admitted in the facility beginning of this year, already admitted with contractures and with order for bilateral knee immobilizer. Restorative initiated the immobilizer. I re-evaluated R93, and the bilateral knee immobilizer was change on 4/26/23 to bilateral knee splint. With scheduling time, alternating schedule time. We don't put two immobilizers both at the same time, and I recommended to make a wearing schedule for the alternating wearing time for right and left knee splint at this time. On my assessment there are more flexion and worsening of contractions. On 4/27/23 at 1240pm (V13) stated that the immobilizer is used immobilized the legs of any resident with order for immobilizer. R93 has that contracture, and it is most likely ordered to prevent further contraction. Restorative Contracture Observation sated 2/1/23 reads in part: left knee and right knee: fixed joint or no joint mobility available. Resident has splint/orthosis: Bilateral Knee Immobilizer Physical Therapy Screening Form dated 2/1/23 reads in part: Joint limitations/contractures. Patient admitted from nursing home. Patient at baseline restorative will refers if any changes. R93 has a care plan for would benefit from use of bilateral knee immobilizer due to he has actual contracture related to CVA. dated 3/29/23. Restorative Nursing program with a revision date of 1/4/2019 reads in part: To promote resident's ability to maintain or regain the highest degree of independence as safely as possible. Includes, but is not limited to, programs in walking/mobility, dressing and grooming, eating and swallowing, transferring, bed mobility, communications, split or brace assistance, amputation care and continence programs. Identify resident who currently have splints/braces or previous range of motions programs or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 3 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0684 those that have actual and potential limitations with range of motion and/or pain. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 4 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to implement its pressure ulcer prevention policy. The facility failed to follow the manufacturer recommendation for using a low air loss mattress for a resident who has stage 4 pressure ulcer. This deficiency affects two (R42 and R67) of five residents in the sample of 29 reviewed for wound care management. Residents Affected - Few Findings include: R67 is admitted with diagnosis listed in part but not limited to Pressure-induced deep tissue damage of sacral region, Type 2 Diabetes Mellitus with diabetic neuropathy, Obesity, Chronic Respiratory Failure. Physician order sheet indicated: Apply skin protectant to peri-area as needed. Cleanse sacral area with NSS (normal saline solution), apply dermaseptin ointment and cover with foam dressing daily every shift date order 1/17/23 and was discontinued after wound observed by surveyor. Cleanse sacral area with NSS, apply dermaseptin ointment, calcium alginate and cover with foam dressing daily everyday shift- date order 4/25/23. Care plan indicated: She has actual impairment to skin integrity, readmitted with deep tissue injury sacral area due to Chronic kidney disease, Diabetes Mellitus, pulmonary fibrosis, incontinence. Intervention: Monitor/document location, size, and treatment of skin injury. Report abnormalities, failure to heal, signs of infection, maceration, etc., to Physician/ Nurse Practitioner/Physician assistant. Care plan is not updated. On 4/25/23 at 11:11am, observed V4 LPN remove R67's sacral foam dressing soaked with urine. The foam dressing has calcium alginate with a small amount of sanguineous/blood drainage. R67's sacral area has purplish red discoloration with an open wound on both left and right buttocks/gluteal. Both are approximately quarter size but much bigger on the left gluteal area. After cleaning sacral area with normal saline solution (NSS), she applied calcium alginate to both open wound and covered with a foam dressing. V4 did not apply dermaseptin ointment to purplish red discoloration on sacral area. V4 said that she will inform the wound care nurse of the open wound on both gluteal areas. R42 is admitted on [DATE] with diagnosis listed in part but not limited to Pressure ulcer of sacral region stage 4, Diaper dermatitis, Multiple sclerosis (MS), paraplegia. Physician order sheet indicated: Wound vac to sacral area every Monday, Wednesday, and Friday at 125mmhg continuous. Care plan indicated: R42 is admitted with sacral stage 4 pressure ulcer injury wound related to mechanical fall status post (s/p) sacral debridement, MS, and cystitis. Intervention: Provide low air loss mattress and wheelchair cushion. R42's most recent wound report indicated: Sacrum pressure ulcer stage 4 present on admission. Date identified 7/7/22. Epithelial 20%. Bright beefy red 80%. Moderate serosanguineous. 