Inspection·February 4, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few standards of discipline, health, safety, attendance, workmanship, and honesty be maintained. Employees shall have an opportunity to sign formal warning, acknowledging that such warning has been given and to comment on such warning. Maintaining or attempting to maintain a relationship (whether or not consensual) with a resident that is sexual or romantic in nature unless the resident is the employee's spouse. First offense-Discharge. R1's Pre-admission Hospital History and Physical dated 5-1-24 documents, Chief Complaint: Suicidal Ideation. (R1) is a [AGE] year-old with past reported psychiatric history of Bipolar I Disorder with Psychotic Features, stimulant use disorder (methamphetamine), and alcohol use disorder admitted voluntarily for suicidal ideation in the context of methamphetamine use. (R1) has been non-adherent with medication and utilizing methamphetamine which is likely a significant exacerbating factor. The patient warrants inpatient level of care for safety and stabilization. R1's admission Record documents R1 is a [AGE] year-old admitted to the facility on [DATE] with the diagnoses of Bipolar Disorder Severe with Psychotic Features, Suicidal Ideation's, Major Depressive Disorder, Persistent Mood Affective Disorder, Hallucinations, and Psychotic Disorder not due to a substance or know Psychotic Condition. R1's current Physician's Orders document, 24-hour nursing care. Mirtazapine 30 mg (milligrams) one daily at bedtime for the Major Depressive Disorder. Hydroxyzine HCL (Hydrochloride) 50 mg twice daily for Anxiety. Alprazolam one mg three times daily for Anxiety. Aripiprazole 15 mg one time daily for Bipolar with Severe Psychotic Features. R1's Brief Interview for Mental Status dated 1-8-25 documents R1 is cognitively intact. The facility's Serious Injury Incident and Communicable Disease Report dated 1-29-25 documents (R1) reported that (V3/CNA) has been having inappropriate sexual encounters with (R1). (V3) previously resigned from her position. Last day to work was 1-7-25. (Local) police department notified. (Primary Care Physician) notified. Investigation initiated. Final to follow. R1's Hospital Emergency Department Notes dated 1-29-25 and signed by V16 (Hospital Physician) document, Primary diagnosis: Sexual assault of adult. (R1) reports he is here for a rape kit. (R1) reports for something that happened three weeks ago. (R1) reports he has showered and changed his clothing. (R1) reports police have been notified and wanted him to have a rape kit. (R1) reports he just showed them the video. (R1) is from a nursing facility and reports the person was a worker but no longer is employed at the facility. RN (Registered Nurse) spoke with the charge nurse at (the hospital). Due to (R1) reporting this happened three weeks ago, (R1) wouldn't be in the time frame for a rape kit. Medical Decision Making: I (V16) have evaluated (R1) and performed medical screening exam. Evidence was not collected. I have discussed all information regarding the risk of contracting sexually transmitted infections as well as the possibility of pregnancy, as applicable, Prophylaxis for gonorrhea, chlamydia, and trichomonas was given. (R1) declined baseline HIV (Human Immunodeficiency Virus) test, (R1) declined other STD testing as noted in orders. Counseling: You (R1) are a survivor of sexual assault. You may have trouble sleeping. You may have anxiety, irritability, depression, and other symptoms. This is normal. They are reactions to trauma. You can get help. Rape crisis centers have free counseling services. R1's Police Report Incident Number 25-003634 dated 1-29-25 at 3:44 PM and signed by V5 (Local Police Officer) documents, On January 29, 2025, at 3:44 PM I (V5) was dispatched to (the facility) in reference to a Criminal Sexual Assault. During the investigation, the victim (R1), also admitted to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 2 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 - Immediate jeopardy to resident health or safety Residents Affected - Few sending video of the sexual encounters to other people who work at (the facility). (R1) and (V3), an ex-employee, have been having sexual intercourse for the past six months and just recently stopped having sexual encounters after (V3) quit on January 7, 2025. (R1) would also state they (R1 and V3) have had sex approximately 50 times or more. (R1) stated he felt threatened by (V3) and that (V3) has said on several occasions that (V3) could get (R1) kicked out of (the facility) if (R1) did not do what (V3) wanted him to do. (R1) stated (V3) would come into his bedroom, while he was sleeping, and started giving him blow***s. (R1) would wake up and push (V3) away and she