Inspection·December 4, 2023

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medication, we talked to the doctor this morning and got an order to keep the medications at bedside Initially she was ok with us giving her medications, then she started having this issue. I would have to double check how long she has had her medications in her room. Her medications are delivered to the facility. She won't let us touch them. The facility's policy and procedure titled Self-Administration of Medications showed, Policy: Resident have the right to self-administer medications if the interdisciplinary team has determined that it is clinically appropriate and safe for the resident to do so. Procedure: 1. As part of the overall evaluation, the staff and practitioner will assess each resident's mental and physical abilities to determine whether self-administering medications is clinically appropriate for the resident 13. The staff and practitioner will periodically (for example, during quarterly MDS reviews) reevaluate a resident's ability to continue to self-administer medications. Event ID: Facility ID: 145741 If continuation sheet Page 2 of 7 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 12/04/2023 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to identify behaviors, failed to notify the psychiatric nurse practitioner of behaviors, and failed to provide appropriate behavioral health services to a resident with multiple mental health diagnoses for 1 of 3 residents (R1) reviewed for behavioral health services. This failure has resulted in R1 refusing to allow facility staff in her room, covering areas of the walls in her room with aluminum foil, towels, sheets, and covering the ceiling vent with plastic wrap. The findings include: R1's face sheet showed she was admitted to the facility on [DATE] with diagnoses to include major depressive disorder, menopausal and perimenopausal disorder, anxiety disorder, insomnia, paranoid personality disorder, delusional disorders, and unspecified psychosis not due to a substance or known physiological condition. R1's facility assessment dated [DATE] showed no cognitive deficits and R1 to be independent in most cares. The same facility assessment showed R1 to have no behavioral symptoms including hallucinations or delusions. R1's care plan initiated on 3/2/2021 showed, I express maladaptive behavioral symptoms related to: A depressive disorder - attention seeking behavior. The problems and symptoms that I have are manifested by: Reporting/discussing a medication discrepancy that was already resolved in 2020. Prefacing manipulative statements by playing the right card (misinterpreting right issues for personal gain) . I will demonstrate an improvement or reduction in distressing behavioral symptoms in response to behavior management interventions by next review . Explain to me the desired behavior and outcome. Remind me that I am expected to behave respectfully and with maturity. Review rules and behavior expectations with me to help improve my judgement and self-control. R1's care plan last revised 6/16/2021 showed, I may voice false allegations of mistreatment or exploitation by caregivers. This behavior appears to be related to: Feelings of paranoia, fear, powerlessness, helplessness and loss of control. Difficulty controlling anger and depression . R1's care plan last revised 4/29/2021 showed, I display behavioral symptoms related to: Personally feeling displaced and having difficult time adjusting to life in the long term care facility. I manifest these behavioral symptoms through: Socially inappropriate and/or maladaptive disruptive behavior. Manipulative behavior. A disturbed sense of entitlement . Review the behavioral symptoms that I display to determine what strengths or abilities and needs are communicated via the behavior . R1's care plan last revised 10/26/21 showed, I have a history of aggressive, inappropriate, attention-seeking and/or maladaptive behavior. My history includes: Conflicts with others. Threatening behavior. Disrespectful, insulting, demeaning behavior . If I become preoccupied by hallucinations, and/or delusional thoughts, do not attempt to talk me out of the delusions. Simply remind me that I am in a safe and secure environment in the facility. Acknowledge to me that it must be difficult for me to be able to function well while having such disturbing thoughts . R1's care plan last revised 12/29/21 showed, I demonstrate behavioral distress related to: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 3 of 7 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 12/04/2023 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ineffective coping mechanisms. Feeling powerless, out of control. Being challenged by mental illness. The symptoms I have are manifested by: Verbally aggressive behavior when agitated. Use of profanity, demeaning statements, verbal threats and yelling at others . R1's care plan last revised 1/20/23 showed, I display disruptive behavioral symptoms related to persistent mental illness (Paranoid Personality Disorder, Delusional Disorders, Anxiety Disorder, and Major Depressive Disorder). I manifest these behavioral symptoms through visual hallucinations and paranoid/persecutory delusions (i.e.: false belief that I am being stalked, others are deliberately destroying my property, I am a victim of theft or I am being conspired against, there are people