Health inspection·September 28, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to assist residents identified as needing assistance with personal hygiene and mobility. Residents Affected - Some This applies to 5 of 5 residents (R10, R13, R29, R63 and R75) reviewed for ADLs (activities of daily living) in the sample of 19. The findings include: 1. R13 had multiple diagnoses including hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, weakness and type 2 diabetes mellitus, based on the face sheet. R13's quarterly MDS (Minimum Data Set), dated July 31, 2023, showed the resident was cognitively intact and required extensive assistance with personal hygiene. R13's active care plan showed the resident had impaired physical mobility requiring assistance with mobility related to CVA (cerebrovascular accident) with left hemiparesis and hemiplegia. The same care plan showed multiple interventions including, Ensure that all hygiene needs have been met, e.g. (for example) skin care, oral care, hair, nails, etc. On September 25, 2023 at 11:27 AM, R13 was in bed, alert, oriented, and verbally responsive. R13 had weakness to her left arm and hand. R13 was not able to open her left hand to extend her left fingers. R13's right hand fingernails had black substances underneath. On September 26, 2023 at 11:05 AM, R13 was in bed, alert, oriented and verbally responsive. R13 had weakness to her left arm and hand. R13 was not able to open her left hand to extend her left fingers. R13's right hand fingernails had black substances underneath. V3 (ADON/Assistant Director of Nursing) who was present during the observation stated that R13's fingernails needed cleaning. On September 26, 2023 at 12:20 PM, V5 (CNA/Certified Nursing Assistant) stated she was the regular staff assigned to take care of R13 at least four times a week. V5 stated R13 needed extensive to total assistance from the staff with regards to personal hygiene, including cleaning of fingernails. 2. R29 had multiple diagnoses including COPD (chronic obstructive pulmonary disease) and dementia without behavioral disturbance, based on the face sheet. R29's quarterly MDS, dated [DATE], showed the resident was cognitively intact and required extensive assistance from the staff with personal hygiene. R29 had an active care plan in place that showed the resident had ADL self-care performance deficit. The same care plan showed multiple interventions including, Personal hygiene/oral care: extensive assistance with 1 (one). On September 25, 2023 at 12:22 PM, R29 was in bed, alert, oriented, and verbally responsive. R29 had weakness to the left arm and was not able to open/extend her left hand fingers. R29's right hand fingernails had black substances underneath. R29 stated she wanted the staff to clean her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 2 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0677 fingernails. Level of Harm - Minimal harm or potential for actual harm On September 26, 2023 at 11:10 AM, R29 was in bed, alert, oriented and verbally responsive. R29 had weakness to her left arm and was not able to open/extend her left hand fingernails. R29's right hand fingers had black substances underneath. V3 (ADON), who was present during the observation, acknowledged R29's right hand fingernails needed cleaning. Residents Affected - Some 3. R63's active care plan in place, initiated on February 7, 2022, showed the resident had impaired physical mobility requiring assistance with mobility related to weakness, Alzheimer's disease and dementia. The same care plan showed multiple interventions including, Ensure that all hygiene needs have been met, e.g. (for example) skin care, oral care, hair, nails, etc. R63 had multiple diagnoses including, Alzheimer's disease, dementia without behavioral disturbance and need for assistance with personal care, based on the face sheet. R63's quarterly MDS, dated [DATE], showed the resident was cognitively impaired and required assistance with personal hygiene. On September 25, 2023 at 11:11 AM, R63 was sitting in her wheelchair inside the unit small dining area. R63 was alert and verbally responsive. R63 had accumulation of long curling hair on her chin area and on the sides of her mouth/lips. In the presence of V5 (CNA), R63 was asked if she wanted the staff to shave/remove her facial hair. R63 stated okay. 4. R75 had multiple diagnoses including dementia without behavioral disturbance, based on the face sheet. R75's quarterly MDS, dated [DATE], showed the resident was cognitively impaired and required one staff physical assistance with personal hygiene. R75's active care plan, initiated on May 10, 2023, showed the resident had impaired physical mobility requiring assistance with mobility related to dementia and weakness. The same care plan showed multiple interventions including, Ensure that all hygiene needs have been met, e.g. (for example) skin care, oral