would continue to give (R1) a blow**b. (R1) advised that (V3) would also help him with his showers due to him not being able to reach his right side with how badly his left arm is injured. (V3) would help him in the shower and while helping him in the shower (V3) would get naked and bend over so (V3 and R1) could have sex. (R1) stated (V3) would take him to her friend's residence who lived close to the nursing home when (R1) was able to leave on his own time. (R1) and (V3) would go to her friend's residence and have sex, along with (R1) recording some of these sexual encounters happening. (R1) stated the last time (R1) had a blow**b or sex with (V3) was before (V3) quit on January 7, 2025. When (R1) was asked about the recordings he stated he advised (V3) about the recordings and (V3) was okay with him recording the two of them. (R1) showed (V5) one of the videos of (V3) giving (R1) a blow**b in (R1's) room inside (the facility). (R1) stated (V3) would send pictures and videos back and forth of the two masturbating on several occasions. (R1) advised he would like to go to the hospital and have a sex assault kit done.(V1/Administrator) and (V15/Regional Director of Operations) stated they would arrange transportation for (R1) to get to the hospital. (R1) advised he was supposed to leave and spend time with (V3) on January 27th, 2025, but (V3) had canceled plans. (R1) advised he was upset with (V3) due to her not being able to spend time with him. (R1) advised he was feeling down and upset on January 28, 2025. While feeling like this (R1) finally told an employee about the sexual encounters between him and (V3). (R1) stated he recorded the two (R1 and V3) having sexual encounters several times with (V3's) permission. (V3) sent the videos via (social media). Once (R1) sent the video to one employee, other employees started to ask (R1) for the video to be sent via (social media). (R1) stated he sent the videos to several employees including (V11/CNA), (V12/CNA), (V13/LPN/Licensed Practical Nurse), and (V14/LPN). R1's updated Care Plan dated 6-4-24 to current documents, Focus: I am at risk for abuse/neglect/exploitation related to my SMI (Serious Mental Illness) diagnoses of Bipolar Disorder with Psychotic Features, Major Depressive Disorder, and Anxiety. Goal: I will verbalize to staff any instanced of abuse/neglect/exploitation through the next review period. Interventions/Task Provide care in a manner consistent with training and (facility) policies and procedures as appropriate to responsibilities and job tasks. Provide re-assurance if negative feelings occur. Provide regular opportunity for me to communicate my choices, preferences, needs/wants, related to my care and opportunity for me to express my concerns about care. Report any verbalization of abuse/neglect/exploitation to administrator immediately. Focus: Due to personal report of trauma history, I benefit from trauma informed care. I shared that my three-month-old daughter accidentally suffocated after my ex-wife put her in bed with her after coming home from work near Christmas of 2016. Goal: I will share my trauma related history and the challenges it presents to the degree I am comfortable in order to begin the healing and recovery process through the next review. Interventions/Tasks: Encourage me to participate in group/individual psychotherapy/counseling. Monitor of signs/symptoms of PTSD (Post Traumatic Stress Disorder), document, and notify my IDT (Inter-Disciplinary Team) including therapist as applicable, psychiatrist, and Primary Care Provider. Respect my choices/wishes. Offer care and assistance in a way that promotes re-assurance, comfort, choice, dignity, and safety. On (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 3 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 - Immediate jeopardy to resident health or safety Residents Affected - Few 1-31-25 at 1:30 PM R1 stated, Around six months ago (June 2024) V3 (CNA) would bring me in alcohol, gummies, and vapes (electronic cigarettes) in to trade for sex. We would have sex in my room with other residents in the room. (R2) caught us several times. We have had sex almost every time (V3) has worked, over 100 times. I would have to have sex when she wanted to, or she would cut me off from vapes or anything else I wanted. It was a threat over my head. I have not had sex with any other residents here. A couple times I woke up to her giving me h**d. I told her to knock it off and she continued to give me h**d. She would say she is union, and they can't fire her, and the facility would never believe anything she said. I recorded with my phone when she would give me oral sex. I felt like she was the one in power. She initiated the sex the first time and the last time. She would bribe me with