outside my window in white sheets, that staff are staring at me and harassing me). Despite reassurances and/or factual information providing otherwise. I have a history of calling authorities via 911 or reporting desire to contact FBI and/or political offices related to my delusions/psychosis (i.e.: to report people in cloaks/sheets in my room, people lighting fireworks outside my bedroom window, seeing footsteps from malevolent people outside . Administer my psychoactive medication as ordered by my physician. Record my behavioral symptoms including verbal/physical aggression, inappropriate behavior and side effects such as tardive dyskinesia and anticholinergic effects . If I become preoccupied by hallucinations, and/or delusional thoughts, do not attempt to talk me out of the delusions. Simply remind me that I am in a safe and secure environment in the facility . Provide me with a psychiatric and psychological evaluation, supportive mental health intervention and treatment recommendations . R1's care plan last revised 1/5/22 showed, I have displayed symptoms of anger related to: Concern, worry regarding medical symptoms and condition. Psychotic symptoms (i.e.: Hallucinations, delusions, especially paranoid delusions. Personality disorder symptoms (i.e.: viewing people/objects as all good or all bad, anger, splitting, confabulation, manipulation, inability to allow myself to be satisfied.) The problem/need that I have is manifested by: Poor listening skills (often becoming angry, defensive, oppositional when assistance and suggestions are provided). Verbal expressions of distress. Persistent insecurity, apprehension, worry . R1's care plan last revised 2/28/22 showed, In spite of repeated counseling attempts, I continue to refuse recommended interventions promoting enhanced mental health and physical well-being. It appears that my resistance and refusals to these interventions are secondary to impaired judgment and insight due to psychiatric illness and rigid personality traits. These symptoms are manifested by refusing to engage in recommended mental health treatment (psychological counseling) . R1's care plan last revised 5/27/2022 showed, DELUSIONAL IDEATIONS: I demonstrate delusional ideations due to persistent mental illness (Paranoid Personality Disorder, Unspecified Psychosis, Delusional Disorders, Anxiety Disorder, and Major Depressive Disorder). I lack adequate reasoning and express bizarre delusional thoughts. The symptoms that I have are manifested by strongly identifying with my past role as an RN and self-diagnosis based on my delusional beliefs. I have used non-prescribed products to treat a rash/itching that I believe was caused from radiation being pumped into my room. I dismiss medically based or prescribed treatments, as I do not trust healthcare professionals and express unfounded belief that I am a victim of malintent. Encourage the resident to share thoughts with a social worker and to engage in listening to the social worker who will help measure/evaluate paranoid thoughts . R1's care plan last revised 1/20/23 showed, DISRUPTIVE BEHAVIOR: I display disruptive behavioral symptoms related to persistent mental illness (Paranoid Personality Disorder, Unspecified Psychosis, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 4 of 7 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 12/04/2023 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 0740 Level of Harm - Minimal harm or potential for actual harm Delusional Disorders, Anxiety Disorder, and Major Depressive Disorder). I have a h/o calling authorities via 911 to make false reports rt: delusional beliefs (ie: my food has been tampered with and/or staff are intentionally not distributing my food tray to my liking). I refuse to accept facts that contradict my allegations and hold firm to these fixed beliefs .Provide me with a psychiatric and psychological evaluation, supportive mental Residents Affected - Few health intervention and treatment recommendations . On 12/3/23 at 12:52 PM, this surveyor knocked on R1's door to her room. R1 opened the door a small bit and asked for a moment to finish up a telephone conversation. R1 then reopened the door and allowed this surveyor in her room. R1's sofa was just inside the room on the right hand side. The sofa was covered in sheets. All four walls had areas where aluminum foil was taped to the walls, towels were taped to the walls, tape was placed in areas on each wall, sheets were covering the entire surface of the windows, the television had a towel covering it, the door handle had been taped up completely, and upon entering the room R1 pushed a towel across the gap under the bottom of the door. R1 had shoes in clear plastic bag, a lamp in a clear plastic bag, and there was plastic wrap (like one would use in kitchen) taped on the ceiling covering the vent. R1 had a storage trunk sitting next to her bed covered with plastic and there was a roll of aluminum foil sitting on the trunk. R1 said she has the foil, the towels, and the tape, and the plastic to keep the chemicals from coming into the room and running down the walls. On 12/3/23 at 12:52 PM, R1 pointed to this surveyors face mask and goggles and asked what was going on with wearing these. R1 said, They say they have COVID here now but the testing is being done in this facility not in a lab. They are getting results very fast. I came in with COVID then had