Inspection·July 7, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview and document review the facility failed to provide a safe, functional, sanitary and comfortable environment for residents and staff on 4 of 5 resident floors (2nd, 3rd, 4th, and 5th floors) of the facility. Findings include: The following was observed during tour of facility on 7/5/24 with V3 (Housekeeping staff). R6's room was observed with extensive wall damage at the wall/floor junction on all 4 walls. R7's toilet room was observed with heavy ceiling plaster damage on entire ceiling. The plaster was wet and had black mold. The plaster/drywall was sagging . On 7/5/24 at 10:22AM R7 stated it has been in that condition for a long time. R8's room was observed with plaster wall damage at the floor/wall junction next to the window. R10's room was observed with extensive plaster wall damage at the floor/wall junction on all 4 walls. R1's room was observed with wet and collapsing plaster damage above the room window at the ceiling wall junction. The plaster had black mold like growth on the surface. Walls of room had drywall damage on all 4 walls. R20's room was observed with falling plaster damage at the wall / ceiling junction above the window. R21's room was observed with extensive wall damage at the floor wall junction on all 4 walls, the wall behind bed was plaster damaged. The wall ceiling above room window was plaster damaged. On 7/6/24 at 10AM V1 (Administrator) stated I am aware of the wall damage in the facility. The wall damage was caused by leaking air conditioner units, leaking showers and leaking toilets. I have a maintenance crew of 3 staff that are presently working on repairs. Air conditioning units are being replaced. Showers are being recaulked. These repairs are ongoing. On 7/7/24 V1 (Administrator) was requested to provide a maintenance policy that includes maintaining walls/ceilings of residents rooms. V1 provided the following. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 145834 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 145834 B. Wing (X3) DATE SURVEY COMPLETED A. Building 07/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austin Oasis, The 901 South Austin Blvd Chicago, IL 60644 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)