care, hair, nails, etc. On September 25, 2023 at 11:13 AM, R75 was ambulating inside the unit dining area. R75 was alert but confused. R75 had accumulation of long chin hair. R75 was asked if she wanted the staff to shave or remove her chin hair. R75 stated, Yes. V5 (CNA) was present during the observation. On September 26, 2023 at 12:19 PM, V5 stated she regularly took care of R75 during the morning shift, and at times during the afternoon shift. V5 stated R75 needed assistance from the staff with regards to personal hygiene, including removal of unwanted facial hair. On September 27, 2023 at 12:09 PM, V2 (Director of Nursing) stated it is part of the nursing care and service to provide assistance to all residents needing assistance with shaving/removal of unwanted facial hair and cleaning of fingernails to ensure and maintain good hygiene and grooming. 5. R10 had multiple diagnoses on face sheet including spinal stenosis, thoracic region, other intervertebral disc degeneration, lumbosacral region, paraplegia, Type 2 diabetes mellitus with diabetic chronic kidney disease, muscle weakness, chronic diastolic (congestive) heart failure, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 3 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some atherosclerotic heart disease of native coronary artery without angina pectoris, peripheral vascular disease, and chronic obstructive pulmonary disease. R10's significant change of condition MDS, dated [DATE], showed R10 was moderately impaired in cognition and required extensive to total dependence of one -two persons for bed mobility and personal hygiene. R10's care plan, revised January 25, 2023, included R10 has impaired physical mobility requiring assistance with mobility. Interventions included : Ensure that all hygiene needs have been met, e.g. (example) skin care, oral care, hair, nails, and so forth. Assist with positioning/mobility while in bed or chair. On September 25, 2023 at 11:19 AM, R10 was lying flat on his bed and appeared to be grimacing and groaning. R10 stated his arms hurt and he received Tylenol about an hour ago. R10's skin on both arms appeared extremely dry, scaly, and flaky, with extensive bruising especially on right arm, with scattered open areas that had congealed and fresh blood. R10's finger nails were caked with blackish substance underneath most of the nail beds. When asked if he wants it cleaned, R10 remarked, It not dirt. It's dry blood. Probably from scratching. R10 appeared uncomfortable lying flat, and when asked if he would like to get up, R10 stated, Sure would like to get up. They tell me that I should stay in bed. I don't know why. On September 25, 2023 at 1:05 PM, V7 (Licensed Practical Nurse) was notified about R10's skin condition and nails and that R10 would like to get up from the bed. V7 stated, I'll have somebody clean him up. The activities usually do finger nails. They have a day to do so. On September 26, 2023, at 10:21 AM, R10 was still lying flat in bed and stated, Sure I would like to get up. But they have to help me and they don't get me up. R10's skin appeared more smooth with scattered flaky skin. R10 noted still scratching his arms. R10 remarked, They put something on it yesterday and its better but its still itches. This was relayed to V7, who stated R10 does not have any medicated topical's for anti itch ordered nor protective barriers for his arms. V7 stated she will notify the doctor and follow up. R10's requests of getting up to be seated in the recliner was again relayed to V7 and V8 (CNA/Certified Nursing Assistants). On September 26, 2023 at 2:26 PM, V7 stated she called the doctor and he ordered protective sleeves for R10 and a medicated topical [Triamcinolone Acetonide External Cream 0.1 %]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 4 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents identified with heart disease and renal disease were weighed daily as ordered by the physician. Residents Affected - Few This applies to 2 of 19 residents (R18 and R284) reviewed for physician orders in sample of 19. Findings include: 1. Review of R18's face sheet documents an [AGE] year old male readmitted to the facility on [DATE], with diagnoses that include End Stage Renal Disease, Chronic Obstructive Pulmonary Disease with Exacerbation, Type 2 Diabetes Mellitus with diabetic Neuropathy, and Hypertensive Heart Disease with Heart Failure. R18's Physician orders document the following order by V23 (Physician), dated August 15, 2023: Daily weight every day shift for Chronic Kidney Disease. R18's care plan for congestive heart failure documents the following: Monitor/document/report as needed any signs and symptoms of congestive heart failure: dependent edema of legs and feet, and weight gain unrelated to intake. R18's care plan for renal failure documents the following: Monitor/document/report as needed the following signs and symptoms: Edema, and