Inspection·September 23, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few said he didn't think it was odd that R1 did not urinate that shift because he worked with R1 in the past and R1 did not urinate. V1 omitted getting permission to check R1's brief for incontinent episode. V1 said R1 is alert and orient, R1 is incontinent and in the past R1 would put the call light on if she needed to be changed of bowel movement. V1 said he worked with R1 a few times in the past.9/23/25 at 11:21am V9 (CNA) said when checking for incontinence and providing incontinence care, you should knock on the door, get permission to enter, announce yourself, inform the resident that you want to check and change their brief. V9 said if the resident is alert and orient, you should ensure to get permission before you touch them. If the resident refuses inform the nurse for guidance. V9 said if the resident is not alert and or has dementia, you should still announce yourself, inform the resident of the care you are planning to provide and keep them informed during the task. V9 said you check the brief by opening the Velcro, check the front, and also have the resident to turn to check the back because sometimes the resident brief looks dry in the front, and the brief is wet in the back. V9 said sometimes the brief is visibly soiled and you can see from the outside that it is wet. V9 said it is not the practice to pat/ massage or squeeze a brief.9/22/25 at 9:51am V5 (Director of Nursing) stated that the facility practice is to check the resident for incontinence, sometimes residents are not alert and orient, staff should announce themselves, inform the resident of what they are about to do. V5 said if a resident is alert and orient staff should get permission before touching a resident.9/22/25 at 3:35pm V11 (Social Service) stated she assessed R1's BIMS, V11 said R1 was alert and orient and forgetful of a few words during her assessment. 9/22/25 at 2:45pm V12 (Rehab Director) said R1 was dependent of staff for toileting, R1 needed one person assist with toileting, R1 could assist with turning.R1 care plan dated 9/16/25 denotes the resident denies having been exposed to trauma abuse/neglect prior to admission and denies having been the perpetrator of mistreatment, abuse, neglect, and/exploitation. The resident does not present with unusual risk in these areas at this time. The resident however does experience frailty/weakness. The resident will be treated with respect, dignity, and reside in the facility free of mistreatment (i.e., abuse/neglect) through the next review. Interventions are to conduct an Abuse/Trauma/Substance History assessment (as needed) to promote knowledge and understanding of residents past including social support system and coping mechanisms, and any history that may be useful towards the persons plan of care. Please encourage resident to maintain strong friendships and community involvement so that they are less likely to be isolated or lonely. Utilize person-centered care models that provide as much initiative, control, and self-determination as possible to address the persons physical, psychological, and social needs within a trusting, open, supportive and nonjudgmental professional relationship.R1 base line care plan dated 9/16/25 shows toileting not assessed.Facility policy titled Incontinence care with last revision date 4/20/2021, denotes in part to prevent excoriation and skin breakdown, discomfort and maintain dignity. Incontinent resident will be checked periodically in accordance with the assessed incontinent episode or appropriately every two hours and provided perineal and genital care after each episode. Explain the procedures to resident and bring equipment to bedside. Provide for privacy. perform hand hygiene and put on non sterile gloves. Facility policy abuse prevention and reporting effective date 11/28/2026 last revision date 10/24/22 denotes in-part; the facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of the residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145779 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 145779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Palos Heights 12550 South Ridgeland Avenue Palos Heights, IL 60463 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 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete prevent occurrence of abuse neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment of the residents. Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means abuse is the willful infliction of injury unreasonable confinement intimidation or punishment with resulting physical harm pain or mental anguish to a resident. Event ID: Facility ID: 145779 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 145779 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Palos Heights 12550 South Ridgeland Avenue Palos Heights, IL 60463 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review the facility failed to follow their policy to report an allegation of abuse within two hours of receiving an allegation for one of three resident (R1) reviewed for abuse reporting. Findings include: 9/21/25 at 2:25pm V2 (LPN) stated that R1 and R1 family alleged abuse by staff on 9/19/25 around 10:30pm. V2 said the administrator was made aware that night.9/22/25 1:55pm V4 (VP of Operations) stated the administrator did not report the allegation of abuse to the state department with 2 hours of receiving the allegation. V4 said an allegation of abuse should be reported within two hours of receiving the allegation. 9/22/25 at V5 (Director of Nursing) stated she reported an allegation of sexual abuse on 9/20/25.Review of the reportable submitted to the state department, report date is 9/20/25 at 1:43pm for sexual abuse.Facility policy abuse prevention and reporting effective date 11/28/2026 last revision date 10/24/22 denotes in-part; Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means abuse is the willful infliction of injury unreasonable confinement intimidation or punishment with resulting physical harm pain or mental anguish to a resident. Any allegation of abuse or any incident that results in serious bodily injury will be reported to the department of public health immediately, but not more than two hours after the allegation of abuse. Any incident that does not involve abuse and does not result in serious bodily injury shall be reported within 24 hours. Internal reporting requirements and identification of allegation: any allegation of abuse or any incident that results in serious bodily injury will be reported to the department of public heath immediately, but not more than two hours after the allegation of abuse. Any incident that does not involve abuse and does not result in serious bodily injury shall be reported within 24 hours. Event ID: Facility ID: 145779 If continuation sheet Page 4 of 4