Health inspection·December 17, 2023

F 0600 if a resident is abused, they can be traumatized and feel less than other people/residents. Level of Harm - Minimal harm or potential for actual harm On 12/16/2023 at 12:57pm, V2(Director of Nursing/DON) said she was not here on the day of the incident, but V7(CNA) was taking care of a resident from a room across the hall from R1, and he heard commotion, so he turned to look across the hall, and he stated he saw V8 (Former Agency Certified Nursing Assistant) hitting R1's hands repeatedly. V2 said V8 had not received abuse training before working at the facility. V2 said there is an orientation check list that includes forms of abuse that the facility is supposed to go over with new nursing staff, and V8 had not completed or given the orientation packet. V2 stated residents are not supposed to be abused, because the resident can become withdrawn, aggressive, fearful, loss appetite because of depression, become scared, and the resident can be affected mentally from any form of abuse. Residents Affected - Few On 12/16/2023 at 2:42pm, V9(RN) said she was R1's nurse when R1 was hit by V8 at about 11:10pm. V9 said V7(CNA) approached her and told her that he heard a loud smacking when he was in a room across from R1's room, taking care of a resident. V9 stated that V7 said he saw V8 (CNA) in R1's room and V8 was smacking R1 repeatedly on R1's hand, and when V8 saw that V7 had seen her (V8) hitting R1, she (V8) slammed and closed the door. V9 said she notified V11(RN) who was working on another floor, and both nurses went to R1's room and found her in bed, alert and confused. V9 said R1 was resisting full body assessments, but V9 and V11 were able to check the hands and arms and there was no redness were noted. V9 said V11 called V10 (Registered Nurse Manager-RN) who come to the facility. V9 said she has had abuse training and last one was two weeks ago. V9 named forms of abuse and said V1(Administrator) is the abuse coordinator. V9 said if abuse is suspected or witnessed, it is reported immediately to the supervisor on duty. V9 said residents supposed never be abused because it is not right, and it is inhuman, and residents must be treated with care and respect. On 12/16/2023 at 2:59pm, V10(RN) said on that night when R1 was hit by V8, she was the manager on duty and she received a call from V11 who said V7 had noticed V8, who was taking care of R1, slapping R1 on the hand. V10 said V8 was removed from patient areas immediately, and when V10 arrived at the facility she found V8 waiting in the dining room area. V10 said V8 gave her statement and denied hitting R1, V7 gave his statement and said he witnessed V8 hitting R1, and V9 also gave her statement. V10 said she called the police and then went to see how R1 was doing. V10 said she found R1 sleeping and woke her up to speak to her. V10 said R1 told her that she, (R1) said she has had a rough night, and R1 was upset that V10 had woken her up. V10 said she then checked R1's skin for visible injuries and did not see any visible injury. V10 said not all abuses are visible and stated that mental abuse is one of the forms of abuse that is not visible. V10 said when the police got to the facility, she took them to R1's room, where they interviewed R1, then after that they interviewed V8 and as soon V8 completed her statement with the police, V10 asked V8 to leave the building and not to return to the facility. V10 said she also informed R1's family, R1's physician, and V1(Administrator) who is the abuse coordinator. V10 said after that, she went to see all the residents who were assigned to V8, and she and another nurse (No name provided) did skin assessments on all of them and V10 stayed all night to make sure all the residents were ok. V10 said she also completed the FRI (facility Reported Incident Report) and started the abuse prevention training right away for the buildings' nursing staff. V10 said residents should never be hit or abused by any staff member per facility policy. On 12/16/2023 at 3:17pm, V1(Administrator) said R1 was a resident of the facility, and V7 witnessed V8 slapping R1's the hands. V1 said hitting a resident is physical abuse, and V8 was removed from the building after she was witnessed hitting R1. V1 said she was aware this was a noncompliance because the policy is for residents to remain free of abuse. V1 said staff were educated regarding resident abuse. V1 said the policy is before a staff starts working at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 2 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility, the staff should have had abuse prevention training. V1 said V8 fell through the cracks and there is no training on abuse for V8 before V8 started taking care of residents at the facility. V1 said it is important for staff to be trained on abuse and abuse prevention to prevent resident abuse. V1 said R1 did not sustain physical/psychosocial trauma and was assessed by her providers. V1 said R1's BIMS (Brief Interview of Mental Status) when R1 was in the facility was 3/15, meaning R2 has severe cognitive impairment. V1 said residents are not supposed to be abused in the first place, period. Facility Policy titled Abuse prevention, with last approval date of 06/2022, document: POLICY STATEMENT: Our residents have the right to be free from neglect, misappropriation of resident property, and exploitation. This includes but not limited to freedom from corporal punishment, involuntary seclusion, verbal, sexual, of physical abuse or chemical restrain 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. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish including abuse facilitated or enabled through the use of technology. Prior to the survey date, the facility took the following actions to correct the noncompliance: 1.Corrective action for residents noted to have been affected by deficient practice: R1 was assessed by RN on 11/9/23, no treatment was needed, as the hands had no swelling, no bruising, no redness, and the resident had no complaint of pain. Social Worker assessed for emotional upset and trauma evaluation and was negative. R1 remains at baseline for mental and emotional status. 2.How will the facility identify other residents having the potential to be affected by the same deficient practice: Other current residents residing in the facility are at risk. Social Services completed random resident interviews on 11/9/23 and the Director of Nursing has reviewed non-interviewable residents' skin evaluations in the last 30 days and behavioral logs and no other residents were identified. 3. The measures the facility will take or systems the facility will alter to ensure that the problem will be corrected and will not recur: -AdHoc QAPI meeting was held on 11/10/23 by the interdisciplinary team within 10 days and this plan of correction was developed and implemented. This plan meets the elements of past noncompliance as stated in the SOM. -The Medical Director was notified by RN on 11/10/23. -Current associates will be re-educated by the Social Worker or designee on or before 11/11/23 or prior to working their next scheduled shift on the community's Abuse, Neglect, Exploitation Prevention Policy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 3 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0600 Level of Harm - Minimal harm or potential for actual harm -Interdisciplinary team has reviewed Abuse, Neglect, Exploitation Prevention policy and procedure on 11/9/23 and it is in compliance with CMS regulation F600. -The Executive Director or designee will review grievances, abuse, neglect or exploitation investigations to monitor compliance ongoing. Residents Affected - Few 4. Quality Assurance Plans to monitor facility compliance to make sure that corrections are achieved and permanent: Monthly review of completed Grievances and abuse, neglect, or exploitation investigations results and trends will be completed by the Social Worker or designee and reported to the facility's QAPI Committee for the next 3 months and then re-evaluated to determine if further monitoring is indicated. Completion date: 11/11/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 4 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interviews and records review, the facility failed to ensure a Certified Nursing Assistant/CNA possessed the competencies and skill sets necessary to provide nursing and related services in a safe manner for one (R1) resident of three reviewed. This failure resulted in a CNA physically abusing (hitting) R1. This past noncompliance occurred from 11/9/2023 to 11/11/2023. Findings include: On 12/16/2023 at 3:17pm, V1(Administrator) said R1 was a resident of the facility, and V7 (Certified Nursing Assistant/CNA) witnessed V8 (CNA) slapping R1's hands. V1 said hitting a resident is physical abuse, and V8 was removed from the building after she was witnessed hitting R1. V1 said she was aware this was a noncompliance because the policy is for residents to remain free of abuse. V1 said staff were educated regarding resident abuse. V1 said the policy is before a staff starts working at the facility, the staff should have had abuse prevention training, and V1 said V8 fell through the cracks and there is no training on abuse for V8 before V8 started taking care of residents at the facility. V1 said it is important for staff to be trained on abuse and abuse prevention to prevent resident abuse. V1 said R1 did not sustain physical/psychosocial trauma and was assessed by her providers. V1 said R1's BIMS (Brief Interview of Mental Status) when R1 was in the facility was 3/15, meaning R2 has severe cognitive impairment. V1 said residents are not supposed to be abused in the first place, period. On 12/16/2023 at 3:57pm, V7(CNA) said he was in the room across from R1's room, and he was helping another resident get into bed when he heard a loud smacking and V8 (CNA) saying to R1 give me your hand, give me your