weight gain of over 2 pounds a day. Review of R18's weights that are recorded in the weights/vitals section of R18's electronic medical record document weights on the following days only: 8/15/2023, 9/12/2023, 9/15/2023, and 9/19/2023. On September 25, 2023 at 10:35 AM, R18 was in the hallway of the facility about to go to out to dialysis. Both of R18's legs were extremely large and edematous. On September 26, 2023 at 10:48 AM, R18 was sitting in his room. Both of his legs were still very large and edematous. R18 stated the facility was not weighing him every day. 2. Review of R284 face sheet and progress notes documents a [AGE] year old female admitted to the facility on [DATE] with diagnoses that include Chronic Kidney Disease, Stage 3A, and Congestive Heart Failure. R284's Physician orders document the following order by V23 (Physician), dated September 8, 2023: Daily weight and record in the morning for edema. R284's care plan was absent of a care plan for Chronic Kidney Disease. Review of R284 weights that are recorded in the weights/vitals section of R284 electronic medical record document weights on the following days only: 9/8/2023, 9/18/2023, and 9/24/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 5 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0684 Level of Harm - Minimal harm or potential for actual harm On September 25, 2023 at 11:00 AM, R284 was sitting in her room in a wheelchair. R284's legs were very large and edematous. On September 27, 2023 at 1:50 PM, R284 was lying in the bed and looked uncomfortable. R284 stated the staff does not weight her every day. Residents Affected - Few On September 26, 2023 at 2:43 PM, V2 (Director of Nursing/DON) stated she expects staff to follow doctor's orders. V2 stated the CNAs are charged with weighing residents. V2 (DON) stated nurses should chart the weights in the electronic medical record under the weights/vitals tab. While reviewing the weights in the electronic medical record with V2 (DON), V2 (DON) stated she does not see daily weights for R284 or R18, but will continue to look for where else in the electronic medical record it could be. V21 (Certified Nursing Assistant/CNA) was assigned to and working on R18's and R284's unit for the last 3 days of the survey (September 25, 26, and 27) On September 27, 2023 at 10:01 AM, V21 stated she has worked at the facility since April, and usually works on the unit she was on. V21 stated it is CNAs responsibility to weigh residents. V21 (CNA) stated there is no one on her unit that requires daily weights that she is aware of. On September 27, 2023 at 10:06 AM, V22 (Registered Nurse/RN) stated R18 and R284 should be weighed daily. V22 (RN) stated CNAs are responsible for weighing the residents. V22 stated she enters the weights that CNAs submit into the resident's electronic medical record. V22 stated it is the nurse's responsibility to let the CNAs know who needs to be weighed. V22 stated she did not tell the CNA to weigh R18 and R284. V22 stated she assumed V21 already knew to weigh R18 and R284. V22 stated communication was off, because she assumed the CNA already knew to weigh R18 and R284. On September 27, 2023 at 4:06 PM, V23 (Physician) stated the order for R18 to continue daily weights was a recommendation from the hospital upon discharge. V23 stated he continued the order because he was confident in hospital physicians to recommend it. V23 stated the hospital physicians probably wanted the resident to be closely monitored because of his diagnoses of Congestive Heart Failure and Chronic Kidney Disease. V23 stated he understands and had no concerns with that, thinking that is why he continued the orders. V23 (Physician) also stated R284's orders were written by his Advanced Practice Nurse at the facility R284 was being transferred from. V23 stated the reason for the daily weight order for R284 was because of R284's diagnoses of Congestive Heart Failure, Edema, and Chronic Kidney disease. V23 stated he expects his orders to be followed by the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 6 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0688 Level of Harm - Minimal harm or potential for actual harm Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, interview, and record review, the facility failed to assess and provide supportive device/splint to a resident, to prevent further reduction in ROM (range of motion). Residents Affected - Few This applies to 1 of 3 residents (R13) reviewed for range of motion in the sample of 19. The findings include: R13 had multiple diagnoses including hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, weakness, and type 2 diabetes mellitus, based on the face sheet. R13's quarterly MDS (Minimum Data Set), dated July 31, 2023, showed the resident was cognitively intact and required extensive assistance from the staff with most of her ADLs (activities of daily living). The same MDS