it again in the later part of 2022. At that time I was sent to my room by two people who were here working overnight. When I got to my room I felt a blast of chemicals and it all hit me quickly, pain in my arms, and I felt terrible. Then all of a sudden everyone on this hall had COVID. There was something with those two people. There was stuff running down the walls in here. Medications were being tampered with. I had some Prevacid capsules that were small and then longer. I was sick and in pain. I questioned how the Prevacid kept changing. [The facility pharmacy] was handling the medications. I decided I didn't have to get it from them and insurance started sending them to me instead of the facility. I got them. I was taking them all appropriately and I got to have them in my room. Then they came in and said I couldn't have them in the room anymore The stress here is overwhelming. It damages your physical and mental health. They beat the hell out of the guy across the hall. A man from [NAME] went in there. That man went to the hospital and when he came back he wouldn't speak. They got him all mixed up. They can't do this to me because I'm too alert. It is best that I leave here. I've been working with people at [local community program] to get me out of here. I don't like those people. They send different people here every 6-7 months. They were helping me with housing. The DON decreased my lorazepam from 1 mg to 0.5 mg. Its odd because a couple days before that I was having increased depression and anxiety. Then he decreased my Ativan. I was in nursing for 40 plus years, why would you decrease a medication when someone has excessive depression? They need someone to come out here and look at their personnel charts to see who these people are. Administrator doesn't have a license. I know they need a license . I have a PRN (as needed) order for lorazepam I take at night. I know its addicting so I try not to take it but there is a lot of screaming and yelling here at night. I try to avoid but under this stress, anxiety gets high. Someone put another resident up to assaulting me. How can they put psych patients in with other medical patients? . I leave the room to get sheets, towels, and my meals but I come right back because if you leave your room they will come in and do stuff to your room. I think they are afraid to let me go because I know too much . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 5 of 7 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 12/04/2023 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/3/23 at 12:21 PM, V14 (Local Community Programs Social Service Worker/Case Manager) said their program has been working towards getting R1 housing but their team has concerns with her current state of mental health. V14 said V13 RN (Registered Nurse for the Local Community Program) had seen R1 barricaded in her room and laying on the floor with tin foil on her head. V14 said they requested that the facility try and petition R1 for mental health services due to her paranoia, delusions, and the tin foil. The facility said they have not seen these behaviors and have no reason to petition her for mental health services. On 12/4/23 at 11:11 AM, V13 (RN working for the Local Community Program) said, I went into the facility to get a baseline on how [R1] was doing and talk with the staff to see what all she had going on. I was evaluating her to see if she would appropriate to transfer into the community. [V14] had told me about [R1's] behaviors beforehand so we were evaluating to see just how appropriate she would be . When I went in to visit she didn't respond when I knocked on the door, I tried to open the door and the door was barricaded with her couch. The facility said that is very normal for her. I went and got the nurse and I pushed the door open a little bit and we found her in a very deep sleep. She had tin foil wrapped around her head. The facility staff said that was very normal for her. I spoke to a manager type person who I don't remember their name. I asked them if they think she is appropriate to be living in the community by herself. They said yes and that this is her normal behavior. They said it's a response to her being in a nursing home. On 12/3/23 at 3:19 PM, V9 (RN) said she was familiar with R1. V9 said R1 is alert and oriented x 3, but can be forgetful at times. V9 said R1 is very particular and can become very vocal with the staff if they don't respect her wishes. V9 said she's never been in R1's room, but she has seen things over her windows. V9 stated, She doesn't allow us in her room. If we knock, then she will come to the door. Or she will come out here and ask us for something. The surveyor described R1's room and paranoid behaviors and asked V9 if this was concerning. V9 replied, Yes, I would tell the Administrator and DON right away. On 12/3/23 at 3:20 AM, V10 (LPN) replied to the surveyor describing the current status of R1's room with,That's not normal. Those behaviors should be charted in the nurses' notes. I would be concerned and call the doctor. On 12/3/23 at 3:29 AM, V11 (RN) said she is familiar with R1. V11 said R1 is an advocate for herself and very particular on her care. V11 stated, She can over exaggerate. For example, she told me that she heard a man knocking on her window. I never heard anything and there wasn't a man seen outside the building. One time she told me that she