Health inspection·January 30, 2026

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few Based on interview and record review the facility failed to prevent resident to resident physical abuse for two (R1, R2) of seven residents reviewed for abuse. This failure resulted in R2 sustaining an injury near the right eye and being sent to the hospital for evaluation. It can be determined that the reasonable person would have experienced psychosocial harm as a result of the physical abuse, since a reasonable person would not expect to be injured in this manner in his/her own home or a health care facility. Findings Include:R1 has diagnosis not limited to Nicotine Dependence, Cigarettes, Peripheral Vascular Disease, Type 2 Diabetes Mellitus with Diabetic Neuropathy, Acquired Absence of Right Foot, Mononeuropathy of Right Lower Limb, Complete Traumatic Amputation at Level Between Knee and Ankle, Right Lower Leg, Type 2 Diabetes Mellitus with Foot Ulcer, Morbid (Severe) Obesity due to Excess Calories and Major Depressive Disorder. R1's MDS (Minimum Data Set) BIMS (Brief Interview for Mental Status) score is 15 indicating intact cognitive response.R1's Care plan document in part: Focus: R1 is a long-time smoker and expresses the desire to smoke at this facility. Focus: R1 has/have a Right Below-the-Knee (BKA) Amputation.R1's Progress note dated 12/05/25 document in part: Visit Type: Follow-up Details: Chief complaint: Follow-up visit for evaluation of physical altercation with another resident. Patient seen and examined today 12/05/25. Per nursing, patient had a physical altercation earlier today with another resident. Per patient, he (R1) was hit on the Left side of his (R1) face, no bruising or redness or swelling noted on the affected area. Patient is aware and agrees that he (R1) will be sent out to Hospital for psych evaluation under petition. Social History: smoker, Nicotine Dependence Tobacco Abuse Counseling - patient is a current everyday smoker. Progress note dated 12/05/25 document in part Change of Condition Situation: 1. The change in condition, symptoms, or signs observed and evaluated is/are: Resident (R1) hit another resident 2. This started on: 12/05/25. 7. Other relevant information: Resident (R1) hit another resident 1. Summarize your observations and evaluation: resident hit another resident 2a. Recommendations of Primary Clinicians (if any): send to ER (Emergency Room) for psych evaluation. R1's Progress note dated 12/05/25 17:26 document in part: General Progress Note Text: Called Hospital, resident is admitted dx (diagnosis) Psyche evaluation (Under Petition). Progress note dated 12/8/25 15:03 document in part: admission Summary Note Text: patient from Hospital readmitted in the facility with the diagnosis of major depression with single episode w/o (without) psychosis. Abuse Reportable Initial Form dated 12/05/25 document in part: Allegation Type: Physical. On 12/05/25 at approximately 09:40 AM it was reported to this writer that during a dispute that occurred on the way out to the smoking patio between R1 and R2. R2 alleged that R1 hit him in the face. R2 was observed with redness on his upper cheek. Summary of Investigator's findings: Police were called they stated that it is unclear if there was an aggressor, and each individual thought they needed to defend themselves. R2 was sent to the hospital for evaluation. R2 had redness. On 01/29/26 at 02:28 PM R1 stated There is a smoke ramp that is between 2 doors. R2 was coming through the dining room and went through the Page 1 of 3 145838 145838 01/30/2026 Peterson Park Health Care Ctr 6141 North Pulaski Road Chicago, IL 60646