showed R13 had functional limitation in range of motion on one side of both upper and lower extremities. On September 25, 2023 at 11:27 AM, R13 was in bed, alert, oriented, and verbally responsive. R13 had weakness to her left arm and hand. R13 was not able to open her left hand to extend her fingers. R13 stated she does not use any splint or device on her left arm and/or hand. On September 26, 2023 at 11:05 AM, R13 was in bed, alert, oriented, and verbally responsive. R13 had weakness to her left arm and hand. R13 was not able to open her left hand to extend her fingers. R13 stated, I cannot open it, referring to her left hand. V3 (Assistant Director of Nursing), who was present during the observation, stated, her left hand is contracted. V3 was prompted to request the therapy department to screen and/or evaluate R13 with regards to the resident's left hand contracture. On September 26, 2023 at 2:38 PM, V6 (Physical Therapy Assistant) stated she had screened R13 that day before lunch per facility request. V6 stated during the screening of R13, the resident's left hand was in a fisted position (clenched). R13 was able to extend her left index, middle, ring and little fingers only with staff assistance, and R13's left thumb was contracted. According to V6, based on R13's screening, the resident needed a resting soft splint to the left hand to prevent the hand from being in constant fisted position, to prevent further contracture, for resident's comfort, and for easy cleaning of the hand. On September 27, 2023 at 12:06 AM, V2 (Director of Nursing) stated as part of the nursing service, the nursing staff should monitor any changes in a resident's range of motion and to refer to the therapy department for screening and/or evaluation as needed to determine the need to receive any services or for any needed splint application. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 7 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0690 Level of Harm - Minimal harm or potential for actual harm Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, interview, and record review, the facility failed to provide incontinence care in a manner that would prevent urinary tract infection (UTI). Residents Affected - Some This applies to 4 of the 4 residents (R4, R7, R9, R44) reviewed for incontinence care in the sample of 19. The findings include: 1. R7 is 82 years-old who has multiple medical diagnoses which include hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, muscle weakness, and urinary tract infection (UTI). On September 25, 2023, at 11:29 AM, R7 was sitting on the bedside commode having bowel movement. There were some drops of loose stool or fecal matter on the floor. After R7 used the commode, V10 (Certified Nursing Assistant, CNA) assisted R7 to get up and proceeded to clean R7 from mid-perineum to the back peri-area. V10 wiped R7 multiple times using same wet wipes. V10 took another set of wipes and gave R7 one final sweep from the mid-perineum to the back peri-area. V10 proceeded to pull the incontinence brief and pant back in place. V10 did not clean the frontal area such as the pubic, labial folds, and groins, to ensure the urine and potential fecal material was removed. 2. R4 is 97 years-old who has multiple medical diagnoses which include Alzheimer's disease and generalized muscle weakness. On September 26, 2023, at 10:15 AM, V9 (CNA) assisted R4 to go to the bathroom where R4 voided. After R4 finished voiding, V9 assisted R4 to stand up, and proceeded to wipe the rectal area of R4. Then she (V9) pulled the incontinence brief and pants back in place. The brief was soiled with urine and had a fecal stain. V9 did not clean R4's frontal perineum (pubic area, labia, and groins). 3. R9 is 82 years-old who has multiple medical diagnoses which include UTI, urinary retention, and personal history of parasitic diseases. On September 26, 2023, at 10:39 AM, V9 (CNA) rendered incontinence care to R9, who was wet with urine and had a big bowel movement. She wiped the frontal perineum, wiped pubic area, and outer labial area. She (V9) did not separate labia to clean inner corners, and she did not clean R9's groins. V9 turned and repositioned R9 on the left side and proceeded to clean the back perineum. V9 used one wash cloth over and over by folding the washcloth repeatedly to wipe R9's rectal and buttocks area. Her gloved hands directly made contact with the fecal matter. V9 used another washcloth to give R9 one final sweep to clean R9's buttocks and rectal area. V9 did not ensure the area was completely free of any fecal material. Though V9 folded the washcloth multiple times and attempted to use the clean side of the washcloth, it was visibly soiled with fecal matter, which had penetrated through the washcloth. 