Inspection·May 9, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on interview and record review the facility failed to keep two residents (R2 and R5) free from abuse of three reviewed for abuse in a total sample of nine residents. Residents Affected - Few Findings include: On 5/2/25 at 1:30 PM, R2 said R5 hit her in the head with an open milk carton and milk went everywhere. R2 said R5 and her popped each other. R2 was smoking a cigarette outside. R5 said R2 needs to do something with her hair and kept calling R2 big girl. R5 wouldn't leave R2 alone. R2 pushed R5's face, I muffed him. R5 threw an open milk carton in R2's face. R2 said there was no staff outside. V11 (Psychosocial Aide/Social Service Assistant) came outside after everything happened. R2 said R5 talks about her almost every day. R2 said they talk about her weight, hair, and how crazy she is. On 5/6/25 at 10:00 AM, V2 (Director of Nursing) stated the incident with R2 and R5 happened on the patio during smoking break. The police were not notified of the altercation between R2 and R5. R2 was sent out to the hospital. On 5/6/25 at 10:30 AM, R5 said the incident with R2 was during a smoke break. R5 and R2 were on the back patio. R5 said the staff was not outside with them. The staff was at the door on the inside of the building. R5 said R2 was asking everybody for a cigarette. R5 told R2 to stop asking for cigarettes. R2 was being annoying by asking the same people for cigarettes. R5 and R2 exchanged a couple words. R2 got up and hit R5 in the face. R5 hit R2 back in the face. Staff separated us and told us to stay apart, and only one of us should be on the patio to smoke at a time. We speak to each other now; everything is cool now. We apologized to each other. I feel safe. The police were not called. I did not go out to the hospital. They looked me over to see if I was injured. On 5/7/25, at 1:05 PM, V11 (Psychosocial Aide/Social Service Assistant) stated R2 and R5's altercation was during the early smoke time/break. I was outside monitoring. I heard verbal aggression between R2 and R5. They were calling each other B****. R5 said R2 was all up in his space. R2 said she can be wherever she wants. I separated them outside and monitored them. I did not observe physical aggression. R2 has good days and bad days. She has the tendency to invade people's space, but I don't think she means any harm. I have witnessed R2 being verbally aggressive to staff. R5 has no behaviors and is liked by the residents and staff. R2's face sheet list diagnoses that include but are not limited to schizophrenia, major depressive disorder. R2's BIMS (Brief Interview for Mental Status) is 15 indicating intact cognition. R2's Abuse Risk Review, 4/21/2025, indicates R2 has risk factor for aggression/combativeness. According to care plan, R2 displays disrespectful, combative, verbally aggressive behavior towards staff and peers (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 2 Event ID: 145970 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 145970 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elevate Care Windsor Park 2649 East 75th St Chicago, IL 60649 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)