Health 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. Page 1 of 4 145834 145834 07/07/2024 Austin Oasis, The 901 South Austin Blvd Chicago, IL 60644

F 0921 Facility policy titled Preventative Maintenance & Inspections states including: Level of Harm - Minimal harm or potential for actual harm 1. Policy Guidelines Residents Affected - Many In order to provide a safe environment for residents , employees , and visitors , a preventative maintenance program has been implemented to promote the maintenance of equipment in a state of good repair and condition. C. Inspections 1 A schedule is developed to delineate all inspections that are to be completed on a regular basis. Inspections verify that all equipment and furnishings are in working order and free from safety hazards. 4 Building inspections included the following : Heating and air conditioning systems Mechanical equipment & ventilation ducts. Doors-electronic, patient rooms, stairwells. Interior hallways and common areas Resident/patient rooms. 145834 Page 2 of 4 145834 07/07/2024 Austin Oasis, The 901 South Austin Blvd Chicago, IL 60644

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and document review the facility fails to maintain an effective pest control program so that the facility is free of insects and rodents on 5 of 6 floors of the facility. Residents Affected - Many Findings include: The following was observed during tour of facility on 7/5/24 with V3 ( Housekeeping staff). R9's room was observed with a live adult roach on the floor in the toilet room. R12's room was observed with a rodent glue board on floor of outside wall, the glue board had 3 dead adult roaches attached. Mouse droppings were observed in the corner of floor next to the window. On 7/5/24 at 10:37AM R12 stated there are roaches and mice in our room all the time. R13's room mouse droppings in the toilet room on the floor. R15's room mouse droppings on the floor in room. Two dead roaches on the floor in the toilet room. On 7/5/24 at 10:55AM R15 stated there are mice and roaches in my room at night. I don't like them in here. R18's room was observed with 4 adult roaches on the floor behind the bedside cabinet next to bed. On 7/5/24 at 11:25AM R18 stated there are a lot of roaches in my room. They came in here and tried to cover the holes. But there are still roaches. R22's room was observed with 1 live adult roach on the floor near the bed. On 7/5/24 at 11:05AM R16 stated there are little roaches in my room at night all the time. On 7/5/24 at 11:15AM R17 stated there are roaches and mice in our room mostly at night. On 7/5/24 at 1:15PM R3 stated there were roaches in our toilet room two days ago. My room mates and I see roaches all the time. On 7/5/24 at 11:50AM V5 (Cook) stated we have a roach problem in the dietary area. In the dietary food prep area in basement 5 adult roaches were observed under the dishwasher countertop on the wall behind 2 inch copper water pipes. 3 adult roaches were observed under the 3 compartment sink countertop. In the dietary dry food storage room in basement 1 adult roach was observed on the floor under storage shelf. Mouse droppings were observed under the storage shelf in corner of room. In the laundry service soiled linen storage room [ROOM NUMBER] adult live roach was observed on the floor. 145834 Page 3 of 4 145834 07/07/2024 Austin Oasis, The 901 South Austin Blvd Chicago, IL 60644

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 7/6/24 at 9:47AM V1 (Administrator) stated I do not know why the pest control service reports have not been showing any sightings of roaches and mice. I keep a binder on each floor for residents and staff to report sightings of rodents and insects. I myself have been seeing roaches on the floors and have made reports to the pest control service. I train my staff in monitoring for pests in the facility. On 7/6/24 at 11:29AM R23 (Resident Council President) stated the residents have been complaining of roaches and mice in the building . The residents are sick and tired of the roaches and mice. Some say they see big rats in the building on the 2nd floor. This information was brought up at the last resident council meeting. The residents have also been complaining about all the wall damage and leaks in the residents rooms. They stated sometimes facility staff come in room and just throw some plaster over the wall and leave it that way. They never finish and paint the walls. Facility policy titled Pest Control Policy states Purpose : To prevent or control insects and rodents from spreading disease. Responsibility : Administrator, Environmental Services 145834 Page 4 of 4