4. R44 has multiple medical diagnoses which include mixed irritable bowel syndrome, hemiplegia, and hemiparesis, affecting right dominant side, vascular dementia, and generalized muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 8 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On September 26, 2023, at 1:19 PM, V9 (CNA) rendered incontinence care to R44, who was wet with urine and had a bowel movement. When V9 opened R44's incontinence brief, the fecal matter was dry and caked on the rectal and buttocks area extending to the front in between R44's thighs and partly covering the outer lower labia. Using a wet washcloth, V9 wiped R44's pubic area; she folded the washcloth and wiped the outer labia a few times. She did not clean inner labia and groins. V9 proceeded to clean the back perineum, she used another washcloth, however, V9 folded the washcloth repeatedly and used it to clean the rectum and buttocks. When V9 completed the incontinence care and was about to close the clean incontinence brief, V9 was prompted to wipe the frontal perineum. As V9 did so, the washcloth showed fecal stains. V9 folded the washcloth multiple times and attempted to use the clean side of the washcloth; however, it was visibly soiled with fecal matter which had penetrated through the washcloth. On September 27, 2023, at 2:30 PM, V2 (Director of Nursing/DON) stated, When staff provides incontinence care, the staff should clean from front to back, wash the peri-area with washcloth with soap and water. If the washcloth becomes soiled with feces, they shouldn't fold it and use the other side, they should get a new washcloth. If there's bowel movement, get another washcloth. If the resident is female the staff must clean the outer and inner labia, groins, pubic area, and abdominal folds. If the resident is standing, the staff must wipe the front and the back. This is to prevent cross contamination and infection. Facility's Policy and Procedure for Perineal Care dated July 11, 2011, showed: Policy: It is the policy of this facility that perineal care will be done with AM and PM care and after each incontinence episode. Procedure: For female: b. Separate labia. With washcloth, soap and warm water or peri wash, clean downward from front to back with one stroke. Use clean surface of each washcloth with each wipe. c. Repeat as many times as necessary until the area is clean. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 9 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0805 Level of Harm - Minimal harm or potential for actual harm Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to serve pureed consistency Teriyaki beef tips and rice for the lunch meal. Residents Affected - Few This applies to 2 of 2 residents (R37, R44) reviewed for pureed diets in the sample of 19. The findings include: On September 26, 2023, at 10:57 AM, the pureed meal prep by V19 (Dietary Aide) was observed in facility kitchen. V19 pureed three 4 oz/ounce portions each of cooked teriyaki beef and rice in a blender. V19 then opened the blender and stated it was ready for service, and was going to transfer the contents to a container. The pureed mixture appeared granular with shreds of intact beef and small grains of rice on the sides of blender. When taste tested, pureed item had grains of rice and small shreds of beef. V19 and V16 (Dietary Manager) were notified the mixture was not safe to serve. V16 stated the sides should have been scraped down and pureed again. V16 also added the item should be smooth like baby food. On September 26, 2023 at 01:26 PM, V18 (Dietitian) stated the final product of the pureed meat and rice mixture should have been like mashed potato consistency. Facility pureed recipe for Beef and Pepper [NAME] Bowl (Recipe #7064) included: 1. Remove portions required from the regular prepared recipe and place in food processor. 2. Process until fine in consistency. 4. Add broth and process until smooth. Scrape down sides of processor with a rubber spatula and process 30 seconds. Facility diet order list printed on September 25, 2023, included R37 and R44 were on pureed diet consistency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 10 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to follow sanitary practices during dish washing, meal prep, and meal service. Residents Affected - Many This has potential to affect all 80 residents that received foods in the facility kitchen. The findings include: Facility Resident Census and Conditions of Residents form (CMS 672), dated September 24, 2023, showed the facility census was 80. Facility gave additional information there were no residents that were on nothing by mouth status. On September 25, 2023, at 9:49 AM, the initial tour of kitchen was conducted in the presence of V14 (Cook). In the reach in cooler, there was a container (1 gallon/container) of 2% milk, dated use by date September 24, 2023, which appeared less than half full. In the walk-in cooler, there were several unopened containers (1 gallon/container) showing use by dates as follows: 1 whole milk