Health inspection·September 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Dear V34, I hope this letter finds you well. To ensure the safety and comfort of all our visitors and residents, we have established the following visitation guidelines: Please make an appointment for your visit 24 hours in advance by contacting V1. This helps us ensure your loved one is ready for your visit when you arrive. Some areas within our facility are limited to you. Please follow any guidance from our staff regarding where you can and cannot go. You may have access to the coffee station and sitting areas in front of the reception desk. We kindly request that all visitors behave respectfully and courteously towards our residents, staff, and other visitors. Disruptive behavior will not be tolerated. Your visit will be limited to one hour to ensure our residents and staff maintain their routine. Please cooperate with any time restrictions that may apply. We appreciate your cooperation in following these visitation guidelines. They are in place to create a safe and pleasant environment for everyone. If you have any questions or need further information, please do not hesitate to contact me. I could not believe it; I called the police for assistance. Once the police arrived, V1 came outside. I explained the whole situation to the police officer and asked for a wellbeing check on R90. V2 [Director of Nursing] brought R90 outside for me to see her. I observed a bruise on the left side of her head above the ear. I told the police, V1, and V2 I was taking R90 to the hospital for an evaluation. At that time, I noted a sign on the door that indicated IDPH was conducting a annual survey and anyone could speak to them. V1 told me that the surveyors would not speak to me and to call the hotline number, so that is what I did. I knew V1 was not telling the truth, because he never went into the building to ask the surveyor if I could speak to them, so I knew that was not true. V1 did not want me to tell everything to the state surveyor. R90 had a CT scan of the head, and it was negative, but R90 has a urinary tract infection. On 9/19/23 at 5:20 PM, V1 stated, I restricted V34's visitation guidelines on 9/12/23. V34 was asked to leave the facility due to her having an outburst. V6 and I went to speak with V34 about her behavior and speaking to staff disrespectfully, and her disruptive behavior was not allowed. During the conversation V34 began to yell, while we were standing in the hallway at V6 and I. V34 kept cutting me off while I was speaking, and V6 asked her to allow me to speak. V34 began to speak to V6 disrespectful so V6 and I walked away from V34. I went to my office and V34 went back into R90's room. I decided to restrict V34's access to the facility due to V34's outburst. I called the police for them to witness and notify V34 to leave the facility. At that time, I told V34 in the presence of the police, she will receive new visitation guidelines. V34 did not make any verbal or physical threats to me, staff or any residents. V34 was disruptive in the hallway. I did meet with V34 in the hallway to have a conversation. The conversation did not occur in my office or private area. On 9/18/23, I sent V34 her new visitation guidelines. The guidelines included, that V34 would have to notify me 24-hours in advance notice to visit, some areas of the facility were restricted, V34 could visit with R90 at the reception area near the coffee machine for one hour. On 9/18/23, I saw V34 about to enter the facility and I met her in front of the facility. I asked V34 if she checked her email to review her visitation guidelines. V34 walked away. A little while later V34 came back to the facility with the police to conduct a well being check. V34 told me that she wanted to take R90 to the emergency room for an evaluation. I explained the staff will get R90 ready and she will have to wait a few minutes. While waiting for R90, V34 asked to speak to the surveyors, I explained that she [V34] was not allowed in the building and could call the hotline phone number. Meanwhile, V2 called R90's physician, gave report to the hospital, and printed off paperwork for the emergency room and then brought R90 outside to V34. Later, I was notified that R90 was admitted to the hospital for urinary tract infection. All head scans were negative for injury in relation to the discoloration noted on R90's left side of head. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 2 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0550 Level of Harm - Minimal harm or potential for actual harm Reviewed V1 email that was sent to V34 dated 9/18/23 at 8:28 AM. Indicates V34 need to call 24 hours in advance for a visit, visitation will occur in the reception area near coffee machine, the visit will be for one hour. Policy: Documents in part: Residents Affected - Few Resident Rights -Federal and state laws guarantee certain basic rights to all residents of this facility -resident's has the right to visit and be visited by others from outside the facility FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 3 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure proper grooming for one resident (R322) in a sample of 25 residents reviewed for activities of daily living care. Residents Affected - Few Findings include: On 9/17/23 at 11:50 AM, Observed R322 sitting in a wheelchair in R322s room. Observed R322 fingernails to be long and dirty. R322 stated I want my fingernails cut. My husband (V31) asked last week. He went to the desk to ask