Inspection·December 11, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/9/23 at 2:31PM, V9 (Physical Therapist) stated, I'm not entirely sure how the (mechanical lift) transfers are supposed to work for (R1). I haven't actually seen the staff do them and I didn't do any training with them on the lift with her. On 12/9/23 at 3:20PM, V3 (Director of Nursing) stated, I can't confirm how the grab bar is supposed to be positioned with the (mechanical lift). I'm not sure what (R1's) transfer status is, therapy handles all of that. On 12/9/23 at 4:22PM, V3 stated, We can't transfer (R1) the correct way because she said it hurts her back. It is documented that we spoke with her about this, and she confirmed she understood the risks with not using the lift properly. (The facility was unable to provide documentation regarding this conversation with R1 and R1 declined knowledge of this conversation). The facility's policy titled, Using a mechanical lifting machine dated 07/2019 showed, The purpose of this procedure is to establish the general principles of safe lifting using a mechanical lifting device. It is not a substitute for manufacturer's training or instructions .12. Attach sling straps to sling bar, according to manufacturer's instructions. A. make sure the sling is securely attached to the clips and that is properly balanced. B. check to make sure the resident's head, neck and back are supported . The undated mechanical lift owner's manual provided by the facility showed, Move the lift slowly towards the user and position the spreader (grab) bar over the user's patient's chest. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145932 If continuation sheet Page 2 of 4 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 145932 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Wilmette 432 Poplar Drive Wilmette, IL 60091 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to perform incontinence care and provide catheter care in a manner to prevent urinary tract infections for 1 resident. The facility also failed to position a resident's urinary catheter bag off the floor for 1 resident. These failures apply to 2 of 3 residents (R1, R2) reviewed for incontinence care in the sample of 4. The findings include: 1) R1's electronic face sheet showed R1 has diagnoses including but not limited to urinary tract infection, morbid obesity, acute pulmonary edema, and heart failure. R1's facility assessment dated [DATE] showed R1 has no cognitive impairment and is occasionally incontinent of bladder. R1's care plan dated 10/26/23 showed, The resident is at risk for incontinence related to activity intolerance, has current bowel incontinence, current urinary incontinence, impaired mobility, physical limitations, and diagnosis of overactive bladder .The resident uses disposable briefs. Change as needed. Check routinely, upon request, as needed for incontinence. Wash, rinse, and dry the perineum, and apply a barrier cream. On 12/9/23 at 10:30AM, R1 stated, I was in the hospital at the beginning of November for a urinary tract infection. They told me it was a complicated infection and I had to get intravenous antibiotics. They don't change me enough here and when they do, they don't clean me well. On 12/9/23 at 11:36AM, V4, V5, and V6 (Certified Nursing Assistants) provided incontinence care for R1. V6 removed R1's heavy, urine soaked and odorous incontinence brief. V6 cleansed both sides of R1's groin with the same side of the wipe and then pushed the wipe down into R1's vaginal area. V6 performed this action twice in a row while wiping from R1's groin down into her vaginal area. V6 then cleansed R1's vagina by wiping 4 times down the front of R1's vagina with the same side of the wipe. V6 stated that is how he provides incontinence care, and no one has ever told him differently. V6 stated there is nothing incorrect with the way he provides incontinence care. On 12/9/23 at 3:20PM, V3 (Director of Nursing) stated, When staff are providing incontinence care for a female resident, they should be cleansing the groin and vaginal area with different wipes, not wiping from the groin down into the vaginal area. If staff clean a resident's groin and push it into the vaginal area that could introduce bacteria into the vagina and puts the resident at risk for a urinary tract infection. The facility's policy titled, Perineal Care dated 02/2018 showed, The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition .For a female resident: b. wash perineal area, wiping from front to back. 1) Separate the labia and wash area downward from front to back. 2) Continue to wash the perineum moving from inside outward towards the thighs . 2) R2's electronic face sheet printed on 12/9/23 showed R2 has diagnoses including but not limited to multiple sclerosis, need for assistance with personal cares, and neuromuscular dysfunction of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145932 If continuation sheet Page 3 of 4 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 145932 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel Care Center-Wilmette 432 Poplar Drive Wilmette, IL 60091 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 0690 bladder. Level of Harm - Minimal harm or potential for actual harm R2's facility assessment dated [DATE] showed R2 has no cognitive impairment and is dependent on staff for personal hygiene. Residents Affected - Few R2's care plan dated 11/11/23 showed, The resident has a Suprapubic Catheter: (Neurogenic bladder. Foley catheter) and chronic obstructive pyelonephritis. On 12/9/23 at 1:10PM, R2's urinary catheter bag was laying on R2's floor, in direct contact with the floor. R2 stated, Right before I was admitted here, I was in the hospital for a urinary tract infection, and I ended up with sepsis. I was very ill and in the hospital for quite a while, so they kept the catheter in me to see if it helps with my infections. On 12/9/23 at 1:36PM, V7 and V8 (Certified Nursing Assistants) provided urinary catheter care for R2. V8 cleansed each side of R2's groin with the same side of the wipe and then pressed the wipe down into R2's vaginal area. V8 did not clean R2's vaginal area or catheter tubing. R2's vaginal area had several chunks of a white substance stuck on her vagina. V7 stated R2's urinary catheter drainage bag should not be on the floor due to infection control concerns. On 12/9/23 at 3:20PM, V3 (Director of Nursing) stated, Catheter bags should always be placed in a dignity bag and should never be lying on the floor due to infection control. When performing catheter and perineal care for a resident with a catheter, the staff should be cleansing the vagina and wiping down the catheter tubing to prevent infections. The facility's policy titled, Perineal Care dated 02/2018 showed, The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition .for a female resident: 1) if the resident has an indwelling catheter, gently wash the juncture of the tubing from the urethra down the catheter about 3 inches. Gently rinse and dry the area. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145932 If continuation sheet Page 4 of 4