Inspection·February 22, 2026

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on interviews and reviews, the facility failed to maintain a safe, comfortable home-like environment for one [R1] of four [R5, R7, R8] residents reviewed for smoking. Findings include,R1 was reviewed as a close record. R1 no longer resides in the facility. R1 intake details read: R1 reported, R7 constantly smoke in our room.R1's clinical record indicates in part: R1's medical diagnosis of anxiety disorder, bipolar disorder, paraplegia affecting right side, cerebral infarction, and asthma. Reviewed R1's face-sheet, medical diagnosis, physician order sheets, minimum data set [MDS] Brief Interview Mental Status Score Indicates R1 is cognitively intact, care plans, medication administration record, treatment administration record, and progress notes. R7's clinical record indicated the following in part: R7's medical diagnosis of nicotine dependence, cognitive communication, dementia, major depressive disorder, memory deficit following cerebral infarction, and chronic osteomyelitis. Reviewed R7's face-sheet, medical diagnosis, physician order sheets, minimum data set [MDS] Brief Interview Mental Status Score Indicates R7 is cognitively intact, care plans, medication administration record, treatment administration record, and progress notes. R7's Smoking Risk Review dated 1/28/26R7 has been continually educated on the importance of following facility policy and refraining from smoking in the room. Recommendations and outcome: R7 may not be capable of handling, carrying any smoking materials and requires supervision when smoking.R7's Smoking Contract dated 1/28/26, documented in part:R7 will not smoke anywhere else in the building. R7 will surrender all smoking materials to the facility. R7 will not carry on him, or possess in R7's room, or clothes any smoking materials.Consequences of violating smoking policy will result in losing smoking privileges. Further violations will be under review, may include involuntary discharge.R7's census documents R7 were R1's roommate from 1/23/26 through 1/27/26. R7's Care plain in part:R7 has a behavior of smoking cigarettes in his room dated 6/13/25.R7's social service progress notes documented in part R7 were observed smoking in his room on the following dates:6/13/25, 6/14/25, 6/19/25, 6/25/25, 8/20/25, 10/3/25, 10/17/25, 11/20/25, 1/25/26, 1/28/26, 2/12/26, and 2/13/26. V5 [Social Service Director] progress note:1/25/26 at 5:21PM- V5 met with R7 due to staff reporting R7 was smoking in his room. A room search was conducted with consent and R7 verbalized that he was smoking in the room. [R7 was roommates with R1 on 1/25/26 per R7's Census Report]. On 2/21/26 at 1:45 PM, R7 stated, I smoke in my room because I don't feel like getting up to go outside, and now its cold outside. I know the rules. I don't suppose to smoke in my room, but I don't care. On 2/21/26 at 10:18 AM, V11 [Licensed Practical Nurse] stated, I was R7's nurse on the first floor when he was roommates with R1. R7 smoked in the room. R1 did complain of smoking, because R1 had a diagnosis of asthma, and he did not want his asthma to flare up. R7 was moved to the third floor. On 2/21/26 at 2:10 PM, V11 [Licensed Practical Nurse] stated, R7 smokes in his room. However, we make rounds on him all the time to make sure he is not smoking and during smoke times we offer assistance to get him up so he can go outside and smoke. On 2/21/26 at 3:00 PM, V2 [Director of (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: 145995 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 145995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Archer Heights Healthcare 4437 South Cicero Chicago, IL 60632 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)