3cm x 4cm x 0.30cm. Expose muscle and bone. On 4/25/23 at 3:48pm, observed R42 with V11 (RN) lying on low air loss (LAL) mattress bed. Observed folded linen in quarters over the flat sheet covering the LAL mattress. R42 has wound vac on sacral area due to Stage 4 Pressure ulcer. V11 said that there should be only flat sheet over the LAL mattress. V11 said that she will inform the CNA to remove the folded linen underneath R42's. On 4/25/23 at 4:14pm Informed V3 ADON of all above observation. V3 said that she is also the wound coordinator. V3 said V24 Wound Care Nurse does schedule wound treatment and the floor nurses change the dressing as needed when it becomes soiled. V24 does the wound assessment and V3 does the wound care plan update/revision. V3 said that resident on LAL mattress should only have flat sheet over the mattress. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 5 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 4/26/23 at 9:48am, Review R67's medical record with V3 ADON. V3 said that R67 is recently admitted on [DATE] with MASD (Moisture Associated Skin Disorder) and DTI (Deep Tissue Injury). She said R67 is at moderate risk for skin impairment. V3 said that R67's wound assessment report dated 4/1/23 indicated that MASD was healed. V3 said that most recent wound assessment done on 4/24/23 indicated DTI on sacrum date identified on 1/16/23, has 80% deep [NAME] and 20% beefy red tissues, no exudate, measures 0.40cm x 0.50cmx0.10cm. Informed V3 that R67's MASD is not addressed in care plan. R67 was provided wound treatment of calcium alginate without physician order and inappropriate treatment for DTI. There is no ongoing wound assessment and documentation done for R67. R67 was observed to have 2 new open wounds on both right and left gluteal. V3 said that any skin/wound changes observed should notify the physician for appropriate treatment order and update care plan. V3 said that wound treatment should have physician order. V3 said that calcium alginate is inappropriate treatment given for R67 because she does not have increase wound drainage. On 4/26/23 at 10:15am, Reviewed R42's medical records with V3 ADON. V3 said that R42 is at moderate risk for skin impairment. R42 is on wound vac for Stage 4 pressure ulcer. Informed V3 of observation made on 4/24/23 that she has multiple layers of linen (folded linen in quarter) over the flat sheet covering the LAL mattress. R42 does not have order for LAL mattress. V3 said that R42 should have written order for LAL mattress as part for wound management and she should have only 1 flat sheet over the LAL mattress. Quick reference topical wound care provided by V3 ADON indicated that Calcium alginate is used for moderate to heavy wound drainage. On 4/27/23 at 12:12pm, V25 RN said that she did the wound treatment of R67 from 4/20 to 4/24/23 on sacral area. She said that V24 Wound Care Nurse is not available for those days that's why she did R67's wound treatment. V25 denied that she applied the calcium alginate to R67's sacral wound. She said that she applied the dermaseptin ointment to the superficial open wound on sacral area and covered with foam dressing. She said that R67 has superficial sacral open wound that has been there since she did her treatment. She said that she does not know if there is a change in R67's skin condition because she does not read the wound report done by V24 WCN. V25 said that wound treatment is administered per physician order, they cannot apply treatment without an order. V25 said that any changes in skin/wound condition should be called to physician for appropriate treatment. Facility's policy on Pressure Ulcer Prevention indicates: Purpose: To prevent and treat pressure sores/pressure injury. Guidelines: 9. Pressure reducing (foam) mattresses are used for all residents unless otherwise indicated. Specialty mattresses such as low air loss, alternating pressure, etc., may be used as determined clinically appropriate. Specialty mattresses are typically used for residents who have multiple Stage 2 wounds or one or more Stage 3 and Stage 4 wounds. Facility's policy on Pressure injury and Skin condition assessment indicates: Purpose: To establish guidelines for assessing, monitoring, and documenting the presence of skin breakdown, pressure injuries and other ulcers and assuring interventions are implemented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 6 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7. At the earliest sign of a pressure injury or other skin problem, the resident, legal representative and attending physician will be notified. The initial observation of the ulcer or skin breakdown will also be described in the nursing progress notes. 11. A wound assessment for each identified open area will be completed and will include: site location, size (length x width x depth), stage of pressure ulcer, odor, drainage, description, date, and initials of the individual performing the assessment 17. The resident's care plan will be revised as appropriate, to reflect alteration of skin integrity, approaches, and goals for care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 7 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to check a Gastrostomy tube (GT) for proper placement prior to administration of medication. This deficiency affects one (R212) of three residents in the sample of 29 reviewed for Tube feeding management. Findings include: R212 is admitted on [DATE] with diagnosis listed in part but not limited to Parkinson's disease, Gastrostomy, Collagenous colitis, Gastro-esophageal reflux