Inspection·December 18, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete was standing at the elevator. R7 was making verbal threats to R4 after R4 told R7 to move from in front of the elevator because she (R4) could not get on. R7 told R4 that he would get another resident to fight R4. Once inside the elevator, R4 and R7 keep making verbal threats and then R7 hit R4 in her head (right side) twice with his cane.Police Report dated 12/11/25 documents R4 as the victim in a simple battery incident.R4's Progress Note dated 11/15/25 documents R4 was sent out to hospital due to having headache and sensitivity to light. R4's family, Medical Doctor and Director of Nursing made aware; R4 returned to the facility with Minor Closed Head Injury.Hospital Record indicates R4 was transmitted to the hospital Emergency Department via ambulance on 11/15/25 at 1935 (7:35 PM); R4 seen in the hospital for headache and a diagnosis of minor closed head injury.Petition for Involuntary admission dated 12/15/25 at 12:30 pm documents, R7 in need of immediate hospitalization for the prevention of harm; R7 presenting with verbal and physical aggression, continuing to escalate despite attempts to de-escalate; R7 having bizarre delusions about other residents; R7 is presenting with labile mood.AMA (Against Medical Advice) Form dated 11/15/25 documents, R7 signing himself out AMA.R7's Nursing Progress Note dated 11/21/25 documents, R7 returned from the hospital; R7 left AMA.Abuse Prevention Program Policy documents, this facility is committed to protecting our residents from abuse by anyone including but not limited to, facility staff, other residents, consultants, volunteers, staff from other agencies providing services to the individual, family members or legal guardians, friends, or any other individuals. Event ID: Facility ID: 145834 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 145834 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 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)

F 0675 Honor each resident's preferences, choices, values and beliefs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure adequate running water and failed to provide adequate hot water. This failure has affected four residents (R1, R3, R9 and R10) and has the potential to affect all 181 residents that reside in the facility. Findings include:R1 is [AGE] year-old with diagnosis including but not limited to: Type 2 diabetes mellitus, unspecified asthma, essential hypertension, insomnia and gastro-esophageal reflux disease without esophagitis.R1 has a BIMS (Brief Interview of Mental Status) score of 15, which indicates cognitively intact. R3 is [AGE] year-old with diagnosis including but not limited to: Chronic obstructive pulmonary disease with acute exacerbation, type 2 diabetes mellitus without complications, epilepsy, acute kidney failure and essential hypertension.R3 has a BIMS (Brief Interview of Mental Status) score of 15, which indicates cognitively intact.R9 is [AGE] year-old with diagnosis including but not limited to: Other specified disorders of kidney and ureter, essential hypertension, chronic kidney disease, hypokalemia and anemia.R3 has a BIMS (Brief Interview of Mental Status) score of 15, which indicates cognitively intact.R10 is [AGE] year-old with diagnosis including but not limited to: Unspecified asthma, otalgia, type 2 diabetes Mellitus and gastro-esophageal reflux disease.R10 has a BIMS (Brief Interview of Mental Status) score of 15, which indicates cognitively intact.On 12/08/25 at 11:15 am, V1 (Administrator) stated the following, We have an issue with water pressure, valves, and ball joints. The water is running, but at a very low pressure. 4th and 5th floors have more of an issue with pressure.On 12/08/25 at 11:50 am, V5 (Project Manager) stated the following, We have been having issues with the water pressure. The City wants us to change our water meters, but we've had to change two water valves beforehand. We were able to change one valve but had issues with the other valve. The Plumbers could not cut the water supply off from the City in order to change the other valve. The City came out and closed the valve but when they tried to reopen, it did not open all the way. This is why the water pressure has been low. I've been in contact with the City and the plumber in order to finally take care of the water issues. They are both scheduled to come out this Saturday to make the repairs.On 12/08/25 at 1:56 pm, R1 turned on his hot water and Surveyor noted cold water running from the faucet.At that time R1 stated the following, I understand that the building is old, but we should have hot water. The water in the shower is ice cold. I need a shower bad. I have to clean myself the best way that I can. When I get up at around 2 am, I check my water, and it is a little warm then. The last time I was able to take a shower here was last month sometime. My toilet doesn't even flush at times, and we (residents) were told that it was due to the low water pressure here on the fifth floor.On 12/08/25 at 1:57 pm, R1 attempted to flush his toilet but it would not flush.On 12/08/25 at 2:18 pm, R3 stated the following, About two months ago is when the water issue first started. The water had gone out completely in my room and since then, it's hit or miss. Sometimes it runs ok, sometimes is runs very slow and sometimes it don't run at all. That's why I keep a jug of water in my bathroom to at least wash my face or take a sponge bath in my bathroom. My last shower was about four days ago. I don't know why we have the worst water issues here on the 5th floor. If my toilet doesn't flush, I have to pour water into the toilet so that the urine or feces will go down. I know that this is an old building an I heard that they have been working to fix the issue, but I feel like two months is enough time to fix it. At that time, R3 turned on her hot water valve. Surveyor noted a small stream of cold water flowing from R3's faucet and R3's toilet did not flush.A gallon of water was also noted in R3's bathroom.On 12/10/25 at 10:36 am R10 stated the following, the water works off and on. Sometimes the toilet won't flush because of the low pressure. Right now, the water doesn't get hot. I have to wake up at 4am in order to get Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145834 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 145834 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 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)