someone. I don't know who he talked to. On 9/17/23 at 2:44 PM, V31 (R322 family member) stated, last week Wednesday I asked a nurse to cut R322's fingernails. R322 is diabetic and if R322 scratches self it could be a bad thing. I don't think they (staff) clean the fingernails. They (staff) brought a pair of clippers in here today and left them, but they did not cut the nails. I don't know if they brought them in here for me to cut R322 nails. On 9/17/23 at 2:50 PM, V32 (Licensed Practical Nurse) stated R322's fingernails are long. If residents' fingernails are too long, they can scratch and injure themselves. To prevent infection, you have to keep fingernails short if the resident lets you. CNAs (Certified Nursing Assistants) can cut fingernails but not toenails. On 9/19/23 at 1:50 PM, V2 (Director of Nursing) stated for ADL (activities of daily living) care, V2 expects staff to change residents when residents are wet to shower residents when scheduled twice a week to provide incontinent care. V2 expects staff to keep residents clean and dry, to do oral care, to comb hair, to make sure the resident is neat, clean, and dry. Staff can cut fingernails. Nurses and CNAs (Certified Nursing Assistants) can provide fingernail care, can cut fingernails. If family asks and we determine that the nails are long enough, then they should be cut by staff. If staff see that nails are dirty or too long then they should clean and cut the nails. They should be cut within the same day that the resident asks. If staff is busy, they can ask someone else to do it. If not able to do it the same day, then it should be done the next day. We cut and clean nails so nails are clean and nice. According to R322 MDS assessment, August 28, 2023, R322 requires extensive assistance for personal hygiene with one-person physical assist. Facility policy Activities of Daily Living (ADLs), Supporting, March 2018, documents in part: Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident an in accordance with the plan of care, including appropriate support and assistance with: hygiene (bathing, dressing, grooming, and oral care) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 4 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 Based on observation, interview and record review the facility failed to ensure proper use of pressure relieving devices. This failure affected one resident (R322) out of 3 reviewed for air mattress pressure in a sample of 25 residents reviewed. Residents Affected - Few Findings include: On 9/17/23 at 2:45 PM, Observed R322 lying in bed with a low-air-loss mattress. The control panel for the low air loss mattress was set to 230lbs and observed multiple fabric layers between R322 and the mattress. On 9/17/23 at 3:00 PM, V32 (Licensed Practical Nurse) stated I never touch the device (low-air-loss mattress control panel). V32 said the control panel should be set to the resident's weight and there should only be one layer between the resident and the mattress. V32 confirmed on R322's mattress there was a flat sheet, a pad, a second flat sheet folded 2 times (4 layers), R322 was wearing an adult brief and the control panel was set to 230lbs. On 9/17/23 at 3:25 PM, V2 (Director of Nursing) confirmed that R322 was on a low-air-loss mattress with a pump. The pump is set to 230lbs. V2 said the pump is set to the weight of the resident and there should be one layer between the resident and the mattress. V2 confirmed R322 mattress had a flat sheet, a pad, a draw/pull sheet (flat sheet folded two times) on it and R322 was wearing an adult brief. V2 said for a low-air-loss mattress, it's supposed to have a flat sheet only. There should not be that many layers between the resident and the mattress. With too many layers, the resident is not getting the benefit of the mattress. The mattress is to provide pressure relief to prevent pressure ulcers. On 9/19/23 at 11:08 AM, V30 (Wound Care Coordinator) stated Monday through Friday when I do the wound treatments, I check the weight of the patient versus the settings on the low-air-loss mattress machine. The setting on the machine should reflect what the resident's weight is. The nurses and CNAs (Certified Nursing Assistants) know about it. Sometimes during care, they (nurses, CNAs) accidentally hit the knob and it changes the setting. If it is not set correctly the resident is not receiving the full benefit of the mattress. The resident is on the mattress for pressure ulcer prevention and to promote healing. Only cover the low air loss mattress with a flat sheet. Only the flat sheet should be between the resident and the mattress. The flat sheet should not be folded. There should not be a pad or pull sheet on the mattress. If the flat sheet is folded twice that is 4 layers. The pad is hard. For residents with pressure ulcers, we don't use the pull sheet or the pad. The resident will not get the full benefits of the mattress. There should only be the adult brief and the flat sheet between the resident and the low air loss mattress. The setting should be set to the patient's weight. I put the weight of the resident on the machine weekly, that is what the resident weighted that week. Weights and Vitals Summary, 9/19/23, documents in part: R322 weight on 9/14/2023 is 172lbs, on 9/8/2023 is 183lbs, on 9/1/2023 is 175lbs. R322 Patient Risk Profile, printout date 9/18/23, documents in part: Braden Score, risk for acquiring pressure wounds, is 8 (Very High Risk). Preventive Interventions-Recommendations include use pressure redistribution surface if bed or chair bound. