Inspection·March 28, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3/15/24 at 2 PM passed with no communication from [V7]. I gave an extra hour grace period and still nothing. I was furious and I called in the complaint. The facility has changed ownership while all this was happening and [V7] told me he was busy with the transition. It's all just so ridiculous! R1 pointed to a yellow bag in the corner of the room. The bag had a skew number and room number written in black marker. R1 said the facility labels the bag with the resident room numbers. The resident laundry is collected in the yellow bag and the CNAs are supposed to remove the laundry bags to send out. R1 said sometimes the CNAs don't remove the laundry and V6 (Housekeeper) will remove them. R1 said in the past she had received an entire bag of clothing that did not belong to her and once her blanket got mixed into someone else's bag. R1 stated, I know to check what I put in the laundry bag and what comes back to me. This isn't the first and probably won't be the last time I have a laundry issue. They (the facility) need to get it together! It's 3/28/24 and I still have no check! R1's Facesheet dated 3/28/24 showed diagnoses to include, but not limited to: asthma, morbid obesity, mechanical complications of an implanted neurostimulator of the spinal cord, hyperkalemia, hypothyroidism, anxiety, dorsalgia, major depression, and insomnia. R1's facility assessment dated [DATE] showed she was cognitively intact. R1's Progress Notes were reviewed from 10/1/23 - 3/28/24. These notes did not contain anything about R1's missing clothing or updates regarding the clothing. The progress notes showed R1 was admitted to the hospital on [DATE] and readmitted to the facility on [DATE]. The facility's Grievance Log showed an initial missing item concern filed by R1 on 10/12/24 with a due date of 10/19/24. The log showed R1 filed another missing item concern on 3/21/24 with due date of 3/28/24. R1's Concern/Complaint Form dated 10/12/24 showed V7 (Guest Relations Director) took the complaint in person on 10/12/23. This document showed, The resident states a black PJ top, lounge pants with blue combo top and bottom did not return from the laundry. This form showed V7 was assigned the concern for follow-up. The form showed the allegation was substantiated and there was a search for the missing items. The missing items were not located and a re-imbursement form was sent to [the laundry company]. This form showed, .They do not contact us for follow-up and mail out a check to the resident. [R1] was satisfied . R1's Re-imbursement Form dated 10/12/23 showed R1's lost items cost $55.98 with each item price listed below. The form had a '?' listed under Resident Bag Number. This form does not show the date it was sent to the laundry company. The surveyor requested a fax transmittal or email to prove the form was sent on 10/12/23. The facility was unable to provide these documents. R1's Concern/Complaint Form dated 3/20/24 showed, Resident states she did not receive reimbursement from laundry company from a prior concern last year. V7 documented, Reached out to [the laundry company] again, they stated they will locate the bar code and follow-up. Apologized for the inconvenience. This formed showed Y the concerns was resolved on 3/22/24, but showed N the resident was not satisfied with the resolution, Will not be satisfied until check is received. (R1 had not received the check as of 3/28/24.) The facility's Resident Council Meetings Minutes dated 3/6/24 showed, Maintenance: There were concerns about a resident's missing laundry . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145936 If continuation sheet Page 2 of 7 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 3/28/24 at 1:52 PM, V3 (ADON) said the resident laundry is collected in yellow bags. The yellow bags are labeled with the resident's room number. The CNAs collect the yellow bags on Monday, Wednesday, and Fridays and place them in the soiled utility room. V6 (Housekeeping) picks up the yellow bags, places them in a big bin, and takes them downstairs for the pick up. The laundry is not done here at the facility. It's all done off site. The laundry is returned after it's cleaned and V6 returns it to the residents. V3 said a week or 2 ago, R1 was very upset. At first R1 said that it wasn't a nursing issue, but she could tell R1 was very upset. V3 said eventually, R1 said she was very upset that she hadn't been reimbursed for clothes that were lost in October 2023. V3 said a concern form was completed and she told R1, I'll try to do what I can. She (R1) told me she was waiting for a $56 check since October and I thought there must be a logical explanation. I looked into it and apparently the laundry company is responsible for issue of the check. Before the end of my shift, I stopped and updated [R1]. I have no idea why it's taken so long. I have no idea what happened. I just knew she was very upset and tried to do what I could. That's what nurses do. On 3/28/24 at 2:07 PM, V5 (Maintenance/Housekeeping Director) said the facility does not launder the resident clothes, but had a contracted laundry service. V5 said yellow laundry bags are supplied by the laundry company. The bags are coded with a skew number, but we