Health inspection·January 30, 2026

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based upon interview and record review, the facility failed to report an injury of unknown origin to the state surveying agency within regulatory requirements for one (R7) resident. This failure has the potential to affect all 172 residents residing in the facility. Findings include: Findings include: On 01/27/2026 at 2:02PM, Facility Reported Incidents/FRIs were requested from V1 (Administrator) for the past 3 months. V1 provides surveyor with three incident reports via scanned email, that are dated 12/02/25, 12/16/25, and 01/14/2026. V1 states these are the only facility reported incidents that occurred in the facility for the past 3 months. During record review of facility's reported incidents, surveyor observes that they were not submitted to the correct email address. On 01/29/2026 at 2:12PM V1 states she was made aware of R7's incident by V2 (DON). V1 states she reported R7's incident to the state agency via email on 12/16/2025, the same day it was reported to her. V1 is made aware that the state agency is not in receipt of the reported incidents. V1 is asked by surveyor to access her emails electronically and send surveyor email confirmation of the successful submission of the reported incident for R7 to the state agency. V1 states she is unable to access her emails at the current moment and will check for the email confirmation later. On 01/29/2026 at 3:32PM, surveyor receives an email from V1 stating she did not receive email confirmation from the state agency that the reported incident for R7 was received. V1 states the email was kicked back to her email and not sent successfully to the state agency. V1 states R7's reported incident was also sent from V2's email to the state agency. V1 emails surveyor a scanned email documenting a time stamp of an undeliverable blank email to the state agency. V1 also emails surveyor a scanned email documenting a time stamp of a blank email being sent from V2's email to the correct state agency's email. Both scanned emails do not have R7's facility reported incident attached showing proof of submission to the state agency. On 01/29/2026 at 4:07PM, surveyor requests V1 to directly forward surveyor the email that was sent from V2's email to show confirmation of R7's reportable incident that was sent to the state agency. Surveyor asks V1 not to scan the email and send it to surveyor, but to forward the exact email with R7's reportable attached that was sent to the state agency. This email was not provided to surveyor during this survey. On 01/29/2026 at 4:42PM, record review confirms that a facility reported incident for R7 was not received by the state agency from the facility. Further record review documents and confirms that a facility reported incident has not been received by the state agency from the facility since 12/03/2025. On 01/30/2026 at 10:51AM, V1 states that she has been the administrator since 08/2024 and was not aware that she was submitting the facility reported incidents to the incorrect email address. V1 states she never received confirmation that the email was sent to the state agency. V1 states herself and V2 share responsibilities with submitting the facility reported incidents to the state agency. V1 states since being informed by surveyor of using the incorrect email, she has now obtained a fax number to use instead of the email. V1 states the fax number is 708-544-92XX and V1 is made aware by surveyor that this is also an incorrect fax number for (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 6 Event ID: 145914 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 145914 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southpoint Nursing & Rehab Center 1010 West 95th Street Chicago, IL 60643 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)