home visits and would sign me out. She would meet me at the corner of the building so staff would not see us. I went to her house twice and had sex and sex at a hotel once. We would have normal sex and oral sex. She even told me she was pregnant with my child and had a miscarriage. That caused me severe depression as I have had a child of mine die in the past. I have not spoken to her in the last three days. I have blocked her on all accounts. I lived at an apartment prior to here. The police officer said it was the best thing to do was to go to the hospital for a rape kit. The hospital said it had been over three weeks so there was really no reason to do a rape kit since I have showered, and all the evidence would be gone. She would bring me in alcohol and vapes as a bribe for sex. Once in a while she would bring me in THC (Tetrahydro-Cannabinol) gummies. I am not aware of her having sexual relations with any other residents. I showed some staff the videos because the staff asked me to send them to them. I sent videos to staff on Monday. On 1-31-25 at 12:55 PM V1 (Administrator) stated, On Wednesday (R1) reported to me that he felt coerced and raped by (V3). When (R1) reported it on Monday to me, (R1) did not report feeling coerced or raped by (V3). As soon as (R1) reported sex with (V3) as not being consensual, I notified the police and the physician. (R1) was interviewed by the police for three and a half hours. We (the facility) sent (R1) to the hospital to have a rape kit done. A rape kit could not be done since it had been over three weeks since (R1 and V3) had sex. Staff having sex with residents is against company policy and against the employees' union agreement. (V3) had not worked here since January 3, 2025, as (V3) quit after I had suspended her after having reports that (V3) was bringing in CBD (Cannabidiol) gummies to the residents. On 1-31-25 at 2:10 PM R2 (R1's roommate) stated, I would hear or see (V3) and (R1) having sex almost every time (V3) worked. I would tell (V3) that it was going to catch up with her and (V3) was going to get fired. I would see (V3) bring in alcohol, vape pens, and weed to (R1). A couple times I heard (R1) say he did not want to have sex and (V3) told (R1) if he didn't want to have sex anymore she was not going to bring him in any more alcohol or vapes. It really bothered me that (R1 and V3) would have sex in my room. On 1-31-25 at 2:20 PM V6 (LPN) stated, On Saturday night (R1) showed me a video of (V3) performing oral sex on (R1). I was not sure if it was consensual. It is not ethical and against company policy for a staff member to have sex with a resident. (R1) said (V3) had been having sex with him for months. On 1-31-25 at 2:30 PM V7 (R1's Primary Physician) stated, (R1) should not be subjected to sex from a staff member. That is unethical and abuse. Staff should not be bringing in drugs or alcohol to the residents. On 1-31-25 at 4:40 PM V12 (CNA) stated, Either last Saturday or Sunday (R1) told me (V3) was having sex with (R1) while (V3) was working within the facility. (R1) sent a video on Monday to my (social (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 4 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 media) and I saw (V3's) face plain as day, in (R1's) bed, performing oral sex on (R1). That is not okay. Level of Harm - Immediate jeopardy to resident health or safety On 1-31-25 at 5:10 PM V14 (CNA) stated, (R1) told me Sunday night that (V3) was having sex with (R1) in his room with (R1's) roommates in the room. (R1) said for the past six months (V3) would bring him alcohol and THC edibles and have sex with (R1) while (V3) was supposed to be working. (R1) said (V3) had told him she (V3) was pregnant with his child and then told (R1) she had a miscarriage. That was terrible as (R1) has lost a child in the past and was very upset. It is not appropriate for staff to be bringing in drugs and alcohol to the residents or have sex with the residents. (R1) sent me a video on my (social media) and the video was (V3's) face and (V3) was giving (R1) a blow**b while in (R1's) bed. There was also a picture of (V3) in the facility's shower room. (V3) had her shirt raised, exposing her breasts to (R1). (V3) was manipulating (R1). Residents Affected - Few On 2-1-25 at 12:00 PM V13 (LPN) stated, (R1) showed me a video on Monday night of (V3) performing oral sex on (R1). It was disgusting. I could see (R1's) face in the video and could tell by the surrounding they (R1 and V3) were in (R1's) bed. (R1) said (V3) would bring (R1) in alcohol and drugs for sex. (R1) said (V3) would have sex with him almost every night she worked. (R1) seemed upset while telling me about it. That is so inappropriate. Staff should never have sex with residents. On 2-1-25 at 1:00 PM V11 (CNA) stated, (R1) sent me a video on (social media) of (V3) giving (R1) a blow**b. I could tell it was (V3) on the video. Staff should not have sex with residents. On 2-4-25 the surveyor confirmed through interview and record review that the facility took the following actions to remove the Immediate Jeopardy: 1. The Administrator (V1) or designee immediately ensured the safety and well-being of the (R1). V3 was no longer employed with the facility as of 1-7-25. 