Inspection·February 19, 2026

F 0790 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete should follow through with the treatment plan of the physician. Social Service follows the process with the physician so when the notes come in that information is uploaded in the system and gets communicated to the nursing staff, then the nursing staff will assist with getting the treatment plan followed. Surveyor inquired about staff expectations regarding dental services. V2 responded, The Nursing staff should be sending the resident out with their face sheet and orders with any concerns and upon return we (staff) should be documenting that they (residents) returned and what they returned with so we can be following up with the orders. R3's (1/5/26) BIMS determined a score of 15 (cognition intact).R3's (5/30/21) care plan states resident exhibits dental/mouth problems. Intervention: Consider (dental) consult as indicated.R3's progress notes state (8/4/25) Resident returned from dentist appointment, resident has a referral for dentures. (9/15/25) She (R3) is tolerating oral intake without difficulty and is scheduled to return to the dentist for denture fitting. (10/6/25) She (R3) is awaiting follow-up with dental services for upper denture fitting. R3's (1/19/26) dental consult states upper right/left quadrant: no teeth. Denture steps: (nothing is selected). On 2/17/26 at 12:05pm, R3 appeared to be missing all of the upper teeth. Surveyor inquired about dental services R3 stated I'm supposed to get fitted for dentures. My (R3) top teeth were removed in August last year (roughly 6 months ago). She (provider) said the dentist is gonna take 3 visits to fit me but it's taking this long, it don't make no sense and affirmed that the facility hasn't set up an appointment to get fitted for dentures. On 2/18/26 at 3:30pm, surveyor inquired why R3 wasn't fitted for dentures V1 (Administrator) stated They (dentist) weren't accepting her (R3) insurance, so I (V1) had staff call the insurance company. They sent us a list of providers in her network. Now we're (staff) scheduling her appointment (roughly 6.5 months after referral was received) so she can follow up for the dentures.R4's (1/13/26) BIMS determined a score of 9 (moderate impairment). On 2/17/26 at 12:03pm, surveyor inquired if R4 was recently seen by the dentist R4 stated When I (R4) was at another house and was unable to provide additional information.R4's (6/17/25) dental consult states patient has a denture that fits well. R4's (2/10/26) dental consult states the patient is a poor candidate for dentures due to lack of natural bone. Patient may enroll for dental care at facility to try a new denture. On 2/19/26 at 3:11pm, surveyor inquired if R4 was enrolled for dental care at facility to try a new denture. V8 stated, No, no one gave me (V8) anything about that. So, I (V8) don't know.On 2/19/26 at 3:48pm, surveyor inquired if V2 was made aware that R4 may require new dentures per 2/10/26 consult - due to bone loss. V2 stated, I'm not aware of her needing those services.The Dental Services policy (reviewed 1/2026) states documentation by the dentist is recorded in the resident's medical record. Nursing will document dental issues in the EMR (Electronic Medical Record). Event ID: Facility ID: 145758 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145758 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Glenwood 19330 South Cottage Grove Glenwood, IL 60425 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to follow policy procedures, failed to ensure that staff report malfunctioning handicap push buttons, failed to ensure that essential equipment was in safe operating condition, and failed to timely repair malfunctioning equipment. This failure has the potential to affect 143 residents residing at facility. Findings include:The 2/16/2026 facility census includes 143 residents.On 1/23/26, IDPH (Illinois Department of Public Health) received allegations that the facility front doors are not handicap accessible. The doors have not been working since August 2025.On 2/17/26 at 11:15am, surveyor inquired about facility concerns V3 (Family) stated, The main entrance handicap door doesn't work. When you press the button, it doesn't open the door. On 2/17/26 at 11:41am, surveyor inquired if the handicap push buttons (that open the front entrance doors) were working. V4 (Lead Receptionist) stated, That one's not, for a few months now (referring to the push button - adjacent the reception area) but the other one (referring to unit entrance push button) is working.On 2/17/26 at 11:45am, surveyor inquired if the handicap push buttons that open the front entrance doors were working. V5 (Maintenance) replied, I (V5) can go check it real quick. Surveyor inquired if anyone reported that the handicap push buttons were not working. V5 responded, No, nobody said nothing. V5 inspected all 3 front entrance handicap push buttons with surveyors and affirmed that none of them were working (the doors did not open). V5 stated, Friday (2/13/26) they were working because I let the ambulance people in, and it was working for me (V5). R3's (1/5/26) functional assessment states resident uses a motorized wheelchair. R3's (1/5/26) BIMS (Brief Interview Mental Status) determined a score of 15 (cognition intact). On 2/17/26 at 12:05pm, surveyor inquired if the front entrance handicap push buttons were functioning. R3 stated, They were working on Friday (2/13/26) when I (R3) went to visit my family and denied concerns.Considering reasonable person concept the handicap push buttons may have been working intermittently due to V4's statement. On 2/17/26 at 12:59pm, V5 stated, The handicap buttons are working now somebody turned it from automatic to off for some reason. We (facility) just got a whole new door and set up put in about 8 months ago. Surveyor inspected the front entrance door handicap push buttons and affirmed that 2 of 3 were working however the outside front entrance button wasn't working (the door failed to open).On 2/18/26 at 8:54am, surveyor pressed the outside (front entrance) handicap push button however the door did not open. On 2/18/26 at 11:52am, V1 (Administrator) presented the 2/17/26 service invoice and stated the (front entrance) handicap push buttons were repaired yesterday. The invoice received affirms that bad rusty connections were found. On 2/19/26 at 8:30am (the following day), surveyor pressed the outside (front entrance) handicap push button again however the door did not open.The facility logbook documentation includes the (main entrance) doors, locks, gates, and alarms: test operation of doors (handicap push buttons are excluded). Documented on (Monday) 2/2/26, (Tuesday) 2/3/26, (Monday) 2/9/26, and (Tuesday) 2/10/26 therefore twice a week. On 2/19/26 at 12:22pm, V5 stated The only one that has a handicap button is the front entrance doors. I (V5) go to the door to make sure that the mag locks work, the door engages, and make sure that the push bars work every day, but I only log it once a week. Surveyor inquired if the handicap buttons are also checked weekly. V5 responded, Yes but I don't have anything specifically on the form (referring to logbook documentation) that says that. Surveyor inquired why the (outside - front entrance) handicap push button wasn't working yesterday or today if it was repaired on 2/17/26 (per V1). V5 replied, It was reported to me (V5) today (not yesterday) that it wasn't working again. I went and ordered a whole pad instead of playing with the contacts and all that. Surveyor inquired if the handicap push buttons were inspected this week. V5 stated, I didn't do it this Monday or Tuesday like I usually do, I did it today (2/19/26) therefore not conducted weekly as stated. Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145758 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145758 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Glenwood 19330 South Cottage Grove Glenwood, IL 60425 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete The Preventative Maintenance policy (reviewed 1/1/26) states a preventative maintenance policy shall be developed and implemented to ensure the provision of safe, functional, sanitary, and comfortable environment for residents, staff, and the public. The Maintenance Director is responsible for developing and maintaining a schedule of maintenance services to ensure that the buildings, grounds, and equipment are maintained in a safe and operable manner. The Maintenance Director shall assess all aspects of the physical plan to determine if preventative maintenance is required. If preventative maintenance is required, the Maintenance Director shall decide what tasks need to be completed and how often to complete them. The Maintenance Director shall utilize the (Building Management Platform) calendar and scheduled prompts to assist with keeping track of all tasks and work orders. Documentation shall be completed for all tasks. Event ID: Facility ID: 145758 If continuation sheet Page 4 of 4