disease. Physician order sheet indicated: Check tube placement before initiation of formula, medication administration and flushing tube. Care plan indicated: Tube required to assist resident in maintaining or improving nutritional status, at risk for aspiration and infection. Intervention: Enteral feed, every shift check tube placement before initiation of formula, medication administration and flushing tube. On 4/25/23 at 1:08pm, V7 RN observed for medication administration via GT. V7 did not check for GT placement. V7 took the GT syringe, removed the plunger, inserted the syringe to the GT and poured 50 ml of water by gravity, the water is draining slow, so she pushed the water with syringe plunger. She added the crushed medication mix with water then flushed it with water by gravity. On 4/25/23 at 1:23pm, Informed both V7 RN and V9 RN of above observation. Both V7 and V9 said GT placement check is done by auscultation and aspiration. Both said that GT placement must be checked prior to medication administration. V7 said that she forgot to check for placement before she administered the medication. On 4//25/23 at 4:14pm, informed V3 ADON of above concern. V3 said that they don't do the check for GT placement via auscultation. They are checking for aspiration to visually verify stomach contents prior to administration of medication. Facility's policy on Medication administration- Gastrostomy or Nasogastric tube indicates: Guidelines: The following procedures should be followed: 9. Check tube for proper placement: Gastrostomy tube: *Aspirate to visually verify stomach contents. Gastric fluid normal appears clear or yellow with mucus or may appear milky if residual remains from previous feeding. Aspirated contents must be returned to the stomach to maintain pH, fluid, and electrolyte balance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 8 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to obtain an order for oxygen administration for one of five (R76) residents reviewed for oxygen administration order in a sample of 30. The facility also failed to indicate the reason why R76 is on oxygen administration or has a care plan for it. Residents Affected - Few Findings include: On 4/25/2023 at 11:10 AM, R76 was observed in her room lying in her bed. R76 has oxygen with nasal cannula at 2% liters per minute (LPM). On 3/25/2023 at 3:20 PM, R76 was observed again lying in bed with oxygen on. On 3/25/2023 at 3:25 PM, V17 (RN) reviewed R76 physician orders with surveyor and confirmed that there was no oxygen administration order for R76. V17 said that R76 is not on oxygen administration. V17 and surveyor rounded on R76, and V17 saw that R76 is on 2 LPM oxygen via nasal cannula. V17 said that R76 should have an order for oxygen before administration. On 4/27/2023 at 3:24 PM, V2 (DON) said that there should be an order from the doctor to administer oxygen, and oxygen saturation should be checked every shift. R76 is a [AGE] year old female admitted on [DATE] with diagnosis not limited chronic kidney disease, pressure induced deep tissue damage of left buttock, and acute or chronic diastolic (congestive) heart failure. OXYGEN DELIVERY SYSTEM POLICY: It is the policy of this facility that oxygen will be delivered to the residents based upon Physician's orders utilizing the following systems. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 9 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm On 4/25/23 at 12:23 PM V14 (LPN-Licensed Practical Nurse) went into R97's room to check for the manual resuscitator. R97 is on contact transmission-based precautions for ESBL (extended-spectrum beta-lactamases) and VRE UTI (vancomycin-resistant enterococci urinary tract infection). There is signage on the door indicating the transmission-based precautions. V14 was wearing a mask and donned gloves before entering the room and checking through the bedside table for the manual resuscitator. V14 did not put on a gown before touching the items and drawers. V14 was asked why she did not put on a gown. V14 said I put on a gown when I do anything to (R97). Residents Affected - Some On 4/26/23 at 3:00 PM V21 (Infection Preventionist) said the staff should do hand hygiene and put on a gown and gloves when going into the room. Policy: Infection Precaution Guidelines Revisions: 1/10/18 Transmission-Based Precautions will be employed for known or suspected infections for which the route of transmission/prevention is known. The transmission-based categories are the following: Airborne, Droplet, Contact. 