F 0600 Level of Harm - Actual harm Residents Affected - Few first door. R2 was just standing on the ramp to the smoking patio about half the way down lighting a cigarette and knew I was behind him (R2). R2 knew it would be difficult for me to go down and I said let me get by. R2 stepped to a little to the left and I went to the right to go around R2. I brushed R2's jacket then I felt a blow to the left side of my face near the temple. I then reach up to R2, grabbed his jacket collar, pulled him down and gave R2 a couple of punches to the face with my fist. R4 stood over R2, said that was enough and helped R2 up. They called a code; staff came but we were already separated because it was quick within seconds. I said I did not appreciate R2 hitting me in the walk-up ramp to the smoke patio. R2 has diagnosis not limited to Essential (Primary) Hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Alcohol Abuse with Intoxication, Nicotine Dependence, Cigarettes, Ocular Hypertension, Unspecified Eye, Ischemic Optic Neuropathy, Right Eye and Hypotension. R2's MDS (Minimum Data Set) BIMS (Brief Interview for Mental Status) score is 15 indicating intact cognitive response. R2's Progress note dated 12/05/25 17:39 document in part: General Progress Note Text: R2 is admitted with dx (diagnosis) of Hypotension, Facial contusion, Dehydration and Lactic Acidosis. Progress note dated 12/06/25 23:55 document in part: admission Summary Note Text: readmitted resident to the facility from Hospital. On 01/29/28 at 12:57 PM R2 stated there was a battery. This facility has a failure to protect the residents. I was attacked and I am still having problems to my right eye. I was hit on or about the right temple. R1 threatened to beat me into a coma. R1 was beating me in the temple, and he rammed me from behind with his wheelchair. I don't feel safe in my home. This happened in the vestibule on the way to the smoking tent. I was in the hospital overnight. The facility has a legal obligation to protect you.On 01/29/26 at 04:30 PM V1 (Administrator) stated at around 09:40 AM we had a code grey, and all the staff went there. On the way out to the smoking patio R2 was standing blocking the path lighting his cigarette making everyone wait. R1 tried to maneuver pass R2 and R2 attack R1 and pushed R1 out his (R2) way. We petition R1 out to the hospital based on the allegation and R2 went to hospital. After the residents are going down the smoking ramp a little there is a blind spot. V6 (Activity Aide) didn't see R1 push R2, but she saw R2 kind of push R1. R1 said he was trying to protect himself after R2 pushed him (R1) away and R1 hit back, it was defensive. R1 was being attacked and was trying to protect himself.On 01/29/26 at 04:21 PM V2 (Assistant Administrator) stated I was not here that day but the incident between R1 and R2 happened during smoke break. R2 stopped at the threshold to enter the smoking tent to light his cigarette. R1 asked could he proceed as he was trying to get through. R2 was reluctant and R1 tried to move around R2. R1 may have bump R2 unintentionally and there was a misinterpretation of each one's intentions. V6 (Activity Aide) went out to the smoking patio ramp to break up what was happening. R2 did have discoloration, bruising on his face.On 01/29/26 at 04:13 PM V3 (Director of Nursing) stated There was a bruise on the right side of R2's face that started turning dark like a dark spot (black eye).On 01/29/26 at 01:32 PM V5 (Licensed Practical Nurse) stated On 12/06/25 I readmitted R2 into the facility. R2 had a bruise, and his right eye was black. R2 said he got punched by another resident.On 01/29/26 at 01:58 PM V6 (Activity Aide) stated I was sitting here at the table near the smoking patio door. R2 went out the first door to the smoking patio and was standing in the middle of the walkway to light his cigarette. R2 went to the second door and R1 went out and said excuse me. R2 put his hand in R1 face and before I could get up R1 had struck R2 with his fist. I don't know where R1 hit R2 but about time I went out there R2 was on the ground. R4 stopped R1 from hitting R2 when R2 was knocked to the ground.On 01/29/26 at 02:50 PM V7 (Licensed Practical Nurse) stated On 12/05/25 when they went for smoking break around 09:30 AM R1 and R2 wanted to get out the door. R2 hit R1 first and R1 hit him *(R2) back. We separated the residents for safety and went to 145838 Page 2 of 3 145838 01/30/2026 Peterson Park Health Care Ctr 6141 North Pulaski Road Chicago, IL 60646

F 0600 Level of Harm - Actual harm Residents Affected - Few the administrator to report the abuse. R1 and R2 were sent to separate hospitals for evaluation.On 01/29/26 at 03:26 PM V9 (Wound Care/Licensed Practical Nurse) stated R2 came back from the hospital with discoloration on the upper right cheek. The area was a maroon color.On 01/29/26 at 02:15 PM R3 stated I witnessed the incident between R1 and R2. In the process of R1 rolling backwards down the smoking patio ramp R2 was coming through there. R1 and R2 had an altercation, and their voices elevated. R2 tried to act like he was going to hit R1 and R1 knocked R2 down. R4 helped R2 up from the ground. In a reaction, R1 hit R2 back in his face.On 01/29/26 at 01:20 PM R4 stated I was sitting on the southeast end of the smoking patio in a chair. I heard a disturbance and looked over to the side and say R2 was on the ground. They were coming down the ramp and R2 bumped into R1.On 01/29/26 at 01:49 PM R5 stated I was out there when R1 and R2 were arguing. R1 grabbed R2 threw him to the ground and start hitting R2 in the face. R2's eye was messed up for about 3 weeks.Policy:Titled Abuse and Neglect revised 01/09/26 document in part: It is the policy of the facility to provide professional care and service in an environment that is free from any type of abuse. Physical abuse includes but not limited to infliction of injury that occur other than by accidental means and requires medical attention. 145838 Page 3 of 3