Health inspection·February 23, 2026

F 0684 Level of Harm - Actual harm Residents Affected - Few 5:19pm documents in part, Nutrition Summary: Resident was discussed during the NAR meeting due to excessive weight gain and concern for fluid retention. Total gain: 55.4lbs over 6 months. Bilateral lower extremity swelling noted at most recent weight. Referred to NP (Nurse Practitioner) for routine lab work to assess renal and metabolic status. Referred to cardiology consult to evaluate fluid status and CHF management. Continue monitoring weight and edema.R3's progress note dated 06/30/25 at 4:25pm documents in part, Reason for visit: Weight gain, increased need for ADL (activities of daily living) assistance, wheelchair bound. Monitor for CHF/CKD signs.R3's hospital record dated 08/10125 documents in part, CXR (chest x-ray) shows cardiomegaly with pulmonary vascular congestion and pulmonary edema. Suspected small right pleural effusion. Pulmonary: Breath sounds; Examination of the right-lower field reveals decreased breath sounds and rales. Examination of the left-lower field reveals decreased breath sounds and rales. Decreased breath sound and rales present. Musculoskeletal: Right lower leg: Edema present. Left lower leg: Edema present.R3's hospital records dated 08/13/25 documents in part, Bilateral pleural effusions and bibasilar atelectasis. Diuresing well with 15lbs weight loss since admission.On 02/11/26 at 2:30pm V8 (Certified Nursing Assistant/CNA) stated that R3 liked sitting in the dining room with her husband and participate in activities. V8 stated that when R3 started gaining weight, R3 was in a lot of pain and had no desire to get out of bed. V8 stated that before R3's weight gain, R3 would notify staff when she needed to use the bathroom and only needed assistance from one staff member. V8 stated that R3 did not like to use the bathroom in adult diapers. V8 stated that after R3 gained weight, R3 became dependent on the use of diapers and could not get out of bed to use the bathroom. V8 stated that she could visually see R3's swelling. V8 stated that R3's whole body was swollen.On 02/17/26 at 11:15am V7 (Registered Nurse/RN) stated that at the beginning of her shift she noticed that R3 edema. V7 stated that when she noticed R3's edema, V7 called to inform the doctor. V7 stated that while on the phone with R3's doctor, the staff informed V7 that R3 had lost consciousness. V7 stated that R3's edema was significant.On 02/17/26 at 12:25pm V14 (Registered Dietician) stated that she remembers R3 having edema with a diagnosis of congestive heart failure and chronic kidney disease. V14 stated that R3's appetite never changed and wasn't the problem causing R3's weight gain. V14 stated that R3's edema was what was impacting R3's weight gain. V14 stated that R3's 48% weight gain was extremely significant and concerning. V14 stated that she never spoke to a physician about R3's weight gain and that she would communicate her concerns to the ADON (Assistant Director of Nursing).On 02/17/26 at 2:42pm V15 (Nurse Practitioner/NP) stated that weight gain started in March of 2025. V15 stated that she wanted R3 to be seen by a cardiologist but appointments take time. V15 stated that R3's weight was always concerning. V15 stated that she assumes that R3 had a functional decline because of the weight gain and the pressure from the weight. V15 stated that R3's excess fluid could affect R3's breathing and refractory period.On 02/18/26 at 1:20pm V18 (Transportation Coordinator) stated that he arranges upcoming doctor's appointments for the residents. V18 stated that the nurses inform him of any appointments that need to be made, and he then schedules them. V18 stated that R3 had no appointments scheduled in July 2025. V18 stated that he was informed to schedule an appointment for R3 on 08/07/25 and that appointment was scheduled for October 2025.R3's physician order dated 08/06/2025 documents in part, Schedule appointment with . MD (medical doctor) ASAP (as soon as possible) in 1 week.R3's care plan dated 01/16/25 documents in part, R3 as potential for renal insufficiency related to kidney disease stage 3. R3 will have no signs/symptoms of complications related to fluid overload. monitor and report changes in mental status, lethargy, tiredness, fatigue, tremors, seizures.R3's care plan dated 01/16/25 documents in part, R3 has altered cardiovascular status related to CHF, hypertension, afib (atrial fibrillation). R3 will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145775 If continuation sheet Page 2 of 3 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 145775 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harmony Healthcare & Rehab Ctr 3919 West Foster Avenue Chicago, IL 60625 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete free from signs/symptoms of complications of cardiac problems. Assess for shortness of breath and cyanosis every shift. Monitor/document/report to MD changes in lung sounds on auscultation, edema and changes in weight.Facility's policy titled Weights revised 07/03/25 documents in part, Policy statement: It is the facility's policy to obtain resident's monthly weight unless otherwise ordered differently by the physician. For a resident who is on dialysis, the resident's dry weight will also be obtained monthly. Procedures. 3. The significant weight changes (monthly 5%), quarterly (7.5%), and every 6 months (10%) will be assessed and addressed by the IDT (interdisciplinary team) which includes but not limited to the Dietician, Physician, Medical Specialist, Speech therapist, Nutritionist, and Nurses.Facility's policy titled Medical Appointment revised 07/02/25 documents in part, Policy Statement: It is the policy of this facility to ensure that all resident medical appointments are scheduled on a timely manner in accordance to the physician orders. Procedures: 2. Resident medical appointment shall be approved and ordered by the resident's physician and documented in the resident clinical records.Facility's job description titled RN Floor Nurse dated 12/1/2019 documents in part, Summary/Objective: In keeping with our organization's goal of improving the lives of the Guest we serve, the Registered Nurse (R.N.) plays a critical role in providing superior customer service and nursing care to all Guest and guest. The RN provides supervision of staff and will safeguard the health, safety and welfare of all Guests under their care by following applicable laws, regulations, and established nursing policies and procedures. Essential Functions: 1. Provides quality nursing care to Guests in an environment that promotes their rights, dignity and freedom of choice.10. Ensure that Guest care plans are being followed and assess each Guest's status in accord with their care plan. 14. Must be knowledgeable of individual care plans and support the care planning process by reporting specific information and observations of the Guest's needs, preferences and report any behavioral change. Event ID: Facility ID: 145775 If continuation sheet Page 3 of 3