Inspection·December 12, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (revised 11/2018) states in part: Your rights to safety- You must not be abused, neglected, or exploited by anyone- financially, physically, verbally, mentally or sexually. On 09/30/2025, surveyor was conducting a facility reported incident related to resident-to-resident abuse, that occurred on 07/02/2025. On 9/30/25 at 2:42 PM, R9 observed sitting in his motorized wheelchair in his room. Surveyor conducted an interview with R9. R9 stated, R10 hit me because R10 was trying to get by. R10 and I were in the cafeteria. I was in my wheelchair. R10 was in his wheelchair. It was not enough space for R10 to get by. R10 put his hand on my chair. I went to move R10's hand. R10 stood up and struck me in the face. I was not injured and R10 was not injured. I did not go to the hospital. R10 went to the hospital for psychiatric evaluation. I feel safe in the facility.On 9/30/25 at 2:34 PM, surveyor conducted an interview with resident, R10. R10 stated, I ain't been fighting with nobody. Ain't nobody hit me. I ain't hit nobody. I stay in my room watching television. I feel safe in the facility.On 12/10/2025 at 10:55AM, V1 (administrator) stated, On 07/02/2025, it was reported that at 3:20PM, R10 was observed hitting R9 in the face, in the dining room. Staff intervened immediately and separated R10 from R9. The nurses completed body assessment on both residents. R10 had no pain or injury. R9 had a superficial scratch on his face. Both R9 and R10's physicians and emergency contacts were made aware of the incident. The police were called, and a report was filed. R10 was petitioned and sent out to the hospital for psychiatric evaluation. R9 was provided first aide for the scratch on his face. The issue started because both residents are in wheelchairs. R10 was trying to get by and could not, and that's how the incident started. R10 became frustrated because he could not get by and struck R9 in the face. R9 and R10 have not had any incidents prior to the physical altercation. R9 and 10 did not have other incidents after the altercation. R9 and R10 both feel safe in the facility.On 12/11/2025 at 9:48AM, V18 (psychiatric rehabilitation services coordinator) stated, On 07/02/2025, I was coming out of the office in the basement, and I heard a commotion coming from the big dining room. I went inside the dining room to see what the commotion was, and I saw that the certified nursing assistants already separated R9 and R10. R10 became furious and he was saying that R9 needs to get out of his way. Where they were sitting, there is a lot of residents in wheelchairs and R10 was trying to get by but couldn't. R10 became frustrated and R10 hit R9 in the face. I saw R9 with a scratch on his face, which was a result of being struck in the face by R10. R9 did not attempt to strike R10 back. R10 was placed on 1 to 1 supervision and R10 was sent out to the hospital for psychiatric evaluation.R9's Progress Note (dated 07/02/25) documents, It was reported that resident had an unprovoked altercation with one of his peers. Resident has 2 scratches to his lower right cheek. Resident stated that the other resident scratched him in the face for no reason. The scratches cleansed with normal saline and left open to air, no bleeding noted. Physician notified. No new orders given. V/S 98.1-78-18-132/77, O2 sat 98% on room air. Will continue to monitor.R9's Progress Note (dated 07/02/25) documents, 1:1 VISIT TOPIC: Well-being Check. Writer met with resident in an effort to process event and to assess resident's mood/behavior. Educated the resident on importance of verbalizing any concerns immediately to staff for intervention/support. Processed with resident event; he reported no additional concerns and presented with adequate mood and stated feeling okay but verbalized feeling somewhat upset by event. Feelings/concerns were validated, resident reported no concerns. Resident was alert and oriented x3. PLAN: Continue to be available to resident as appropriate.R10's Progress Note (dated 07/02/2025) documents, It was reported by social service that resident had and altercation with another resident and the other resident sustained scratches to his face. Resident received delusional and uncooperative with social services as to what led up to the altercation. Physician called and order given to send resident to community hospital emergency room with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145829 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 145829 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kensington Place Nrsg & Rehab 3405 South Michigan Avenue Chicago, IL 60616 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 - Minimal harm or potential for actual harm petition.R10's Progress Note (dated 07/02/2025) documents, Ambulance called for transport with ETA (estimated time of arrival) 30-40 minutes. Nursing report given to registered nurse at community hospital emergency room. Sister of resident was notified that resident will be sent to community hospital. Resident remains on the unit at this time.R10's Progress Note (dated 07/03/2025) documents, Resident has been admitted DX (diagnoses): aggressive behavior. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145829 If continuation sheet Page 3 of 3