2. On 1-29-25 V1 initiated and abuse investigation into R1's abuse allegation. 3. On Upon notification of the allegation on 1-29-25, police were notified and R1 was sent to the emergency room for evaluation and examination. 4. As of 02-03-25 V1 or designee educated all staff on what constitutes all forms of abuse and bribery. 5. As of 02-03-25 V4 (Social Service Director) completed an Abuse/Neglect/Trauma screening on all residents and any resident who triggered at risk for abuse neglect, or trauma was educated on what to report and who to report to. 6. On 02-02-25 the quality assessment and assurance committee developed and implemented plans to ensure further abuse and bribery of the residents does not continue within the facility. 7. On 02-03-25 the abuse policies were reviewed and revised by the quality assurance committee prior to educating staff. 8. On 02-03-25 a root cause analysis was completed for the alleged sexual relationship that occurred between R1 and V3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 5 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 - Immediate jeopardy to resident health or safety Residents Affected - Few 9. V1 received education on 2-1-25 from V15 (Regional Director of Operations reporting abuse timely and thoroughly investigating all abuse allegations. 10. All newly hired staff and agency staff will be educated by V1 (Administrator), V20 (Director of Nursing), or designee prior to the start of their shift on abuse prevention and reporting as well as what constitutes bribery, prohibiting staff from providing contraband to residents, and maintaining professional boundaries with residents, staff not having a physical relationship with residents, and for staff to not request or view photos or videos of residents. Completion date: 2-3-25 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 6 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review and interview the facility failed to implement their Abuse Policy to immediately report an allegation of staff-to-resident sexual abuse to the State Agency for one of three residents (R1) reviewed for Abuse in the sample of four. Findings include: The facility's Abuse, Neglect, and Exploitation policy dated 2024 documents, Reporting/Response: 1. The facility will have written procedures that include reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies within the specified timeframes: a. Immediately, but not later than two hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury. The facility's Serious Injury Incident and Communicable Disease Report dated 1-29-25 documents (R1) reported that (V3/CNA/Certified Nursing Assistant) has been having inappropriate sexual encounters with (R1). (V3) previously resigned from her position. Last day to work was 1-7-25. (Local) police department notified. (Primary Care Physician) notified. Investigation initiated. Final to follow. On 1-31-25 at 12:55 PM V1 (Administrator) stated, I was informed by (V6/Licensed Practical Nurse) on 1-27-25 about (R1) stating (R1) and (V3/CNA) were having sexual encounters. I did not report the sexual encounters to the State Agency until 1-29-25 when (R1) said the sexual encounters were not consensual. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 7 of 8 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 145987 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Allure of Galesburg 1145 Frank Street Galesburg, IL 61401 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on record review and interview the facility failed to ensure all staff received annual QAPI (Quality Assurance and Performance Improvement) in-service training. This failure has the potential to affect all 93 residents residing within the facility. Findings include: The facility's Resident Roster dated 1-31-25 documents the resident in-house census as 93 residents. The facility's Staff Training and Staff In-Service Logs dated 1-1-24 through 2-3-25 do not include documentation of facility staff receiving annual QAPI training. On 2-4-25 at 10:30 AM V17 (Corporate Nurse) stated, No staff at this facility have received annual QAPI training. Our training program did not list this as one of the trainings that needs completed yearly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145987 If continuation sheet Page 8 of 8