write the room number on the outside of them. The bags are given to the residents and the resident or the CNAs load the clothing into the bags. The CNAs collect the resident bags and take them to soiled utility room. The housekeepers collect the laundry bags in a cart and keeps them downstairs until the laundry company comes to pick them up. V5 said the facility is in the process of changing how they track the bags, but it is still a work in progress. V5 said the facility would write the resident's room number on the outside of the bag in black marker, but the laundry company tracks the bags by the skew number. V5 said some of the room numbers weren't matching the skew codes. V5 said lost clothing is handled by himself or V7 (Guest Relations Director). V5 said he wasn't aware R1 had lost clothing in October 2023 and still had not been reimbursed. V5 said there have been issues with getting reimbursement from the laundry company. V5 stated, I've only gotten 1 reimbursement in 6 years and it was a $50 gift card, not a check. We should have regular communication with the resident while there is a claim out. We want to at least keep them updated. Unfortunately that part is out of our hands. V5 said V6 (Housekeeper) has the most interaction with the residents and should report any missing items to himself or V7 right away. On 3/28/24 at 2:16 PM, V6 (Housekeeper) said picks up the laundry bags from the soiled utility room and placed them in a cart for pick up. V6 said when the clothes come back, then he usually delivers them and checks the bag with the resident. V6 said if a resident is missing clothing, then I'll keep an eye out for it. If I can't find the clothing, then I notify V7 (Guest Relations Director). V6 said if the resident is only missing 1-2 articles of clothing it is difficult to track. V6 said it's easier to locate an entire bag. V6 said the laundry company does laundry for other facilities and there are times the contents get mixed up. V6 said a resident had received an entire bag of someone else's clothing. V6 stated, It happens. V6 said in the past R1's blankets were mixed with another rooms linens. V6 said he does not do the grievance and can't promise anything, but the does try to locate lost clothing. V6 said R1's very frustrated because her clothes went missing in October 2023 and she still hasn't been reimbursed. V6 stated, She (R1) gave me a list of the missing items and I gave it to whoever was handling it. I'm sorry I'm not sure who it was. I think (V7) was on vacation when it all happened. On 3/28/24 at 2:41 PM, V7 (Guest Relations Director) said lost resident laundry is usually handled by Maintenance. V7 said if the clothing can't be located, then a reimbursement form must be completed and sent to the laundry company. V7 stated, That's it for me. From there it is up to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145936 If continuation sheet Page 3 of 7 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few laundry company. V7 said he sent the reimbursement R1's reimbursement form. (The form does not show a fax transmittal. The surveyor requested email proof of the date the form was sent. The facility was unable to provide emails of communication with the laundry company from 10/2023-2/2024. The only email provided was dated 3/20/24). V7 said R1 requested follow up and he thinks he followed up in November on R1's concern, with the laundry company. V7 said the laundry company doesn't usually contact him and there is minimal contact between himself and the laundry company. V7 said R1 complained again in March 2024 and he filed another concern via email. V7 provided an email dated 3/20/24. The email showed, I submitted an inquiry around November abut missing clothes for a resident and was never able to get a response. We were also previously known as [previous facility name] and are now [current facility name]. I had submitted a Reimbursement form as well. The resident states that the quoted price of missing belongings is $55.98. Are you able to write a check to her? It has been a long time since then and she is still asking for compensation for it. What are some steps we can do to remedy this? V7 said he still hadn't received a response from the laundry company (8 days later). V7 said he had not attempted to call the laundry company, but pointed to the phone number on the bottom of the reimbursement form. V7 said he had not updated the resident on the status of her concern because R1 is very upset about this situation and he didn't want to have her shoot the messenger. V7 said 6 months was too long for a response to R1's concern. V7 said he notified V1 (Administrator), but he was not sure what happened after that. V7 said unfortunately, they have problems reaching the laundry company. On 3/28/24 at 3:24 PM, V1 (Administrator) said when a resident has a concern, then a Concern/Grievance concern is started. The concern is assigned to the appropriate manager. The manager is responsible for the follow-up and he oversees the process. The manager is responsible for discussing the concern with the resident, updating the resident, and discussing the resolution with the resident. V1 said he had communication with the laundry company, but was unable to provide a date. V1 said the communication and