container September 3, 2023, 7 whole milk containers September 17, 2023, 4 whole milk containers September 24, 2023. V15 (Dietary Aide) stated that she served 2% milk for breakfast which was poured into jugs for service. On September 26, 2023, at 10:52 AM, V16 (Dietary Manager) stated, The Dietitian wants us to keep it for 2 days after till we smell it. But you were correct, it should have been dumped. On September 25, 2023, at 12:57 PM, V16 was at the dish machine unloading clean dishes. V16 was seen sorting out cleaned dishes that were just washed in the dish machine, and then put a few dishes back in the soiled area. V16 stated those dishes were not washed properly. V16 then went back to putting away cleaned dishes. V16 continued to go back and forth between cleaned and soiled area, repeating the procedure. V16 was not wearing gloves, and stated she washed her hands prior to starting the task initially. On September 26, 2023, 10:57 AM, during pureed meal prep of Teriyaki beef tips and rice mixture, V19 (Dietary Aide) placed a spatula on the prep counter that had dust and spills. V16 was going to use the same spatula to scrape down the sides of the blender. V16 was notified that area was not sanitary, and if spatula is used, the pureed mixture will not be safe to serve. On September 26, 2023, at 12:01 PM, V17 (Dietary Aide) delivered meal trays in an open cart from the kitchen to the hallway of B wing. The dessert of cream puff was noted open to air and not covered. There were multiple residents and staff in the hallway. One resident was noted to be coughing and was not wearing a mask. V16 was notified of the same and agreed that the dessert item should have been covered. On September 26, 2023, at 09:13 PM and at 10:57 AM, V18 (Dietitian) stated, The milk is good until it goes bad. Milk is pasteurized. There is no bacteria in there. When asked if the facility has a written policy with guidance for the same, V18 stated that the facility does not have a policy. When asked what guidance the staff should follow if there is no policy, V18 then stated the staff should use the milk by date shown on the container. V18 stated V16 should have washed hands in between touching dirty and clean dishes. V18 stated the staff should have put a plastic cover on top of the cart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 11 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0812 if any food item was open. V18 stated the clean utensils should not have been set on a dirty counter during pureed meal prep. Level of Harm - Minimal harm or potential for actual harm Facility Policy and procedure titled Cold Food Storage (revised 3/31/21) included as follows: Residents Affected - Many Policy: Food Service staff will practice safe storage techniques. Purpose: To reduce the risk of food borne illness. Procedure: 1. Follow first in, first out inventory control. 10. Potentially hazardous foods cannot be kept in the refrigerator for longer than 7 days. Facility policy and procedure titled Dishwashing Machine Operation (2020) included as follows: Procedure: 9f. Use clean, washed hands to pull out clean racks, and allow to air dry before putting dishes away for storage. Facility menu for week 2, Tuesday included Teriyaki beef tips, rice and puff pastry for the lunch meal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 12 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 record review, the facility failed follow standard infection control practices with regards to hand hygiene and gloving during provisions of incontinence care, and by not donning of personal protective equipment (PPE) when entering an isolation room. In addition, the facility also failed to ensure they have a process to measure or monitor the growth of Legionella and other opportunistic waterborne pathogens in building's water system. Residents Affected - Many This applies to all the 80 residents in the facility. The findings include: Facility Resident Census and Conditions of Residents form (CMS 672), dated September 24, 2023, showed the facility census was 80. 1. On September 25, 2023, at 11:29 AM, R7 was sitting on the bedside commode having a bowel movement; there were droppings of loose fecal matter on the floor. When R7 finished using the commode, V10 (Certified Nursing Assistant/CNA) assisted R7 to get up from wheelchair, and proceeded to clean R7's back perineum, pulled the incontinence brief and pants back in place, assisted R7 to transfer back to the motorized chair, and moved the bedside commode, while wearing same soiled gloves. 2. On September 26, 2023, at 10:15 AM, V9 (CNA) assisted R4 to the bathroom. After R4 voided, V9 assisted R4 to get up and wiped her back perineum. Then she pulled the incontinence brief and pants back up and assisted R4 back to reclining chair, while using the same soiled gloves. 