Inspection·June 4, 2025

F 0684 R3's (5/3/25) Medication Administration Record states that pain was rated 3/10 on evening shift. Level of Harm - Actual harm On 5/28/25 at 10:21 am, V2 (Director of Nursing) stated He (R3) had a fall on 5/2 around 10:00 in the morning. At the time of the fall there were no signs of injury or apparent injuries noted. R3 exhibited facial grimacing during range of motion per 5/2 progress note]. He started showing injury the following day, so the doctor sent him out for evaluation. Residents Affected - Few On 6/2/25 at 11:53 am, V7 (Licensed Practical Nurse) stated On 5/2/25, I saw him (R3) on the floor because it was unwitnessed fall. The resident (R3) can't talk much, he don't (sic) remember exactly what happened. After the assessment was done, he can't verbalize pain but he was grimacing when we were doing the range of motion on the right leg. I notified the doctor and he ordered for x-ray that we should do bilateral x-ray to the legs it was carried out, done. I called the state guardian and give (sic) a pain pill. R3's (5/2/25) X-ray order wasn't put in stat because when I called the doctor, he didn't say to put stat, so I didn't get a stat order from the doctor. I don't remember if the physician ordered x-ray of bilateral hip and knee to rule out injury per progress note (entered by V7), but I know its bilateral leg. I know when I was documenting I wanted to put knee and leg. R3's (5/4/25) history & physical includes Musculoskeletal: Deformity present, right lower extremity externally rotated. R3's (5/6/25) history and physical affirms status-post right hip intramedullary nailing. On 5/29/25 at 1:55pm, V11 (Medical Director) stated When a resident falls, they (staff) usually assess the patient, call me (V11) right away, and let me know what's going on. The resident should be assessed as soon as the patient fell, they have to assess right away. Surveyor inquired if a resident sustains an unwitnessed fall and exhibits facial grimacing during passive range of motion (to the right lower extremity) what should be ordered V11 replied We order the x-rays if there's swelling of the knee or hip we order the x-rays right away. If the patient is confused, we send the patient out [R3's cognitive status is severely impaired]. V11 stated that x-rays (post fall) should be ordered stat and once the xray is done staff should be following up with the provider or the provider should be calling the facility with results and that the provider usually calls within 1 or 2 hours for the results. V11 also stated that resident should be transferred to the hospital if they see any deformity. V11 further explained that a lower extremity varus deformity presents usually the leg is rotated to the left if it was the right leg and that the potential harm to a resident that sustained an unwitnessed fall is that If there's fracture, there is pain and sometimes surgery is required. Considering reasonable person concept, right lower extremity deformity, and fracture (which required surgery) R3's pain was likely excruciating therefore higher than 3/10. On 5/27/25 at 2:12pm, R3 was observed lying on the floor (adjacent the bed) and the curtain was pulled. V6 (Certified Nursing Assistant) affirmed that she was assigned to R3 at the time of R3's fall incindent. V6 stated I was here (room) watching him and went to bring water for him, and the Nurse saw he was sliding down. R3 was unable to provide a description of what happened due to cognitive status. Several staff subsequently entered the room and transferred R3 back to bed [prior to assessment]. On 5/27/25 at 2:22 pm, V7 (Licensed Practical Nurse) entered R3's room and affirmed that she was assigned to R3 at the time of R3's fall. V7 stated He (R3) went for therapy, he just came in. I'm the one that set him down. I saw him from the Nurse's station trying to slide down. Surveyor inquired if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145832 If continuation sheet Page 2 of 5 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 145832 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at the Ridge 6450 North Ridge Blvd Chicago, IL 60626 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 R3's vital signs were obtained post fall V7 responded I want to do it now, I'm doing it. I'm gonna assess the patient and call the doctor [roughly 10 minutes after falling]. V7 also stated If a resident falls, the nurse should assess the resident before we (staff) pick them up. I did not assess R3 prior to placing back in bed because I went downstairs to get the (mechanical lift). No, that getting the mechanical lift is not the priority. Residents Affected - Few On 5/28/25 at 10:36 am, V2 (Director of Nursing) stated When a resident falls, we (Nurses) assess the patient before transferring. We do vital signs, range of motion and assess for injuries before we move this patient. The change in resident condition policy (reviewed 01/2025) states Nursing will notify the resident's physician or nurse practitioner when: there is a significant change in the resident's physical, mental or emotional status. It is deemed necessary or appropriate in the best interest of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145832 If continuation sheet Page 3 of 5 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 145832 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at the Ridge 6450 North Ridge Blvd Chicago, IL 60626 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based upon observation, interview, and record review the facility failed to implement fall prevention interventions. These failures resulted in R3's (5/2/25) fall with sustained right hip impacted