Health inspection·December 18, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide dignity to a resident during provisions of care.This applies to 1 of 26 residents (R118) reviewed for dignity in the sample of 26.The findings include: R118's EMR (Electronic Medical Record) showed R118 was admitted to the facility on [DATE], with diagnoses that included intervertebral disc disorder with radiculopathy, lumbar region, acute respiratory failure with hypoxia, generalized muscle weakness, other chronic pain, dizziness, and giddiness. R118's MDS (Minimum Data Set), dated October 27, 2025, showed R118 was cognitively intact and was dependent on staff for showering.On December 16, 2025, at 9:04 AM, R118 said there was an incident, he thinks it was maybe two weeks ago, when the CNA (Certified Nurse Assistant), whose name he said he could not remember, took him to the shower room and turned on the water. The CNA told R118 she would be right back; she had to go to the other shower room for another resident. R118 said it was around 15 minutes later when the CNA returned, and he was shivering cold. R118 said he was not able to wash himself, so he was just sitting there naked, waiting, and it was cold. On December 16, 2025, at 2:16 PM, V2 (DON/Director of Nursing) said when giving a resident a shower, the resident should never be left alone in the shower room or left naked. On December 16, 2025, at approximately 3:30 PM, V1 (Administrator) said she spoke with R118, and he pretty much told her the same thing. V1 said it was common sense that the staff member should not have left [R118] in the shower room by himself. 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: 146077 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 12/18/2025 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)