3. On September 26, 2023, at 10:39 AM, V9 (CNA) rendered incontinence care to R9 who was wet with urine and had a bowel movement. V9 clean the frontal perineum, repositioned R9 to the right side and proceeded to clean the back peri-area. While V9 was cleaning the rectal and buttocks area, her gloved hands made direct contact with fecal matter. In between the process of cleaning the buttocks, V9 placed a clean incontinent pad and brief underneath R9. V9 assisted R9 to reposition on her back and closed the incontinence brief. V9 wore the same soiled gloves all throughout the care. 4. On September 26, 2023, at 1:19 PM, V9 (CNA) rendered incontinence care to R44, who was wet with urine and had a bowel movement. The fecal matter was dry and pasty from the front to back perineum of R44. V9 cleaned R44 from front to back, and during that process, her gloved hands made direct contact with feces. V9 repositioned R44, then placed a clean incontinence brief underneath R44, while wearing the same soiled gloves. Afterwards, V9 placed the soiled washcloth, pad, and the incontinence brief in plastic bags, then removed her gloves, carried the soiled materials, and left the room, without hand hygiene. On September 27, 2023, at 11:46 AM, V2 (Director of Nursing/DON) stated before providing incontinence care, the staff should do hand hygiene and put on gloves. The staff should change gloves and perform hand hygiene before proceeding to clean task and before moving to another body part. This is to prevent transmission of potential infection and cross contamination. Facility's Policy and Procedure for Hand Washing/Hand Hygiene dated February 26, 2021, indicates: Policy: This facility considers hand hygiene the primary means to prevent the spread of infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 13 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 Procedures: Level of Harm - Minimal harm or potential for actual harm 5-6. Employee must wash their hands for a minimum of twenty seconds using antimicrobial or non-antimicrobial soap and water under these conditions: Residents Affected - Many c. After contact with blood or other body fluids, secretions, mucous membranes, or non-intact skin. d. After removing gloves. e. After handling items potentially contaminated with blood, body fluids, or secretions. 7. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub. If hands are not visibly soiled, use an alcohol-based hand rub containing 60-95% ethanol or isopropanol for all the following situations. a. Before and after contact with residents. f. Before moving from one contaminated body site to a clean body site during resident care. g. After contact with a resident's intact skin. 5. On September 27, at 11:46 AM, V2 (DON) stated she is not involved in the oversight and testing of the waterborne pathogens, including Legionella. On September 27, 12:47 PM, V20 (Environmental Supervisor) stated he doesn't know about the Legionella test in the facility. He also stated he has been in the facility for 2 years, and has not seen the policy or the assessment for Legionnaire's disease. V20 asked when this requirement for an assessment for Legionella or waterborne pathogen start. On September 27, at 1:40 PM, V1 (Administrator) stated they don't have the Legionnaire's testing and monitoring information, but they do have eye station and ice machine in the building. The facility was unable to present policy and procedure for Legionella testing and assessment. The facility's assessment tool did not include Legionnaire's or water borne pathogen policy or assessment.6. R53's face sheet included diagnoses of chronic systolic (congestive) heart failure, diverticulosis of large intestine without perforation or abscess without bleeding, chronic obstructive pulmonary disease, Type 2 diabetes mellitus without complications, personal history of other venous thrombosis and embolism, need for assistance with personal care. R53's quarterly MDS (minimum data set) dated July 5, 2023 showed that R53 was cognitively intact. R53's POS (Physician Order Sheet) included contact isolation due to shingles (start date September 3, 2023). On September 25, 2023 at 12:05 PM, R53's room showed signage of 'Droplet/Contact Isolation' posted on door. The guidance on this signage included: In addition to standard precautions visitors report to nurses station before entering room. The following PPE/personal protection equipment is required: gloves, gown, N95 mask, surgical mask (over N95 mask). There was also a container with PPE stored at the entrance to R53's room and red isolation bins inside the room near the door. V11 (CNA/Certified Nursing Assistant), who was in the vicinity stated, She is on isolation for Shingles. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 14 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On entering the room, R53 stated, I am not on isolation. They are supposed to take the sign down. I have been on isolation since I have been here on January 3rd. Nobody wears a mask or gown here when they come in. Nobody. Friends, relative, staff. My niece, my nephew, and great nephew were here visiting yesterday and they did not wear anything. The staff never wear it either. Nobody wears it other than you. My sister visits me roughly every two weeks and she doesn't wear any mask or gown. When they [visitors] asked, the front desk told the CNA who called up there that I was not on isolation. I have had shingles. I only have one scab left. I have sores on my head. They seem to be loosening up. I got shingles a week ago today. On September 25, 2023 at 10:21 AM, V12 (Housekeeper) went into R53's room, without donning any PPE, including face mask. When V12 was asked if she saw the signage posted on the door, V12 stated, I only cleaned the bathroom. On September 26 , 2023 at 12:15 PM, V13 (Social Service Director) went into R53's room to deliver a lunch meal tray, without donning any PPE including face mask. When asked about the signage for isolation, V13 remarked, I thought it was only for care. On September 26 , 2023 at 3:35 PM, V2 (Director of Nursing) stated anyone who enters a room with isolation for shingles should wear gown and gloves. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 15 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the wheelchair breaks were maintained in working condition. Residents Affected - Few This applies to 3 of 3 residents (R1, R32, R50) reviewed for falls in the sample of 19. The findings include: 1. R1's face sheet included diagnoses of history of falling, unsteadiness on feet, need for assistance with personal care, spinal stenosis, site unspecified, muscle weakness (generalized), other abnormalities of gait and mobility, spinal stenosis, site unspecified. R1's quarterly MDS (Minimum Data Set), dated August 24, 2023, showed R1 was cognitively intact. On September 25, 2023, at 10:48 AM and on September 26, 2023, at 10:16 AM, R1 stated, I fell 3 weeks ago. I was trying to get into or out of bed. The CNA (Certified Nursing Assistant) was helping me. It was something with the wheelchair. The brakes went out and went backwards as I was standing up from it. I sat down on floor. I did not hurt myself. It happened about a week and a half ago at around 10:30-11:30 PM. R1 identified the CNA by her first name. This information was relayed to V1 (Administrator), who stated she was not aware of the fall incident. V1 was also notified about wheelchair brakes not working. 2. R32's face sheet included diagnoses of history of falling, unsteadiness on feet, need for assistance with personal care, weakness, dementia in other diseases classified elsewhere, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, encounter for other orthopedic aftercare. R32's Comprehensive MDS, dated [DATE], showed R32 was cognitively intact. On September 25, 2023, at 10:25 AM, R32 stated, The left brake on my wheelchair does not stay locked. It's dangerous. I told the therapy and the staff within the week or more than the week. R32 could not remember the names of the staff she told. R32 demonstrated on her wheelchair how the brake dislodges. R32 stated she used to walk with a rollator, and recently started using the wheelchair after a fall she had sustained in the room. R32's concern about the wheelchair was reported to V1 (Administrator), who stated she will have maintenance check the wheelchair immediately. 3. R50's face sheet included diagnoses of difficulty in walking, not elsewhere classified, unsteadiness on feet, dependence on other enabling machines and devices, other lack of coordination, other abnormalities of gait and mobility, need for assistance with personal care, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. R50's quarterly MDS, dated [DATE], showed R50 was cognitively intact. On September 25, 2023 at 11:03 AM, R50 stated, The wheelchair brakes don't work. I have falling down more than once. R50 added he can self-transfer to wheelchair. R50 demonstrated how the brakes dislodges on the wheelchair. The concerns about wheelchair brakes were relayed to V1 (Administrator), who stated she will immediately ask maintenance to check it. On September 26, 2023, at 2:30 PM and 3:25 PM, V1 stated the wheelchair brakes were fixed by maintenance, and she confirmed through interviews that the fall incident of R1 had occurred. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 16 of 17 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 146077 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Serenity Estates at Morris 1223 Edgewater Morris, IL 60450 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 0908 On September 27, 2023 at 11:55 AM, V20 (Maintenance) stated regarding checking R1's, R32's and R50's wheelchairs, The brakes on one side were not locking too well and I adjusted it and tightened it back up. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146077 If continuation sheet Page 17 of 17