hadn't slept much because there was a man outside her window, watching her. The night shift nurse said there was not a man outside her window. No one can confirm her delusions. She doesn't let us in her room. I know she has a lot of stuff. If she comes out of her room and I'm in the hall, then I will glance in. I wasn't able to see much, but she had a lot of stuff in her room . On 12/4/23 at 11:59 AM, V15 RN said he works R1's hall frequently. V15 said he has never been in R1's room or seen R1's room. V15 said R1 will come out and talk to you if she needs something. V15 said R1 has verbalized she thinks chemicals are coming into her room. On 12/3/23 at 2:35 PM V3 DON (Director of Nursing) said, R1 is a very nice person who has a tendency to say things that doesn't exist. She says people are behind the window and knocking on it. She thinks that snipers are on top of the roof . Most of the time she likes to stay in the room and close the door. Since I've been here we haven't sent her out to the hospital or anything like that. I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 6 of 7 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 12/04/2023 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few checked with the social worker that was here before me and they said she is always like this. Our psych service comes in every other week to see her. A few times the psych NP has told me that [R1] kicks her out and won't let her in the room. I'm not 100% sure when the last time was she saw her. [R1]was a former nurse before so she thinks she knows everything and doesn't want us to tell her anything. She thinks that she saw a sniper. She thinks chemicals are coming into her room from the outside. She says all kinds of things that we know is not true. She said someone is going to poison her from a chemical outside. Last time I was in the room she had sheets on the walls . It's the delusions that seem to be a problem for her she doesn't think she has delusions. She thinks we have delusions. I think I remember a while ago I went into her room and she was asking me if I can smell a chemical. Psychiatry comes in to see her but she has not been sent out. I would have to check with the psychiatrist to see if she would be a candidate for petition for outpatient psych services. She won't go past the nurses station and then back to her room. I don't think she would go out of this building to anywhere. Even in the summertime I have never seen her go out. Our Social Services should know about her behaviors. Behaviors that would be documented would be aggression. I think she would go back into the community and do well, but she won't let them in. That's her choice and there is nothing we can do about it. I was not aware that she has plastic wrap covering her vent. Maybe I could convince her to let maintenance in the room . If she allowed us to go in to the room it would be different but we can't force into the room. Since there is no aggressive behavior we can't do anything. R1's Behavior Tracking for September 1, 2023 through December 3, 2023 (the date of this survey) there were no behaviors documented for R1. The facility's form for behavior monitoring includes whether or not the resident is having delusions. R1's last Social Services Assessments were completed between 11/10/2022 and 11/13/2022. (Over a year ago.) On 12/3/23 at 2:58 PM, V7 (Facility's Psychiatric Nurse Practitioner) said [R1] was assigned to her at the facility. V7 said she is not sure when the last time she saw [R1] was. V7 said she has not heard anything recently about [R1]. V7 said she was notified that R1 was having increased paranoia, delusions, was refusing treatment, putting tin foil on the walls, taping towels to the walls, and covering the windows. V7 said she certainly did not know that R1 had covered her room vent with plastic wrap. V7 said it is hard for her to know because [R1] doesn't communicate. V7 said she has not seen R1's room. V7 said she would have expected to have been notified of these behaviors and due to the severity of the behaviors she feels that would warrant an involuntary petition. V7 said she would say that R1 needs to be admitted for these behaviors and the petition does not necessarily need to come from her. V7 with R1 covering things like that the facility should have let someone know. The facility's policy revised December 2016 showed, Behavior Assessment, Intervention, and Monitoring, Policy: 1. Behavioral symptoms will be identified using facility-approved behavioral screening tools and the comprehensive assessment. 2. Residents who do not display symptoms of, or have not been diagnosed with, a mental, psychiatric psychosocial adjustment or post-traumatic stress disorder will not develop a pattern of decreased social interaction or increased withdrawn, angry or depressive behaviors that cannot be explained or attributed to a specific clinical condition that makes the pattern unavoidable. Residents will have minimal complications associated with the management of altered or impaired behavior . Assessment: . 3. The nursing staff will identify, document, and inform the physician about specific details regarding changes in an individual's mental status, behavior, and cognition, including: a. Onset, duration, intensity and frequency of behavioral symptoms . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145741 If continuation sheet Page 7 of 7