Inspection·October 4, 2023

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On October 2, 2023, at 3:11 PM, V5 (Assistant Administrator) said she spoke with V10 on September 6, 2023, and V10 said she heard V3 yelling at a resident and the resident yelling at V3. V5 continued to say V10 reported she heard V3 say you are fine, to the resident. V5 said she had submitted a report to the State Agency today, October 3, 2023, and V3 had been suspended starting October 2, 2023, pending the investigation. V5 continued to say V3 was now suspended because it appeared V3 was screaming at a resident. V5 said it was not originally reported because R1 could not recall what happened. V5 said she had interviewed V3 on September 7, 2023, and V3 didn't have anything to say except R1 was aggressive during toileting. V5 continued to say she should have reported the incident to the State Agency earlier. V5 said a staff member should not scream at a resident. V5 continued to say V3 should had been immediately suspended on September 6, 2023, while the incident was investigated because the report from V10 was V3 was screaming at a resident. On October 3, 2023, at 2:28 PM, V5 said the abuse investigation is ongoing and she is following the abuse policy. V5 continued to say the facility should have followed the abuse policy when this was reported on September 6, 2023. The facility's report to the State Agency dated October 2, 2023, at 2:26 PM, showed, Incident Description: Facility received report from surveyor who is in the building on a complaint survey that per anonymous report, a staff was overheard, 'yelling at a resident while toileting her on 09/06/2023.' Investigation has been initiated. POA (Power of Attorney) and MD (Medical Doctor) have been notified. Final report to follow. The facility's policy titled Abuse Prevention dated 06/2022 showed, .Policy Statement: Our residents have the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. This includes, but is not limited to, freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. The objective of the abuse policy is to comply with the seven-step approach to abuse and neglect detection and prevention . Investigation: A. the community will investigate and report any allegations of abuse within timeframes as required by federal, state, and local requirements; B. See 'Abuse Investigation Reporting' policy for reporting guidelines and roles and responsibilities. Protection: A. The community will investigate and report residents from further potential abuse, neglect and exploitation, or mistreatment while abuse investigations are in progress; 1. Respond immediately to protect the alleged victim and integrity of the investigation; 2. Make room or staffing changes, if necessary to protect the resident(s) from the alleged perpetrator; 3. Provide protection from retaliation; and B. Provide emotional support and counseling to the resident during and after the investigation, as needed . The facility's policy titled Abuse Investigation and Reporting dated 07/2022 showed, Policy Statement: All reports of resident abuse, neglect, exploitation, misappropriation of resident property mistreatment, electronic mail, social media, videotaping, photographing, and other imaging of resident and/or injuries of unknown source ('abuse') shall be promptly reported to local, state and federal agencies (as defined by current regulations) and thoroughly investigated by community management. Conclusions of investigations will also be reported, as defined by the [facility] Abuse Prevention policy. Policy Interpretation and Implementation: Role of the Administrator or designee: A. If an incident or suspected incident of resident abuse, mistreatment, neglect or injury of unknown source is reported, the Administrator or designee will assign the investigation to an appropriate individual . D. The Administrator or designee will suspend immediately any employee who has been accused of resident abuse, pending the outcome of the investigation. E. The Administrator or designee will monitor that any further potential abuse, neglect, exploitation or mistreatment is prevented while the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145956 If continuation sheet Page 2 of 3 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 145956 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citadel at Casa Scalabrini 480 North Wolf Road Northlake, IL 60164 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete investigation is in progress . Role of the Investigator: A. The individual conducting the investigation will, at a minimum: 1. Review the completed documentation forms; 2. Review the resident's medical record to determine events leading up to the incident; 3. Interview the person(s) reporting the incident; 4. Interview any witnesses to the incident; 5. Interview the resident (as medically appropriate); 6. Interview the resident's Attending Physician as needed to determine the resident's current level of cognitive function and medical condition; 7. Interview associates members (on all shifts) who have had contact with the resident during the period of the alleged incident; 8. Interview the resident's roommate, family members, and visitors; 9. Interview other residents to whom the accused employee provides care or services; and 10. Review events leading up to the alleged incident . Event ID: Facility ID: 145956 If continuation sheet Page 3 of 3