hand. V7 said he said to himself loudly What the heck is that. V7 said he told the resident he was taking care of to hold on, and he would go to check what was going on because even the resident heard the smacking noise. V7 said he went outside the room he was in and looked through the door of R1 because it was open like a foot, and he saw R1 laying down on the bed, and V8 was on the left side of R1,holding R1's hand and V8 was hitting R1 with the other hand and saying give me your hand, give me your hand, while she (V8) already had R1's hand in her(V8) hand. V8 then looked up and saw V7 looking into R1's room, and she (V8) let R1 hands go and went to the (R1's) door slammed the door closed. Facility Reported Incident (FRI) report dated 11/09/2023 documents: On November 8 at around 11:30 pm, V7(CNA) notified that when he was taking care of resident across the hallway, he heard a smacking noise and when he looked in to R1's room, he noticed that V8 (CNA) was smacking R1 on her hands repeatedly. R1 assessed by staff immediately, stated that It was a rough evening. When asked to elaborate, R1 stated that she was tired, and V8, who helped her tonight was rough, police notified. Investigation started immediately. Investigations concluded: The allegation of abuse was substantiated. On 12/16/2023 at 12:57pm, V2(Director of Nursing/DON) said she was not here on the day of the incident, but V7(CNA) was taking care of a resident from a room across the hall from R1, and he heard commotion, so he turned to look across the hall, and he stated he saw V8( Former Agency Certified Nursing Assistant) hitting R1's hands repeatedly, and reported what he saw to V9(Registered Nurse/RN). V2 said V8 had not received abuse training before working at the facility. V2 said there is an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 5 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0726 orientation check list that includes forms of abuse that the facility is supposed to go over with new nursing staff, and V2 said V8 had not completed or given the orientation packet. Level of Harm - Minimal harm or potential for actual harm Agency Staff Orientation Packet/ In-Service, no date, documents: Residents Affected - Few New Agency staff must complete and sign prior to the start of the shift. Abuse/ Neglect/ Abuse Prevention/ Reporting: Types of Abuse: 1.Physical 4. Sexual 7. Financial Exploitation 2.Verbal 5. Neglect 3.Mental 6. Involuntary Seclusion Facility policy titled Orientation Program for New Hired Employees, Transfers, Volunteers, dated 12/20217 documents: -An orientation program should be provided for all newly hired associates, transfers from other department and volunteers. 4. An introduction of our administration structure, which includes: d. A review of residents' rights Prior to the survey date, the facility took the following actions to correct the noncompliance: 1. Corrective action for residents noted to have been affected by deficient practice: R1 was assessed by RN on 11/9/23, no injury upon assessment and no treatment was required. Assessed by Social Worker on 11/10/23 with no trauma response/no psychosocial sequelae. Resident is at baseline mood. R1 was also assessed by MSW on 11/10/23 and no ill effects, no trauma response, upon assessment. 2. How will the facility identify other residents having the potential to be affected by the same deficient practice: Rounding and interviews were conducted by RN of all remaining patients on the affected assignment. Other current residents at risk were reviewed on 11/9/23 by RN and Social Worker on 11/10/23 and showed no ill effect. 3.The measures the facility will take or systems the facility will alter to ensure that the problem will be corrected and will not recur: -AdHoc QAPI meeting was held on 11/10/23 by the interdisciplinary team and this plan of correction was developed and implemented. This plan meets the elements of past noncompliance as stated in the SOM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 6 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0726 -The Medical Director was notified by RN on 11/10/23. Level of Harm - Minimal harm or potential for actual harm -Current associates will be re-educated by the Director of Nursing or designee on or before 11/11/23 or prior to working their next scheduled shift Abuse Prevention Training. Residents Affected - Few -Interdisciplinary team has reviewed Abuse Prevention Training Policy and procedure and it is in compliance with CMS regulation F600. -Residents with at risk for abuse will be reviewed by the Interdisciplinary Team during the daily clinical meeting for compliance of Abuse Prohibition. -During weekly Resident at Risk meetings, the Interdisciplinary Team will review the clinical record of residents with at risk abuse. The review will be documented in the Resident's clinical record. 