Inspection·May 18, 2023

F 0554 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete documented the policy statement, It is the community's policy to administer all medications and treatments in a safe and effective manner. The procedure specifically stated, 12. Administer medication to resident, with water or juice. 13. Be sure that the resident has swallowed all medications. 14. Sign off medication given on the medication sheet, after giving the medication. The facility also provided their policy, Self Administration of Medications, (dated January 2023) which documented the policy statement, An individual resident may self-administer medication if the resident requests and the interdisciplinary team has determined that self-administration is clinically appropriate. The procedure specifically stated, 3. Complete a self-administration tool . 4. Review the tool with the interdisciplinary team. 5. If the team determines that self-administration is clinically appropriate, obtain a physician's order for resident to self-administer each specific medication that the resident has been qualified to self-administer. 6. Update the resident's care plan to indicate the resident's choice to self-administer medications. Event ID: Facility ID: 146094 If continuation sheet Page 2 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 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 provide oral hygiene, nail care, incontinence care for residents needing assistance for ADLs (Activities of Daily Living). This applies to 5 of 5 (R3, R5, R16, R74, R75) reviewed for ADLs in the sample of 14. Residents Affected - Some The findings include: 1. On 05/15/23 at 10:30 A.M., R5 was observed lying in bed. R5 was restless, moaning and groaning. R5's was wearing heel protectors to her feet. R5's right foot was pushed against the footboard. R5's left foot was dangling to the floor. R5's was sliding off from her bed and need to be repositioned. V14 (CNA/Certified Nurse Assistant) was called to repositioned R5. V14 was asked to view R5's incontinence brief. R5's incontinence brief was soaked with urine. V14 donned on gloves, proceeded to provide incontinence care to R5. During this time, R5 was also noted with long jagged fingernails and toenails, facial hair and chin hair. V14 said that R5 is totally dependent from staff for ADLs. The EMR (Electronic Medical Record) shows that R5, a [AGE] year old female was admitted to the facility on [DATE] R5's diagnoses included but not limited to cellulitis of right lower limb, MRSA (Methicillin Resistant Staphylococcus Aureus) of the right foot ulcer, acute hematogenous osteomyelitis of right ankle/foot, DM2 (diabetes mellitus), TIA (transient ischemic heart attack), needs assist personal care, difficulty walking, muscle weakness, CKD (chronic kidney disease) and anemia, The MDS (Minimum Data Set) dated 3/31/2023, shows BIMS (Brief Interview Mental Status) score 14/15 (cognitively intact); behavior was 0 for rejection of care, bed mobility 3/2 (extensive with 1person assistance); transfers (3/2); dressing (2/2); toilet use including changing of incontinence pads (3/2) and hygiene 2/2 (limited assistance with 1 person assist). The care plan dated 4/5/2023 for ADL shows that R5 is an actual and at risk and for potential complications with deficits with ADL's related to current medical / physical status- impaired mobility, generalized weakness. The care plan shows that R5 will be maintained clean, dry, dressed appropriately and maintain ability to participate in ADL's. Other interventions included assistance to be provided for hygiene, toileting needs, transfers and repositioning. 2. On 05/15/23 at 10:40 A.M., R16 was lying in bed. R16's wife was at bedside. R16 was noted with long fingernails, and toenails that were jagged, and black substance under the nail beds. R16's toenails were long; broken split and causing a cut to the skin. R16's wife said R16 needed a podiatry service. V14 was notified of nail care. V14 said R16 needed assistance from staff for ADLs. The EMR shows that R16 is a [AGE] year-old, admitted to the facility on [DATE]. R16's diagnoses included but not limited to PD (Parkinson's Disease), TBS (traumatic brain injury), UTI (urinary tract infection), DM2 (diabetes melllitus), needs assistance with personal needs, urine retention, repeated falls, atrial fibrillation, dementia and psychosis. The MDS dated [DATE] shows R16's BIMS score of 0, (cognitively impaired); functional mobility for bed mobility, transfer, toilet use, hygiene, dressing was 3/3 (extensive assistance with 2 plus person assist). The care plan dated 3/8/2023 shows that R16 was an actual risk and potential for complications with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 3 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 diabetes. Goal and interventions included that R16 be free of serious complications and R16's needs be anticipated, will be kept clean and dry and skin intact. Other interventions include to observe R16's skin with AM/PM cares for skin redness, rashes, and open areas. 