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 5 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 Wound Assessment Details Report, printout date 9/18/23, documents in part: Sacrum (V30 stated report is mislabeled with sacrum, should be coccyx and the 2 names are sometimes used interchangeably), present on admission, date identified 8/22/23, R322 re-admitted to the facility from the hospital 8/22/23. Seen at bedside for skin assessment and noted coccyx unstageable pressure ulcer wound present. Resident on turning and repositioning, air mattress. Braden score 8 (very high risk). Residents Affected - Few R322 care plan documents in part: R322 has pressure ulcer r/t Immobility with dx: fall at home and PMH: hypomagnesemia, diabetes, and hypertension. Facility policy Support Surface Guidelines, September 2013, documents in part: Any individual at risk for developing pressure ulcers should be placed on a redistribution support surface such as foam gel, static air, alternating air, or air-loss or gel when lying in bed. Follow manufacturers direction for low-air-loss mattresses. Proactive Medical Products operation manual documents in part: Protekt Aire 3000 pump and mattress system is indicated for the prevention and treatment of any and all stage pressure ulcers when used in conjunction with a comprehensive pressure ulcer management program. Operating Instructions: Patients can directly lie on the mattress or cover with a sheet and tuck loosely to increase the comfort of the patient. Determine the patient's weight and set the control knob to that weight setting on the control unit. Facility policy Pressure Ulcers/Skin Breakdown - Clinical Protocol, April 2018, documents in part: The physician will order pertinent wound treatments, including pressure reduction surfaces, wound cleansing and debridement approaches, dressings and application of topical agents. Facility provided Inservice Form, 9/17/23, topic: Inservice on air loss mattress use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 6 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow their smoking safety policy, Failed to ensure that smoking materials are not kept by resident at bedside. Failed to ensure that resident was evaluated upon admission for safety of smoking. Failure to ensure that resident was re-evaluated for their ability to smoke safely on readmission, quarterly or annual basis. These failures affected 1 resident (R69) of 5 residents reviewed for smoking in the sample of 25. Findings include: On 09/17/23 at 10:57 AM, R69 stated he keeps his cigars and lighters with him. R69 opened drawer next to the chair R69 was sitting in, reached into drawer, and showed surveyor 1/2 pack labeled Red 2.0 Premium Filtered Cigars and three disposable lighters. On 09/17/23 at 11:19 AM, V2 (Director of Nursing) observed R69's smoking equipment stored in R69's drawer including the three lighters. V2 stated, we didn't know he had those with him and he shouldn't have them in his room and he's on oxygen which is a safety concern. On 09/17/23 at 11:29 AM, surveyor viewed R69's electronic health record (EHR) and did not see a Smoking Assessment or Safe Smoking Evaluation or a Smoking Care plan. On 09/17/23 at 4:05 PM, V9 (Director of Social Services) stated if a resident smokes, then a Smoking Assessment is completed upon admission, readmission, quarterly, annually and any resident who smokes should also have a smoking care plan. V9 stated that there is never a situation wherein a resident is allowed to keep their smoking supplies in their room because this is for that resident and the rest of the resident's safety. V9 stated if a resident who has the lighter is on oxygen, they could blow up the whole building. V9 stated R69 should not have his smoking equipment including no lighters in his room and that the nurse should be holding R69's smoking equipment. Surveyor asked V9 about R69's Safe Smoking Assessment signed on 09/17/23 and V9 stated V9 opened it on 03/06/23 and stated there are no quarterly re-assessments from 06/2023 or 09/2023 when quarterly MDS assessments were completed. V9 stated, I can look into it and I don't remember what I did. V9 stated that R69's smoking care plan was added today. On 09/19/23 at 12:39 PM, V9 (Social Service Director) stated R69 is allowed to smoke with supervision, R69 does not have independent smoking privileges. R69 was initially admitted to the facility on [DATE]. R69's diagnosis included but not limited to Chronic Obstructive Pulmonary Disease (COPD), Chronic Diastolic (Congestive) Heart Failure, Nicotine Dependence, Obstructive Adult Sleep Apnea, Dependence on Supplemental Oxygen. R69's Order Summary Report dated 09/17/23 documents in part 3.5-liter oxygen with nasal cannula continuous with start date 09/27/22. R69's Care Plans as of 09/17/23, 11:29AM which did not have a smoking care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 7 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few R69's Smoking Safety Screen signed on 09/17/23 by V9 documents in part facility needs to store resident's lighter and cigarettes and that R69 needs supervision to smoke. R69's MDS (Minimum Data Set) dated 06/02/23 indicates intact cognition with BIMS (Brief Interview for Mental Status) 15/15, supervision required with bed mobility, transfer, walking, locomotion, dressing, toilet use and personal hygiene. Facility policy titled, Smoking Policy-Residents dated 07/2017 documents in part the facility shall establish and maintain safe resident smoking practices, the resident will be evaluated on admission and the resident's ability to smoke safely will be re-evaluated quarterly, and a resident without independent smoking privileges may not have or keep any smoking articles, including cigarettes, tobacco, etc. Facility Assessment documents in part residents who may pose a hazard to themselves and others with smoking materials may have their cigarettes, lighters and matches removed from them and kept in a designated location for safety. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 8 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to follow a physician order for fluid restrictions. This failure affected 2 residents (R12, R43) out of 5 reviewed for nutrition care in a sample of 25. Residents Affected - Few Findings include: On 09/17/23 at 12:03 PM, observed water pitcher in R43's room on top of R43's chest of drawers. R43 denies being on a fluid restriction. On 09/17/23 at 12:58 PM, observed R43's meal ticket at lunch. R43's meal ticket did not document that R43 is on a fluid restriction or restrict fluids in any way. R43 received 6-8 ounces hot tea on lunch tray from disposable cup. On 09/17/23 at 12:10 PM, observed the following items on R12's bedside table next to R12's bed: empty water pitcher, one disposable cup 50% filled with apple juice, one disposable cup 75% filled with coffee, small plastic cup 25% filled with water, and empty small plastic cup. Observed sign on R12's wall above R12's bed that documented R12 is on a 1.2-liter Fluid Restriction. On 09/17/23 at 12:48 PM, observed R12 receive lunch tray. R12's meal ticket did not document that R12 is on a fluid restriction or restrict fluids in any way. 6 ounces hot tea added to tray by Certified Nursing Assistant (CNA). Observed R12 drinking soup brought in by R12's wife. On 09/17/23 at 12:12 PM, V19 (Licensed Practical Nurse) observed empty water pitcher and cups on R12's bedside table. V19 stated R12 is on a fluid restriction because of being on dialysis to prevent fluid overload and that R12 should not have a water pitcher or extra fluids in his room at bedside. V19 stated, I will remove them now. V19 stated R12 is on 1.2-liter fluid restriction and the allotment of fluid is divided up between nursing and dietary. V19 stated the water pitcher is not calculated into the fluid restriction which is why R12 should not have it in his room. On 09/18/23 at 12:53 PM, V5 (Food Service Director) stated if a resident is on a fluid restriction it would be specified on the meal ticket and include the amount of fluid allowed at every meal so that the kitchen staff would know what foods need to be calculated as part of the fluid restriction and the Certified Nursing Assistants on the unit would know how many ounces of fluid they can give a resident for beverages at each meal. V5 stated that having the fluid restriction information on the meal ticket is the way the kitchen communicates the physician diet order to the staff upstairs serving the resident their tray. V5 stated the meal ticket would be the first point of contact to alert the nursing staff about the fluid restriction, but they could also check the Electronic Health Record (EHR) or ask the nurse for this information. On 09/18/23 at 1:13 PM, V5 viewed R12 and R43's menu profile and printed R12 and R34's meal tickets from the kitchen computer to provide to the surveyor. V5 stated R12 and R43 are not on fluid restrictions but are on therapeutic diets. V5 stated R43 is limited to 4 oz, milk per day related to therapeutic diet restrictions, not because of a fluid restriction. On 09/18/23 at 1:43 PM, V10 (Registered Dietitian) stated if a resident is on a fluid restriction, then it should be on ticket. V10 stated that unless information about a fluid restriction is listed on the meal ticket the kitchen staff placing food on the trays and the CNAs serving the beverages (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 9 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wouldn't know to restrict fluids and the allowance would not be met accurately. V10 stated that residents on fluid restriction should not have water pitchers in their room and that all fluids, from water to juice to coffee to ice cream to gelatin to soup must be calculated as part of the fluid restriction. V10 stated R43 is on a 1-liter fluid restriction (500 milliliters (ml) nursing, 500 ml dietary) and R12 is on a 1.2-liter fluid restriction (600 ml nursing, 600 ml dietary) to prevent the accumulation of fluid in their body because they are on dialysis. On 09/18/23 at 12:35 PM, V11 (Dialysis Registered Nurse) stated it is important for dialysis residents on fluid restrictions to follow them because removing too much fluid can cause low blood pressure, muscle cramping, and could cause a resident to pass out. V11 stated if a resident does not follow the fluid restriction, then they may need to add another treatment or extend their treatment time. V11 stated R43 is on a fluid restriction and that sometimes R43 drinks too much, and his blood pressure runs low which is why it is important for him to follow his fluid restriction. V11 stated a few months ago R43's dialysis run time had to be extend three hours to 3.25 hours to remove more fluid without causing R43's blood pressure to drop. On 09/19/23 at 12:14 PM, observed water pitcher on R43's chest of drawers in R43's room. V20 (Certified Nursing Assistant) stated R43 is not on a specific fluid restriction but V20 tries not to give R43 too much because R43 is on dialysis. On 09/19/23 at 12:29 PM, V5 stated that as of