4. Quality Assurance Plans to monitor facility compliance to make sure that corrections are achieved and permanent: Monthly review of completed Resident at Risk forms/observations/review results and trends will be completed by the Executive Director or designee and reported to the facility's QAPI Committee for the next 3 months and then re-evaluated to determine if further monitoring is indicated. Completion date: 11/11/23. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 7 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews, and records review, the facility failed to follow their Discarding and Destroying Medications policy, and failed to assure that medications to be disposed were secure and inaccessible to unauthorized staff and residents. These failures have the potential to affect 80 residents living on the first floor that may be able to access the unsecured room. Findings include: On 12/16/2023 at 10:37am, tour of the soiled utility room on the East side of the facility next to the loading dock with V10(Registered Nurse-RN/Quality Director/Infection Preventionist), the door to the soiled utility room was not locked and observed in the room were six 13 gallon clear plastic bags, with five of the plastic bags knotted at the top, and one of the bags was open and medications were observed spilling to the floor, with pills, opened/no wrapper on the floor. Two pills were round, pink in color, one red round pill, one yellow oval pill. V10 said there were around 80 residents on the first floor. V10 said the medications in the room were not properly secured, and if a resident come into the room and consumed the medications, even by accident, it can cause severe allergies, the resident can get sick due to drug interactions depending on the medications the resident is taking, and the residents can become severely ill, and it can even lead to resident death. Observed on the door of the dirty utility room was a sign that stated -Make sure all bags are securely tied before placing in the bins. On 12/16/2023 at 12:10pm, V4 (Director of Facilitates Management) said per policy medications to be wasted should be in a sealed plastic containers and V4 puts those medications in the shed near the dock until they are picked up by the waste company. V4 said the medications to be disposed from the units are supposed to be put in the containers in the soiled utility rooms near the nursing station. The medication disposal containers are square, with a foot activated opening mechanism, and they have a lock on the boxes so that once a medication is put in those containers, it cannot be taken out. V4 said the soiled utility room by the loading dock should not have wasted medication in them, the medications to be wasted should go straight to the shed. V4 said the dirty linen utility room by the loading dock should be locked to limit access to who can get in there. V4 said residents can go the area where the dirty utility room is located. V4 said residents can go to the area where the dirty utility room is located. V4 said there is risk for resident harm if they were to access the dirty utility room that was not secured/locked. V4 said the contaminated needles can hurt residents if residents handle them and the residents can contract diseases than can even lead to death V4 puts those medications in the shed near the dock until they are picked up by the waste company. On 12/16/2023 at 4:27pm V2(Director of Nursing/DON) said the nurse should put medications to be wasted in the bins in the locked supplies room where the nurses have a key to get in. V2 said medication should not be left in an area where residents can access them because it is a safety issue and residents can take the medications which can harm them, because these are not the residents' scheduled medications. Observed on the door of the dirty utility room was a sign that stated -Make sure all bags are securely tied before placing in the bins. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 8 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0761 Facility policy titled Discarding and Destroying Medications, dated 12/2019 documents: Level of Harm - Minimal harm or potential for actual harm -Medications will be disposed of in accordance with federal, state and local regulations governing management of non-hazardous pharmaceuticals, hazardous waste and controlled substances. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 9 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and records review, the facility failed to follow infection control policy by failing to properly dispose of used needles, contaminated blood draw equipment, failed to secure the contaminated equipment by over filling the sharps containers and leaving needles and contaminated tubing exposed, failed to properly close sharps containers by leaving them without top covers while filled with sharps. This deficiency has the potential to affect all 80 residents living on the first floor. Residents Affected - Some Findings include: On 12/16/2023 at 10:37am, tour of the soiled utility room on the East side of the facility next to the loading dock surveyor with V10(Registered Nurse-RN/Quality Director/Infection Preventionist), the door to the soiled utility room was not locked surveyor with V10 observed were four large cartons filled with red sharps containers. Some of the sharps' containers were observed with a black cover/cap, while others were observed to have no covers and were overflowing, with some having needles outside of the sharps' containers. V10 said sharps containers should not be, overfilled and once the sharps container is 2/3 full, it should not be used again and should be disposed of in the right way following infection control procedure. V10 said she could see a butterfly needle and tubing with traces of blood placed/discarded outside of the sharps' container. V10 said residents could access this part of the building if they wanted to. V10 said there were around 80 residents on the first floor. V10 this is an infection control and safety issue because the door to the soiled utility room was not locked and residents can come into the room and touches/handle these containers, and this can lead to a needle prick which can cause infections to the residents and lead to illnesses and the residents can become severely ill, and it can even lead to resident death. On 12/16/2023 at 10:57am, V12 (Registered Nurse/RN) said housekeeping takes the sharps' containers when full to the utility room. V12 said the sharps container should be locked and secured properly because there are sharp/contaminated objects inside the container. V12 said the sharps container and return medications should be secured in a safe place away from residents' access to prevent residents getting access to them because the residents might take the medications not intended for them, and this can lead to drug interactions, overdose, and adverse effects on the residents. V12 said the sharps containers should be secured safely to prevent residents getting assess to them because that would be an infection control issue because the residents can be injured by the sharp contaminated objects in the sharps' containers. On 12/16/2023 at 12:10pm, V4 (Director of Facilitates Management) said when the sharps container is 2/3 full, it should be taken to the soiled utility room near the nursing stations, then the sharps are picked up by EVS(Environmental Services) department and taken to the soiled utility room by the loading dock, where they are packed up/boxed into those boxes given by the medical waste disposal company , then moved to a bio-hazard locked shed, and the sharps are picked up by the disposal company every 2-3 weeks. V4 said residents can go the area where the dirty utility room is located. V4 said there is risk for resident harm if they were to access the sharps containers left in the dirty utility room that was not secured/locked. V4 said the contaminated needles can hurt residents if residents handle them and the residents can contract diseases than can even lead to death. V4 said he is the one responsible for taking out the sharps' containers from the nursing station, straight to the shed outside for safe keeping until the waste company comes to pick them up. V4 said the lock in the dirty utility room was not working and the door can be opened by anyone. V4 said this is a safely and infection control issue because there were sharps containers which were not properly secured in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 10 of 11 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 145960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ascension Resurrection Life 7370 West Talcott Avenue Chicago, IL 60631 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 0880 room. V4 said the dirty utility room should always be locked, and he was going to make sure it saved. Level of Harm - Minimal harm or potential for actual harm On 12/16/2023 at 4:27pm V2(Director of Nursing/DON) said only V4 (Director of Facilitates Management) can take the sharps containers from the locked supplies room to the shed outside, where the containers are locked, until the waste company comes for them when it is full. V2 said if medications are not in a locked door, anybody can have access to them, and the residents can take the wrong medications or get injured by the exposed contaminated needles, and residents could get sick/or contact diseases. Residents Affected - Some Observed on the door of the dirty utility room was a sign that stated -Make sure all bags are securely tied before placing in the bins. Facility policy titled Sharps Disposal dated 12/2017 documents: -Contaminated sharps will be discarded into containers that are: closable, puncture resistant. -Designated individuals will be responsible for sealing and replacing containers when they are 75% to 80% full to protect associates from punctures and or needle sticks when attempting to push sharps into the container. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145960 If continuation sheet Page 11 of 11