F 0675 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete lukewarm water from my faucet to clean myself.At that time, R10 turned the hot water valve on.On 12/10/25 at 10:36 am Surveyor touched the water running from R10's bathroom sink and it was cold.On 12/10/25 at 11:15 am, V10 (Maintenance worker) went with Surveyor to test the water temperature in the 2nd floor shower room. At that time, the water measured 60 degrees F (Fahrenheit) and was cool to touch.On 12/10/25 at 11:23 am, V10 went with Surveyor to test the water temperature in the 3rd floor shower room. At that time, the water measured 62 degrees F (Fahrenheit) and was cool to touch.On 12/15/25 at 12:53 pm, V11 CNA (Certified Nurse Assistant) went with Surveyor to test the water temperature in the 4th floor shower room. At that time, the water measured 58 degrees F (Fahrenheit) and was cool to touch.On 12/15/25 at 1:30 pm, V10 (Maintenance) went with Surveyor to test the temperature of the water in the 5th floor shower room. At that time, the water measured 61 degrees F (Fahrenheit) and was cool to touch.On 12/17/25 at 11:12 am, R9 stated the following, I can only wash up in the bathroom. The shower water trickles down and it's cold. The last time I had a good shower was probably in October.On 12/17/25 3:20 pm, V3 (Director of Nursing) stated the following, The residents should have hot running water. Hot or warm water works better to remove germs during showers. They (residents) are not expected to take cold showers.On 12/17/25 at 3:37 pm, V12 (CNA) stated the following, somedays we have hot water and some days the water is cold. When I give a resident a bed bath, I try to warm the towels by holding it in my hand after lathering the towel. I let my residents know that the shower water is cold and give them the option to shower or not. Some days the water is not as cold, but when it is cold I encourage the residents to just wash up in their bathroom sinks instead of taking a cold shower.On 12/17/25 at 3:50 pm, V13 (CNA) stated the following, I am not able to give my assigned showers because we cannot put the patients in cold water. Some residents refuse the shower just because the water is cold. I wouldn't want to get in a cold water. Even if I offer a bed bath, some people still refuse the bed bath because the water is too cold. When it is cold outside, the water is ice cold.On 12/15/25 at 11:40 am V9 (Dietary Manager) measured the temperature of the hot water running from the main kitchen faucet.At that time, the water temperature was measured at 60 degrees Fahrenheit.Facility Census Report dated 12/07/25 documents 181 active residents in the facility.Facility Maintenance Log document the following maintenance requests for the second floor: 11/13/25- water hasn't been hot in four days; 12/3/25 and 12/8/25- toilet not flushing.Facility Maintenance Log document the following maintenance requests for the third floor: 11/4/25- shower room water is ice cold; 11/5/25- toilet not flushing; 11/11/25- no acceptable water pressure and water temperature no good; 11/22/25- no water from sink, water pressure low; 11/24/25- no water; 12/6/25- water not warm in shower room; 12/17/25- no hot water.Facility Maintenance Log document the following maintenance requests for the fourth floor: 11/6/25- shower room water not working.Facility Maintenance Log document the following maintenance requests for the fifth floor: 11/10/25- water from sink not working and toilet not flushing; 11/21/25- toilet wont flush; 12/4/25- low water pressure.Plumbing Company Estimate dated 3/13/25 documents a total repair cost of $3,250.Facility email between V5 (Project Manager) and V1 (Administrator) dated 8/14/25 documents, Plumbing company will be out on Tuesday (8/19/25) to replace valves on both sides of the water meter.Facility email between V4 (Maintenance Director) and V5 dated 12/2/25 documents, low water pressure/ fire pump not operable.Maintenance Director Job Description documents the following as part of the essential duties: maintain the building in good repair and free of hazards such as those caused by electrical, plumbing, heating and cooling systems, life safety, etc. Event ID: Facility ID: 145834 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 145834 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, record review and interviews, the facility failed to ensure that the kitchen was free from pests. The facility also failed to ensure that the kitchen oven was clean and free from debris. This failure has the potential to affect 181 residents that reside in the facility.Findings include:On 12/15/25 at 11:40 am Surveyor noted a brown bug crawling on the sink across from the oven. The oven was also noted to have brown dried substance on the doors and inside of the oven with black particles in the oven as well.At that time, V9 (Dietary Manager) stated the following, It looks like a roach crawling. I think the oven was last cleaned on our deep cleaning day, last Wednesday. We usually clean and sanitize everything after each use to contribute to pest control.On 12/17/25 at 3:21 pm, V3 (Director of Nursing) stated the following, I would hope to not see pest in the kitchen because that where the food is prepared. They can harbor germs and bacteria.Facility Census Report dated 12/07/25 documents 181 active residents.Dietary Services Policy documents, to store prepare and distribute food under sanitary conditions and prevent foodborne illnesses.Pest Control Policy documents, to prevent or control insects and rodents from spreading disease. Event ID: Facility ID: 145834 If continuation sheet Page 5 of 5