this morning all the residents with orders for fluid restriction have their fluid restriction listed on their meal tickets. V5 stated it was not done before today because the kitchen was not notified about those residents who had physician orders for fluid restrictions. Upon request V5 printed new copy of R12 and R43's meal tickets dated 09/19/23. R12's diagnosis included but not limited to End Stage Renal Disease, Dependence on Renal Dialysis, Heart Failure, Hypotension, Dementia. R12's Order Summary Report dated 09/17/23 documents in part 1.2 liter per day fluid restriction 200 cc AM shift, 200 cc PM shift, 200 cc Night shift. Total for nursing 600 cc. R12's Nursing Care Plan dated 01/23/23 documents in part R12 has order for 1.2 liter per day dx: Congestive Heart Failure, End Stage Renal Disease and 600 cc total for nursing. R12's Nutrition Care Plan dated 01/15/23 documents in part R12 is on a fluid restriction 1200 milliliters per day, encourage resident to comply with fluid restriction and no water pitcher on bedside. R12's MDS (Minimum Data Set) dated 08/07/23 indicates moderately impaired cognition with BIMS (Brief Interview for Mental Status) 12/15, supervision required with eating, extensive assistance required with bed mobility, transfer, locomotion, dressing, toilet use, and personal hygiene. R12 on dialysis. R12's Nutrition/Dietary Note dated 09/12/23, 17:30 documents in part 1.2-liter fluid restriction per day (nursing 600 cc, dietary 600 cc). R43's diagnosis included but not limited to End Stage Renal Disease, Dependence on Renal Dialysis, Chronic Diastolic (Congestive) Heart Failure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 10 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0692 Level of Harm - Minimal harm or potential for actual harm R43's Order Summary Report dated 09/19/23 documents in part fluid restriction total 1000 milliliter (ml) per 24 hours. Nursing 500 ml, Dietary 500 ml. Notify dietary of meal liquid amounts order date 05/12/23. R43's Nutrition Care Plan dated 11/22/22 documents in part R43 is on a 1000 ml fluid restriction, encourage resident to follow fluid restriction and no water pitcher on bedside. Residents Affected - Few R43's MDS (Minimum Data Set) dated 08/08/23 indicates intact cognition with BIMS (Brief Interview for Mental Status) 14/15, limited assistance required with bed mobility, transfer, locomotion, eating, toilet use, and personal hygiene. R43 on dialysis. R43's Nutrition/Dietary Note dated 09/17/23, 23:45 documents in part fluid restriction: 1000 milliliters (mls) per 24 hours. Nursing 500 mls/day. Dietary 500 mls/day. R12 and R43's Lunch Meal Tickets dated 09/18/23 do not indicate R12 and R43 are on fluid restrictions. R12 and R43's Lunch meal Tickets dated 09/19/23 indicate R12 and R43 are on fluid restrictions as part of their diet order after being adjusted by V5. Facility policy titled, Physician Orders dated 02/2019 documents in part all orders including medications, treatments, labs, and ancillary orders must be ordered by a licensed physician and that all orders will be processed and carried out by nursing service personnel as soon as the order has been received. Kitchen policy titled, Fluid Restriction dated 2017 documents in part fluids are restricted as ordered in the medical record, fluids are anything that is liquid at room temperature or melts at room temperature such as water, tea, coffee, milk, soft drinks, juice, popsicles, ice cream, sherbet, gelatin, and soup, and the tray care specifies the fluids provided by the food & nutrition services. Kitchen policy titled, Distribution of Fluid Restrictions dated 2017 document in part when a strict total volume restriction is ordered, the allotted volume will need to be divided between nursing and food & nutrition services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 11 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 Based on observation, interview and record review the facility failed to date and change oxygen equipment every 7 days per facility policy and ensure oxygen cannula tubing is placed in a bag when not in use. These failures apply to 1 resident (R69) out of 5 reviewed for oxygen therapy in a sample of 25. Residents Affected - Few Findings include: On 09/17/23 at 10:55 AM, observed R69 sitting in chair at bedside with oxygen concentrator behind him and oxygen tubing attached to the concentrator with oxygen cannula tubing laying on the floor near R69's feet and garbage can. Oxygen concentrator was not in use. On 09/17/23 at 11:06 AM, R69 stated that he uses oxygen everyday and that the oxygen tubing is not changed on a regular basis and was never given any type of container or storage bag to put the nasal cannula tubing in when not in use. R69 stated he drapes the oxygen tubing on top of the oxygen concentrator when oxygen is not in use. R69 stated the oxygen tubing falls on the floor sometimes and that no one does anything about it. On 09/17/23 at 11:09 AM, observed piece of tape wrapped around the oxygen tubing dated 08/07/23. On 09/17/23 at 11:10 AM, V20 (Certified Nursing Assistant) came into R69's room and looked at the oxygen tubing and stated that the date on the tubing was labeled 08/07/23. On 09/17/23 at 11:13 AM, V2 (Director of Nursing) stated that oxygen tubing is changed weekly on Sunday and as needed. V2 stated when the oxygen cannula tubing is not in use it should be stored in a clean plastic bag. V2 observed R69's oxygen cannula tubing on the floor. V2 stated the oxygen tubing should not be on the floor because the