follow-through on the laundry company's part was not the greatest. V1 said R1 was informed that her reimbursement claim was submitted and payment can take 15-20 days to process. V1 said R1 didn't receive a check yet. V1 said a couple weeks ago R1 brought the concern up again. V1 said the facility had issues with the laundry company in the past. V1 stated, It's the downside of having the laundry outsourced. [R1's] laundry did not go missing on this premises. On 3/28/24 at 5:21 PM, V8 (Customer Relations for the laundry company) said she recalls R1 missing clothing. V8 was unsure of the date the Reimbursement Form was sent. V8 said she would review the file when she returned to the office and call back. V8 said V7 wasn't notified that the Form did not include the bag skew number. V8 said that is how the laundry company tracks the resident laundry. V8 said there were emails that went back and forth, but had not received the bag numbers. V8 said the laundry company hadn't heard anything until two weeks ago and V7 escalated his concern. V8 said V7 provided 3 bag numbers and the laundry company was in the process of reviewed that information. The surveyor asked when the initial Reimbursement Form was received and when V7 had emailed the laundry company. V8 said she reviewed her email and did not see anything from October or November 2023. V8 said she would check the paper file when she returned to the office. (As of 3/29/24 at 2:14 PM, V8 had not provided this information). V8 said the facility is responsible for all communication with the resident's. V8 said the laundry company only communicates with a facility representative. V8 said the checks are directly issued to the resident, but one had not been sent to R1 yet. The facility's Missing Items Policy dated 1/2023 showed, It is the policy of the facility to take (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145936 If continuation sheet Page 4 of 7 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few seriously all issues of missing items and take the necessary measure to locate the items. Responsible Party: Administrator, Social Services. Guideline: 1. All reports of missing items shall be discussed with the resident. 2. A search for the missing items will occur . 4. If the item is not located, then the Administrator will discuss the possible options with the resident . The Laundry Company's Reimbursement Policy for Lost/Damaged Personal Items showed, .Lost items: [The laundry company] will pay for the replacement of any lost items resulting from negligence on our part as outlined below. 1. [The laundry company] will be held responsible only for personal items sent in the bags designated for personal laundry. [The laundry company] is not responsible for any items sent to us mixed in with the bulk linen, or in regular soiled linen bags . 3. In order to receive reimbursement for a lost item, customer shall provide: a. Date item was sent to laundry. b. Date item was returned. c. A picture of the item (if available) and full description. d. Item cost. e. Approximate age of the item. The facility's Concerns/Grievance Policy reviewed 1/10/24 showed, It is the policy of this facility that each resident has the right to voice grievances to the facility or other agency or entity that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal. Responsible Party: All facility staff. Guideline: 1. Notification that Grievances/Concerns may be filed anonymously; A response in writing may be requested; and the grievance must be answered within 72 hours. 2. Any staff member in the facility may receive a grievance or concern from the resident or family member. 3. If possible, upon receiving the grievance or concern, attempt to resolve the grievance or direct the resident or family to the appropriate department head or the Administrator . 6. The department head is responsible for investigating the grievance or concern and speaking with the resident or family member who made the complaint regarding both the concern and possible resolution. 7. The department head will summarize on the bottom of the concern form the resolution and forward the completed form to the Administrator. 8. The Administrator will be the designated Grievance Officer and will review the completed form and action taken and do any follow-up necessary. 2. On 3/28/24 at 12:13 PM, R2 was lying on her bed, eating lunch. R2 said she was missing an off-white sweater with a light stripe across it. R2 said she told V7 (Housekeeping) and he said he would keep an eye out for it. R2 said she told him yesterday (3/27/24). R2 said her clothing had her name on the tag and the laundry bag had her room number on it. R2 stated, I know they were talking in Resident Council about missing clothing. It seems to be a problem. I'm not mad at [V7] it's not his fault, but my clothes aren't cheap and I can't really afford to lose a bunch. R2 said she's received another resident's laundry before, but she didn't know who the clothes belonged to. R2 stated, I just know it wasn't mine. R2's Facesheet dated 3/28/24 showed diagnoses to include, but no limited to: polyosteoarthritis, unsteadiness on feet, polyneuropathy, repeated falls, lack of coordination, and weakness. R2's facility assessment dated [DATE] showed she had moderate cognitive impairment. The facility's March 2024 Grievance Tracking Log showed on 3/8/24 R2 had missing items. There was not other listed Grievances for R2. The facility did not provide a Concern/Complaint Form related to the 3/8/24 Missing Items concern. The facility did not provide a concern form about R2's missing sweater. R2's Concern/Complaint Form dated 3/19/24 showed, Resident believed she misplaced her [NAME] and her silk top . Maintenance found [NAME] ring under sink and silk top in the closet . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145936 If continuation sheet Page 5 of 7 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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 0585 Level of Harm - Minimal harm or potential for actual harm On 3/28/24 at 2:07 PM, V5 (Maintenance/Housekeeping Director) said the facility does not launder the resident clothes, but had a contracted laundry service. V5 said V6 (Housekeeper) has the most interaction with the residents and should report any missing items to himself or V7 right away. V5 said lost clothing is handled by himself or V7 (Guest Relations Director). V5 said he was not aware R2 was missing any clothing. Residents Affected - Few On 3/28/24 at 2:16 PM, V6 (Housekeeper) said picks up the laundry bags from the soiled utility room and placed them in a cart for pick up. V6 said when the clothes come back, then he usually delivers them and checks the bag with the resident. V6 said if a resident is missing clothing, then I'll keep an eye out for it. If I can't find the clothing, then I notify V7 (Guest Relations Director). V6 said he wasn't sure if R2 was missing any clothes. The surveyor described the off-white sweater. V6 stared blankly, I don't recall, but I deal with a lot of residents and laundry. On 3/28/24 at 2:41 PM, V7 (Guest Relations Director) said he was not aware that R2 was missing any clothing. V7 said if R2 notified V6 (Housekeeper), then he should have reported it so a Concern Form could be started. 3. On 3/28/24 at 12:45 PM, R3 was sitting up in bed, eating her noon meal. R3 said she's had several issues with her laundry. R3 said one time they faded her clothes, but they did reimburse her for that. R3 said right now she is missing one pair of black sweatpants, 1 pair of blue sweatpants, a green T-shirt, and a pink T-shirt with blue and white on the front. R3 said the pants have been missing for about 1 month. R3 stated, I talked to V7 (Guest Relations Director) about it, but haven't heard anything back. I did not get a check for these clothes yet. I don't have much money and I can't afford to replace the clothes. The clothes I do have were gifts to me. Those black sweatpants were so warm and comfortable. I miss those the most. It would be nice if someone would follow-up and tell us what is going on. R3 said she told V7 (Housekeeping) about the missing clothes and he said he would look for them. R3 continued, I guess he hasn't seen them because I haven't heard anything. R3's Facesheet dated 3/28/24 showed diagnoses to include, but not limited to: diabetes, abnormal posture, morbid obesity, left below the knee amputation, lack of coordination. R3's facility assessment dated [DATE] showed she was cognitively intact. The facility's March 2024 Grievance Tracking Log showed R3 reported missing items on 3/8/24. R3's Concern/Complaint Form dated 3/19/24 showed, Resident believes to have misplaced some clothing. Resident stated she informed [V7] about her missing items. Stated she has not seen them in 2 weeks . Helped resident find clothing with assistance in going through closet . The facility did not provide a Concern/Grievance Form for the off-white sweater R3 reported missing. On 3/28/24 at 2:07 PM, V5 (Maintenance/Housekeeping Director) said the facility does not launder the resident clothes, but had a contracted laundry service. V5 said V6 (Housekeeper) has the most interaction with the residents and should report any missing items to himself or V7 right away. V5 said lost clothing is handled by himself or V7 (Guest Relations Director). V5 said he was not aware R3 was missing any clothing. On 3/28/24 at 2:16 PM, V6 (Housekeeper) said he picks up the laundry bags from the soiled utility room and places them in a cart for pick up. V6 said when the clothes come back, then he usually delivers them and checks the bag with the resident. V6 said if a resident is missing clothing, then I'll (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145936 If continuation sheet Page 6 of 7 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 145936 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aliya of Highwood 50 Pleasant Avenue Highwood, IL 60040 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete keep an eye out for it. If I can't find the clothing, then I notify V7 (Guest Relations Director). V6 said he wasn't sure if R3 was missing any clothes. The surveyor described the off-white sweater. V6 stared blankly, I don't recall, but I deal with a lot of residents and laundry. On 3/28/24 at 2:41 PM, V7 (Guest Relations Director) said he was not aware that R3 was missing any clothing. V7 said if R2 notified V6 (Housekeeper), then he should have reported it so a Concern Form could be started. Event ID: Facility ID: 145936 If continuation sheet Page 7 of 7