Health inspection·July 20, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete apologized. V3 completed a petition for involuntary admission for psychiatric evaluation on 4/27/25. Care plans for R1 and R2 were reviewed and neither included care plans for consensual relationships.On 7/19/25 at 1:47pm V4 PRSD (Psychiatric Rehabilitative Services Director) said that the incident of 4/27/25 occurred prior to V4 working in the facility, however, V4 would expect for consensual relationships to be reported or at least discussed with the Social Services Department. V4 said that this is important to follow-up with residents regarding safe consensual practice should they choose to engage and also notifies that staff of the relationship should any behavior issues arise. Facility reported incident dated 4/27/25 summarized that R1 alleged R2 engaged in inappropriate behavior towards R1.Facility policy and procedure titled Abuse Prevention Program (no revision date) states in part: Residents have the right to be free from abuse, neglect, exploitation, misappropriation of property or mistreatment. This includes but is not limited to corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat the resident's medical symptoms.Establishing a Resident Sensitive Environment This facility desires to prevent abuse, neglect, exploitation, mistreatment and misappropriation of resident property by establishing a resident sensitive and resident secure environment. This will be accomplished by a comprehensive quality management approach involving the following: Concern Identification and Follow-up: Resident and family concerns will be recorded, reviewed, addressed, and responded to using the facility's concern identification procedures. Residents and families will be informed of the facility's concern identification procedures. An essential element of customer satisfaction is a timely response back to the family or resident to concerns expressed. At least quarterly, the reported concerns from residents and families, and the facility response, will be reviewed by the facility Quality Management committee to assure that individual concerns are being addressed and to assess any patterns that might indicate needed changes in facility practices. Event ID: Facility ID: 145764 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 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow their policy and procedure for reporting an allegation of resident-to-resident abuse. Findings include: This Survey was conducted on-site in the facility from 7/18/25 to 7/20/25. R1 is [AGE] years old and admitted to the facility 10/1/2024 with a diagnosis of chronic kidney disease and is dependent on renal dialysis. Minimum Data Sets (MDS) reviewed on admission [DATE] and most recent of 4/18/2025 indicate that R1 has been assessed to be alert and oriented without cognitive deficit. The MDS also indicates that R1 has not been assessed to exhibit any behavioral or psychotic symptoms.R2 is [AGE] years old and has been a resident of the facility since 2/23/22. R2 has diagnoses that include but are not limited to schizoaffective disorder and Cognitive Communication Deficit. According to R2's MDS dated [DATE] R2 was assessed with mild cognitive impairment. The electronic health record was reviewed for R1 and R2. Progress notes dated 4/27/25 for R1 states: Resident [R1] alleges that co-peer engaged in inappropriate behavior toward him. Residents immediately separated. Co-peer placed on 1:1 monitoring. Body check initiated without findings or complaints of pain. [Medical Doctor], family and police notified. Wellbeing initiated by social services where resident continues to feel safe in the facility. A progress note for R2 on 4/27/25 states: It was alleged that the resident engaged in inappropriate behavior towards co-peer. Residents immediately separated, resident was placed on 1:1 monitoring and will be sent out for an evaluation. MD, family, and police notified.A petition for involuntary admission was completed and signed for R2 on 4/27/25 and included that R2 needed immediate hospitalization to alleged unwanted physical sexual contact to another resident.Facility Incident Report and Investigation were requested from V1 (Administrator) for the alleged incident of 4/27/25. V1 included in the report that both the initial and final investigation were reported to IDPH (Illinois Department of Public Health) on 7/17/25.On 7/19/25 at 2:14PM V1 (Administrator) said that all staff are expected to directly report any allegations of abuse immediately to V1 as they arise as such to begin the investigation and send notification to IDPH. V1 confirmed that this allegation that occurred 4/27/25 is a reportable incident.Facility policy and procedure titled Abuse Prevention Program (no revision date) states in part: 1. Initial Reporting of Allegations - When an allegation of abuse, exploitation, neglect, mistreatment or misappropriation of resident property has occurred, the resident's representative and the Department of Public Health's regional office shall be informed by telephone or fax. Public Health shall be informed that an occurrence of potential abuse, neglect, exploitation, mistreatment or misappropriation of resident property has been reported and is being investigated. The report shall include the following information, if known at the time of the report: Name, age, diagnosis and mental status of the resident allegedly abused, neglected, exploited, mistreated or from whom property was misappropriated Type of alleged abuse reported (physical, sexual, neglect, verbal or mental abuse, misappropriation of resident property) Date, time, location and circumstances of the alleged incident Any obvious injuries or complaints of injury Steps the facility has taken to protect the resident This report shall be made immediately, but not later than two hours after the allegation is made, if the events that cause the allegation involve abuse or resulted in serious bodily injury; or not less than 24 hours if the events that cause the allegation do not involve abuse and did not result in serious bodily injury. The resident or resident's representative will also be informed of the report of an occurrence of potential abuse, neglect, exploitation, mistreatment or misappropriation of resident property and that an investigation is being conducted. 2. Five-day Final Investigation Report. Within five working days after the report of the occurrence, a complete written report of the conclusion (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 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 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 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 0609 of the investigation, including steps the facility has taken in response to the allegation, will be sent to the Department of Public Health. 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: 145764 If continuation sheet Page 4 of 4