floor is unclean and potentially could make a resident sick. On 09/17/23 at 11:16 AM, V2 observed oxygen cannula tubing and V2 read out loud the date labeled on the tubing as 08/07/23. V2 stated the oxygen tubing should have been changed before today. R69's diagnosis included but not limited to Chronic Obstructive Pulmonary Disease (COPD), Chronic Diastolic (Congestive) Heart Failure, Nicotine Dependence, Obstructive Adult Sleep Apnea, Dependence on Supplemental Oxygen. R69's Order Summary Report dated 09/17/23 documents in part 3.5-liter oxygen with nasal cannula continuous with start date 09/27/22. R69's Care Plan dated 02/06/23 documents in part R69 has oxygen therapy related to Congestive Heart Failure (CHF), Obstructive Sleep Apnea (OSA) and COPD. R69's MDS (Minimum Data Set) dated 06/02/23 indicates intact cognition with BIMS (Brief Interview for Mental Status) 15/15, supervision required with bed mobility, transfer, walking, locomotion, dressing, toilet use and personal hygiene. Facility policy titled, Departmental (Respiratory Therapy) - Prevention of Infection dated 11/2011 documents in part, the purpose of this procedure is to guide prevention of infection associated with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 12 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 Level of Harm - Minimal harm or potential for actual harm respiratory therapy, tasks, and equipment. Steps in the procedure included but not limited to change the oxygen cannula and tubing every seven days or as needed, keep the oxygen cannulae and tubing in a plastic bag when not in use. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 13 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observations, interviews, and record review the facility failed to maintain accurate documentation for 1 resident (R275) of 11 residents who received controlled substances from first floor west unit cart. Residents Affected - Few Findings included: On 9/18/23, at 10:56 AM, during the narcotic reconciliation count with V16 [Registered Nurse], on the west unit cart observed R275's Dronabinol 2.5mg [milligram] take 1 capsule by mouth twice daily dated 9/6/23, with 11 capsules in the card. The count of R275's-controlled substances proof of use form, documents [12] capsules remaining in card. On 9/18/23 V16 stated, I forgot to sign out R275's Dronabinol 2.5mg capsule. I administered R275 the medication this morning around 9 AM. I know to sign out the medication, once I administer the medication, I just forgot to do it. On 9/19/23, V2 [Director of Nursing] stated, My expectation for medication administration is , after the nurse administers medication, they are required to immediately sign out that medication on the appropriate documents. Regarding narcotics, the medication must be signed out on the electronic medication administration record and the narcotic sheet to keep an accurate accountability of the narcotic medication. R275's clinical record documents in part: Physician order dated 9/6/23 - Dronabinol 2.5mg [milligram] take 1 capsule by mouth twice daily for anorexia. Policy documents in part: Controlled Substance dated (12/2017) -The facility shall comply with all laws, regulations and other requirements related to handling, storage, disposal, and documentation of schedule II and other controlled substance Medication Administration dated (12/2022) -The individual administering the medication must initial the residents electronic medication administration record after giving each medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 14 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the failed to follow their policy and obtain consent for a psychotropic medication for one resident (R63) of five residents reviewed for consents in a sample of 25 residents. Findings include: R63 is an [AGE] year-old individual admitted to the facility on [DATE]. R63's BIMS (Brief Interview for Mental Status), dated 07/02/2023 documents his BIMS as 11/15, indicating R63 has moderately impaired cognition. R63's medical diagnosis includes but not limited to: vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, major depressive disorder, recurrent, unspecified, insomnia, unspecified. On 09/19/2023 at 9:36 am, R63 said when his medication was increased, he was not informed. R63 said he was asked to sign a paper yesterday, 09/18/2023 for his medication. On 09/18/2023 at 1:37 pm, V2 (Director of Nursing-DON) said that a psychotropic consent from the resident or resident representative is needed before a psychotronic medication is started or increased, to make sure the resident okay with taking the medication. V2 said he cannot find the consent for R63 after R63's medication: Sertraline HCl was increased on 8/1/2023, from 50mg to 75mg. V2 said If it's not documented, it's not done. V2 said when a psychotropic medication is increased, the resident should give a psychotropic consent, and the signed consent should be placed in resident's medical record. V2 said We will ask R63 to sign his consent for psychotropic medication that was increased, after you (Surveyor) brought it to our attention. V2 later stated that he has spoken to R63 and he (R63) has signed the psychotropic consent today, 09/18/2023. On 09/19/2023 at 11:45 am, V2 said in 2021 when R63 was first admitted to the facility, R63 had requested for the facility to call his family member, who is also (POA) Power of Attorney- for consent to his medication, however, R63 now signs for his medications. On 09/19/2023 at 11:55 am, call was placed to R63's family member, V29 (R63's Power of Attorney-POA). V29 was not able to be reached by phone. R63's Electronic Medication Administration Record (eMAR) documents R63 received/receives medication (Sertraline HCl, 75 mg) daily, from 8/1/2023 to current. Facility policy titled Psychotropic Medications, dated 7/2021 documents: -If an order is obtained for a psychotropic medication, the resident, family or POA (Power of Attorney) must be informed of the risks and benefits of the medication. The facility must obtain an informed consent. This documentation will be placed in the medical record in the designated area. R63's Physician Order sheet, documents R63's medication was increased on 8/1/2023 and documents: Sertraline HCl Oral Tablet 25 MG (Sertraline HCl)-Give 3 tablets by mouth at bedtime for mood. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 15 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0758 R63's consent for Sertraline HCl, 50mg was signed electronically on 01/04/2022. 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: 145741 If continuation sheet Page 16 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0761 Level of Harm - Minimal harm or potential for actual harm Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interviews, and record review, the facility failed to label open insulin vials for Residents Affected - Few 2 residents (R276, R323) reviewed for medication labels on 1 of 6 medication carts. Findings include: On 9/18/22 at 11:00 AM, V16 [Registered Nurse] and surveyor conducted inventory of the first-floor west unit medication cart observed the following: - R276's open vial of Humulin N Insulin 100units/ml, without an open date or expiration date. - R323's open vial of Humalog insulin 100units/ml, without an open date or expiration date. R276's physician order dated 9/13/23 Humulin N Insulin 100unit/ml [Lispro]. R323's physician order dated 9/14/23, Humalog insulin 100units/ml [Insulin Lispro] Inject per slide scale. On 9/18/23 at 11:08 AM, V16 stated, I administered R276's insulin to her this morning. I did not notice there was not a date on the insulin. When the insulin is opened, the nurse should place an open date and expiration date. On 9/19/23 at 5:18 PM, [Director of Nursing] stated, All insulins vials, and pens are to be labeled at the time they are open. The label should include the date opened and discontinue date. If the insulins are not labeled, it can potentially cause adverse reactions, and ineffectiveness of the medication that can harm a resident. Policy Documents in part: Administration of Medication dated (12/2022) -The expiration beyond use date on the medication label must be checked prior to administration. When opening a multi-dose container, the date opened shall be recorded on the container. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 17 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record review, the facility failed to properly clean and sanitize service and dishware. This deficiency has the potential to affect 120 residents receiving food from the kitchen. Findings include: On 09/17/2023 at 9:34 am, during kitchen observation, V4 (Dish Washer) was observed putting dishes in the dishwasher. V3 (Dietary Aide) said V4 does not speak English surveyor asked V3 how the dishwasher temperatures are tested. V3 said a test strip is put in the dishwasher and a cycle is run, and after the washing cycle is complete, the temperature test strip should turn black to indicate the dishwasher washed/sanitized at the right temperature. V4 was asked to test the dishwasher temperatures. V4 put test strip on a plate and ran the dishwasher. Test strip came out white. V4 said the test strip should have turned black to indicate the dishwasher temperatures are on the right temperature. V4 tested the dishwasher 4 times and each time the test strips remained white. On 09/17/2023 at 10:20 am, V5 (Food Service Director) said he would test the dishwasher. V5 put a temperature test strip on a plate and ran the dishwasher. After the wash cycle, the temperature test strip come out white. V5 said the test strip should have turned black to indicate the dishwasher washing temperature is at the correct temperature. V5 said the washing water temperature should be at least 180 degrees F, and the rinse should be at least 160 degrees. V5 said if the washing temperature water does not reach 180/160 degrees, the dishes will not be washed/sanitized properly. V5 said if the dishes are not washed properly, the dishes can get cross contaminated, and bacteria can spread on the dishes and cause food borne illness to the residents. V5 said the temperatures are logged in every day. V5 and surveyor reviewed the Dish Washing Machine temperature log. The last temperature log was completed on 9/14/2023, and the test strip was observed to be white. V5 said the machine should be tested every day to make sure the dishes are washing at the right temperature. On 09/17/2023 at 12:27 pm, V7 (Outside vendor) was observed working on the dishwasher. V7 told V5 that the dish washer washing temperature was at 140 degrees F, and it should be at least 160 degrees F to wash the dishes properly. Dish Washing Machine temperature log documented the last temperature log was documented on 9/14/2023, and the test strip was observed to be white. Facility policy dated May 20, 2023, titled: Machine Washing and Sanitizing (High Temperature Dishwashing Machine) documents: -Dishwashing machines using hot water for sanitizing may be used if the temperature of the wash water is no less than that specified by the manufacturer, which may vary from 150 degrees F to 165 degrees F. -The paper thermometer turns color when it registers 160 degrees F which sanitizes the plate, tableware, utensils etc. (160 degrees F on the dish or utensil surface reflects 180 degrees F at the manifold where the temperature of the dishwashing machine final rinse is measured. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 18 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure resident personal refrigerator temperatures were maintained at 41 degrees Fahrenheit, failed to clean personal refrigerators regularly to maintain a safe and sanitary environment for food storage, failed to date/label food items, and failed to Discard expired food items after 6 days for 4 residents (R72, R73 R112, R67) reviewed for personal refrigerators in a sample of 25. Residents Affected - Some Findings included: On 9/17/23 at 10:35 AM, surveyor and V15 [Maintenance Director] made rounds and observed R72, R73, R112, and R67's personal refrigerators. The freezer sections were with thick layer of white ice covering the inside, outside and underneath the freezer sections. No thermometers inside the refrigerators, and personal food containers without dates or labels. The food containers were consisting of meat, salads, and cultural food items. On 9/17/23 at 11:05 AM, V15 stated, All the residents' personal refrigerators should have a thermometer inside, to make sure the refrigerator is at least 41 degrees Fahrenheit. I do not know why all the personal refrigerators needs a thermometer. I do not know what can happen to a resident if they eat expired food. I check the personal refrigerator temperatures a couple times per week. I do not know what happened to the thermometers that was inside all the personal refrigerators. On 9/18/23 at 12:47 PM, V17 [Director of Housekeeping] stated, I am responsible for monitoring residents' s personal refrigerator temperatures. I started a few months ago. The logs are from two-to-three months ago. Housekeepers are to clean the inside and wiping down the outside of the refrigerators. The nurse and CNAs are responsible for labeling and dates of food items. Housekeeping staff do not check labels or dates only monitor refrigerator temperatures. On 9/19/23 at 4:50 PM, V1 [Administrator] stated, All resident refrigerators are monitored everyday by housekeeping and certified nursing assistants [CNA]. All food items should have a date on them with a label if the food came from the kitchen and CNAs places a date on the brought in food. After six days the food is discarded by the housekeeping staff, nursing staff or the manager assigned to that room. Housekeeping staff monitors the temperature daily and keep the outside and inside of the refrigerator clean. If a resident eats food that is older than six days, could potentially make the resident sick. I do not have a year of temperatures, but I assigned the house keeping manager, two weeks ago to monitor all personal refrigerator temps daily and record in the temperature log. Policy documents in part: Foods Brought by Family/Visitors dated (10/2017) -Food brought into the facility will be labeled - Nursing staff will discard foods before or on the use by date Food Brought in by family or visitors/personal refrigerators -perishable foods are discarded on the sixth day after preparation/opening or the expiration date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 19 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0813 -personal refrigerators temperatures are maintained at 41 degrees Fahrenheit Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 20 of 21 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 145741 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel of Glenview,the 1700 East Lake Avenue 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observations, interview and record review, the facility failed to follow their policy on garbage disposal by failing to close lids of the dumpster. This deficiency has the potential to affect all 122 residents residing in the facility. Residents Affected - Many Findings include: On 9/18/2023 at 11:36 am, V5 (Food Service Director) and surveyor went outside to observe the dumpster. The dumpster was observed open on both ends with garbage visible from the outside. V5 said the dumpster covers/lids should be pulled closed after garbage disposal, for infection control, to prevent rodents/rats from getting into the dumpster, and to prevent loose garbage from flying out of the dumpster, which can then spread disease and germs, and spreading germs. On 9/19/2023 at 10:59 am, V17 (Housekeeping/Laundry director) said garbage is collected from the soiled room designated for garbage by the housekeepers, then taken to the dumpster. V17 said the dumpster should be closed so that animals and rain do not get inside the dumpster, as an infection control prevention measure. V17 further stated It is a form of infection control when the dumpsters are closed. the dumpster needs to be covered for infection control. V17 further stated I have never been given a policy on dumpster/garbage refuse policy. I just know in my head that garbage should be covered when being transported, and after it is put in the dumpster, it should be covered for infection control. Facility policy titled Safe Food Handling-Dumpster, dated 2023 documents: -All food will be handled safely and disposed of in a safe manner. The dumpster will be securely covered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 21 of 21