3. Contact Precautions: In addition to Standard Precautions, use Contact Precautions for residents known or suspected to be infected with microorganisms that can be easily transmitted by direct or indirect contact, such as handling environmental surfaces or resident-care items. Based on observation, interview and record review, the facility failed to implement infection control regarding hand washing when performing incontinence care. The facility failed to disinfect blood pressure equipment and a medication plastic tray in between resident usage. The facility failed to don Personal Protective Equipment (PPE) when entering a contact isolation room. These deficiencies affect five residents (R16, R67, R78, R97 and R212) in the sample of 29 reviewed for Infection control. Findings include: On 4/25/23 at 10:53am, observed R67 has a soiled adult incontinent brief with urine. Observed V6 CNA cleanse R67's buttocks/ peri-area with wet towel. After cleansing using the same gloves, she took skin protectant cream and applied to R67's buttocks/peri area. At 10:56am informed V6 of observation made that she did not remove her gloves and wash her hands after cleansing R67's buttocks /peri area before she applied skin protectant cream. V6 CNA said that she forgot to remove her gloves and wash her hands before she applied the skin protectant to buttocks/peri area. On 4/25/23 at 1:01pm, V7 RN prepared medication for R67 and placed it on a plastic medication tray. V7 entered the room and placed the medication tray on R67's bedside tray table. After administration of medication, V7 did not disinfect/sanitize the plastic medication tray. V7 placed the plastic tray on top of the medication cart. On 4/25/23 at 1:08pm, V7 RN prepared medication for R212 and placed it on the plastic medication tray. V7 entered the room and placed the medication tray on R212's bedside tray table. After administration of medication, V7 did not disinfect/sanitize the plastic medication tray. V7 placed the plastic tray on top of the medication cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 10 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 4/25/23 at 1:23pm, Informed both V7 RN and V9 RN of above observation. V7 said that she forgot to disinfect the plastic tray in between resident usage. On 4/25/23 at 4:50pm, V12 LPN checked Blood pressure (BP) on left arm of R16 and obtained a reading of 154/74mmhg. V12 did not disinfect/sanitize the BP equipment and placed it on top on medication cart. Then V12 proceeds to R78 and checked R78's BP on his left arm and obtained 107/78mmhg. After V12 was done taking the BP, informed V12 of above observation. V12 said that he forgot to disinfect the BP cuff and tubing in between resident use. On 4/25/23 at 4:14pm, informed V3 ADON of above observation. V3 said that the CNA should wash her hands and don a new pair of gloves before applying the skin protectant to buttocks/peri-area. V3 said that the nurse should disinfected/sanitized the plastic medication tray and BP equipment after using or in between resident use. On 4/26/23 at 3:06pm V21 Infection Preventionist said that CNA should remove gloves and wash hands after providing incontinence care. CNAs should don a new pair of gloves when applying skin protectant to buttocks/peri area. V21 said that the nurse should disinfect/sanitize any equipment use inside the resident room. The nurse should disinfect/sanitize the plastic medication tray and BP equipment in between resident use. Facility's policy on hand hygiene indicates: Hand hygiene means cleaning your hands by using either hand washing (washing hands with soap and water), antiseptic hand wash, or antiseptic hand rub (i.e., alcohol-based hand sanitizer including foam or gel) Guidelines: When to perform hand hygiene (either alcohol based hand sanitizer or handwashing): *After contact with blood, body fluids or excretions, mucous membranes, non-intact skin or wound dressings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 11 of 12 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 145683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Abington 3901 Glenview Road Glenview, IL 60025 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to ensure that call lights are functioning in 17 of 98 residents bathrooms (200, 225, 227, 228, 229, 231, 232, 235, 244, 308, 322, 328, 342, 346, 347, and 348) observed for bathroom call lights functioning. Residents Affected - Some Findings Include: On 4/26/2023 at 12:15 PM, R364's family member said that the call light in R364's bath room does not work. On 4/26/2023 at 1230 pm, observation was made with V16 (Certified Nurses Assistance) to check call lights functioning in the resident's bathrooms on second floor west unit. Observation was made that the following residents' bathroom call lights were not functioning (225, 227, 228, 229, 231, 235, and 237). room [ROOM NUMBER] bathroom was the only bathroom with a bell. V16 said that if he is at the nurses' station, he will not be able to hear the bell ring. V16 said that he instructs the residents' to yell out or hit the wall for assistance when they are in the bathroom and need assistance. V16 said that the call lights in the bathrooms have not been working for at least one year. On 4/25/2023 at 11:10 AM, observation was made with V18 (Director of Environmental Services), and V19 (Corporate Director of Environment) for the functioning of bathroom call lights in residents' bathrooms. 17 of 98 residents' (200, 225, 227, 228, 229, 231, 232, 235, 244, 308, 322, 328, 342, 346, 347, 348) bathroom call lights were not functioning, and only one bathroom (225) had a bell for an alternative to call light. Facility Call light Policy: Effective Date: 11-28-12 Department: All Reviewed/Approved by: IDT Revisions: 2-2-18 Purpose: To respond to resident' requests and needs in a timely and courteous manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145683 If continuation sheet Page 12 of 12