intertrochanteric fracture with varus deformity which required surgery. Findings include: R3's diagnoses include metabolic encephalopathy, lack of coordination, abnormalities of gait/mobility, and fracture of unspecified part of neck of right femur. R3'S (10/2/24) fall risk evaluation determined a score of 25 (high risk). R3's (5/14/25) functional assessment affirms resident is dependent on staff for chair/bed to chair transfer and walking was not attempted due to medical condition or safety concerns. R3's (7/23/24) care plan states resident is at high risk for falls related to unsteady gait and incontinence. Interventions: (10/2/24) encourage appropriate use of assistive devices. (5/7/25) staff to monitor resident and assist as needed, (5/20/25) keep bed in lowest position, (5/27/25) promote placement of call light within reach, (5/27/25) bed wedges in place on side of bed for additional support, (5/27/25) floor mats in place. R3's (5/2/25) fall incident report states resident observed with an (unwitnessed) fall in his room. Noted lying in supine position on the floor by his bed, with rolling walker next to him. Resident unable to give description. Full body assessment completed, with no apparent injury observed, no opened skin noted. Observed with facial grimacing during passive range of motion to right leg. Medical doctor notified with orders for x-ray of bilateral hip and knee to rule out injury. Order noted and carried out. On 6/2/25 at 11:53am, V7 (Licensed Practical Nurse) stated R3's fall prevention interventions include call light within the reach, bed in the lower position, we monitor the resident every 2 hours, and the resident is close to the nurse's station [bed wedges and floor mats were excluded]. Regarding R3's (5/2/25) fall, I (V7) was doing my morning medication. The patient (R3) is in bed, he is okay, and he is very close to the nurse's station. So, when I went across the hallway, he (R3) was still in his room lying in bed, but he is confused, and we need to remind him to use his walker. I saw him on the floor because it was unwitnessed fall. The resident (R3) can't talk much he doesn't remember exactly what happened. After the assessment was done, he can't verbalize pain but he was grimacing when we were doing the range of motion on the right leg. I notified the doctor and he ordered for x-ray that we should do bilateral x-ray to the legs it was carried out, done. I called the state guardian and give a pain pill. Surveyor inquired if a floor mat was in place at time of fall V7 stated No, he wasn't using floor mat at the time of the fall and he (R3) did not require bed wedges, but he is using it now. On 5/29/25 at 1:55pm, surveyor inquired about potential harm to a resident that sustained an unwitnessed fall V11 (Medical Director) responded If there's a fracture there is pain and sometimes surgery is required. R3's (5/2/25) right hip x-ray affirms impacted intertrochanteric fracture with varus deformity. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145832 If continuation sheet Page 4 of 5 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 145832 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at the Ridge 6450 North Ridge Blvd Chicago, IL 60626 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 0689 R3's (5/6/25) history and physical states status-post right hip intramedullary nailing. Level of Harm - Minimal harm or potential for actual harm _ R3's (5/14/25) BIMS (Brief Interview Mental Status) determined a score of 6 (severe impairment). Residents Affected - Few On 5/27/25 at 2:12pm, R3 was observed lying on the floor (adjacent the bed) and the curtain was pulled. R3's bed was noted to be in low position (without sheets/linen) and the call light was on the floor. R3 was unable to provide a description of what happened due to cognitive status. V6 (Certified Nursing Assistant) affirmed that she was assigned to R3 at the time of R3's fall on 5/27/25. V6 stated I (V6) was here (room) watching him (R3) and went to bring water for him, and the Nurse saw he was sliding down. Surveyor inquired about R3's fall prevention interventions V6 responded There is a form that they (facility) keep here for him then searched the room to no avail and failed to answer the question. V6 affirmed that there was no clip on R3's call light to secure it within reach there was not. On 5/27/25 at 2:22pm, V7 (Licensed Practical Nurse) affirmed that she was assigned to R3 at the time of R3's fall (5/27/25). V7 stated He (R3) went for therapy, he just came in. I'm (V7) the one that set him (R3) down. I (V7) saw him from the Nurse's station trying to slide down. All the people (referring to R3 and 2 other residents) in this room are fall risk so we monitor them. R3's call light, It's not within reach, it's on the floor. There's no clip to secure it within reach, we put it on the side. The fall prevention and management policy (reviewed 2/2025) states this facility is committed to maximizing each resident's physical, mental and psychosocial well-being. While preventing all falls is not possible, the facility will identify and evaluate those residents at risk for falls, plan for preventive strategies, and facilitate as safe an environment as possible. All resident falls shall be reviewed, and the residents existing plan of care shall be evaluated and modified as needed. Residents at risk for falls will have fall risk identified on the interim plan of care with interventions implemented to minimize fall risk. Care plan to be updated with a new intervention based on root cause analysis after each fall occurrence. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145832 If continuation sheet Page 5 of 5