Health inspection·January 24, 2024

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to follow their abuse policy and immediately remove the alleged staff from resident care. This affected one of three (R1) residents reviewed for abuse policy. Residents Affected - Few Findings Include: On 1/23/24 at 11:45AM, R1 stated that R1 went to the third floor looking for someone who can assist him to look for his nurse. R1 went to the back by the med room and knocked, a male voice from the inside answer saying he is not the nurse but will look for my nurse. I just want to make sure, so I know who I was talking to, so I opened the med room door and found V7 (Registered Nurse/RN) inside. V7 stood up from a chair, kneed me with his right knee to my left knee and put his hands on my shoulder and pushed me away from the med room. I told him, take your hands off me. Stated that there were no other staff or residents witnessed the incident. V7 then went back inside the med room and R1 went back to his floor. I checked the 2nd floor med room. R1 reported the incident to V1 (Administrator) via phone around 4 or 5am, and same morning V1 came and talked to R1 in person, they also called the Police Department to report the incident. On 1/24/24 at 8:30AM, interview with V7 (RN) reported that V7 was made aware of the abuse allegation when V7 was already home on 1/3/24, after V7 completed his shift. V7 stated that he received a call from V1 (Administrator) informing him of the abuse allegation and that V7 will be suspended pending the investigation. V7 was scheduled to work on 1/2/24 (11-7 shift, night nurse). Timecard reviewed and showed that V7 clocked in to work that shift at 10:57PM and clocked out at 7:28AM. V7 was not on the schedule 1/3/24 and 1/4/24 due to the investigation. On 1/24/24 at 10:30AM, V1 stated that he was made aware by R1 about the abuse allegation probably around 5am on 1/3/24 via phone. The nurse called V1 and gave the phone to R1. V1 spoke to R1 and R1 reported an alleged abuse from V7. When asked if V7 was escorted out of the facility once the allegation was reported to V1, and V1 stated that V7 was not escorted out of the facility, that the third floor would not have had a nurse. It would have been maybe only an hour or so that V7 stayed in the facility. V1 stated that V1 is not in the facility 24/7 and did the best that V1 could with the situation. V1 stated that V1 was not in the facility to escort V7 out at that time. V1 wanted to make sure that other residents are being taking care of, and to have a nurse on the 3rd floor. V1 stated if there is a crime made, we have 24 hours to report it to the regulatory agency. I don't know what else to tell you. We have abuse policy, but I cannot tell you at this time what was exactly said in our abuse policy. Page 1 of 3 145999 145999 01/24/2024 Aperion Care Niles 6601 West Touhy Avenue Niles, IL 60714

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Abuse Prevention and Reporting policy with a revision date of 10/24/22, reads in part: The facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment of residents. Employees of this facility who have been accused of abuse, neglect, exploitation, mistreatment, or misappropriation of property will be removed from resident contact immediately. The employee shall not be permitted to return to work until the result of the investigation have been reviewed by the administrator and it is determined that any allegation of abuse, neglect, exploitation, mistreatment, or misappropriation of property is unsubstantiated. 145999 Page 2 of 3 145999 01/24/2024 Aperion Care Niles 6601 West Touhy Avenue Niles, IL 60714

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 interview and record reviews, the facility failed to follow its abuse policy and immediately report an allegation of physical abuse to the regulatory agency within two hours. This affected one of three (R1) residents reviewed for reporting allegation of abuse. Findings Include: On 1/23/24 at11:45AM, R1 stated that R1 reported to V1 (Administrator) the allegation of physical abuse by V7 (Registered Nurse/RN) to R1 via phone around 4 or 5am on 1/3/24. On the same morning, V1 came and talked to R1 in person. They also called the Police Department to report the incident. Facility reported incident report confirmation, reads that the incident was reported to regulatory agency on 1/3/24 at 11:39 AM. On 1/24/24 at 10:30AM, V1 stated that he was made aware by R1 about the abuse allegation probably around 5am on 1/3/24 via phone. The nurse called V1 and gave the phone to R1. V1 spoke to R1 and R1 reported an alleged abuse from V7. When asked if V7 was escorted out of the facility once the allegation was reported to V1, and V1 stated that V7 was not escorted out of the facility. V1 said that the third floor would not have had a nurse. It would have been maybe only an hour or so that V7 stayed in the facility. V1 stated that V1 is not in the facility 24/7 and did the best that V1 could with the situation. V1 stated that V1 was not in the facility to escort V7 out at that time and V1 wanted to make sure that other residents are being taking care of, and to have a nurse on the 3rd floor. V1 stated if there is a crime made, we have 24 hours to report it to the regulatory agency. I don't know what else to tell you. We have abuse policy, but I cannot tell you at this time what was exactly said in our abuse policy. Abuse Prevention and Reporting policy with a revision date of 10/24/22, reads in part: The facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment of residents. Any allegation of abuse or any incident that results in serious bodily injury will be reported to (regulatory agency) immediately but not more than two hours after the allegation of abuse. Any incident that does not involve abuse and does not result in serious bodily injury shall be reported within 24 hours. 145999 Page 3 of 3