3. On 05/15/23 at 10:30 A.M., R74 was observed lying in his bed. R74 was restless, moans and groans and repeatedly saying I am dying. V14 (CNA/Certified Nurse Assistant) was at R74's bedside and said, I just provided an incontinence care to (R5). Upon request, skin checked was done with V14's assistance. R74's peri area was observed with accumulation of dried and caked yellowish substance. R74 was also noted wearing an incontinence brief that was saturated with brownish drainage coming off from a loose wound dressing from R5's pressure injury of the sacrum. V14 said I will provide him incontinence care now. V14 also called V16 (License Practical Nurse) to change the wound dressing. V16 came to change the wound dressing from R5's pressure injury. V14 proceeded to cleanse R74's buttocks area, and failed to wipe R74's penile area, groins and removed the dried yellow substance. V14 said the dried yellow substance was an old skin barrier cream. During this observation, R74 was also noted with dried food around his mouth/lips. R74's fingernails and toenails were long, jagged and black substance under the nail beds. V14 said that the dried food was R74's pureed food and that R74 needed assistance for ADLs. The POS (Physician Order Sheet) for the month of May 2023 shows an order dated 5/12/2023 for R74's oral care. The EMR shows that R74 is a [AGE] year-old with diagnoses of non-displaced cervical fracture, restlessness, anxiety, dysphagia, need assistance for personal care, anxiety disorder, major depressive disorder, neuralgia, dementia, and psychosis. The MDS dated [DATE] shows R74's BIMS score of 8/15 (moderate cognitive impairment); 3/3 (extensive assistance with 2 plus person assist) for bed mobility, transfer, dressing, toilet use, hygiene, and 3/2 for eating (extensive with 1 person assist). The care plan for ADL and B/B (bowel and bladder) dated 5/9/2023 shows that R74 is an actual/risk and potential for complications with deficits with ADL's related to current medical / physical status. The intervention was to provide R74's incontinence care with each episode of incontinence. 4. On 05/15/23 at 12:35 P.M., R75 was lying in bed. R75 said my feet hurts, toenails were too long no one here was taking care of it so my family decided to cut the long nails. Now it is so sore, my skin was snipped when they cut my toenails. V14 was prompted regarding R75's concern of nail pain. V14 came to R75 and said (R75's) family had cut (R75's) toenails because they were too long, and this had caused the wound cut under the nail beds. On 05/16/23 at 02:51 PM, R75 said my feet hurts, my toenails that were long were cut so deep and caused the cut the skin next to toenails, bleeding a little, no band aid to cover the cut and blood. The EMR shows that R75 is a [AGE] year-old with diagnoses of BPH (benign prostatic hypertrophy), hyperlipidemia, COPD (chronic obstructive pulmonary disease), and HTN (hypertension). The care plan dated 5/14/2023 for skin integrity shows that R75 is an actual/at risk and potential for complications with impaired skin integrity including skin tears, related to current medical and physical status. The goal was for R75 to be free of serious complications related to current skin status, follow community skin protocol and observe skin with AM/PM cares for redness, rashes, open (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 4 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 areas, pain, swelling and report. Level of Harm - Minimal harm or potential for actual harm The facility's policy regarding ADL with date of May 2023 shows that resident be positioned comfortably; provide incontinence care to residents with incontinence for each episode in a timely and appropriately to prevent infection (UTI/urinary tract infection.) Residents Affected - Some On 5/17/2023 at 2:15 P.M., V2 (Director of Nursing) stated that standard of practice was to provide timely and thorough incontinence care, ensure that hygiene was maintained including nail and oral care. 5. R3 was admitted to the facility 2/6/2019 with hemiplegia and hemiparesis following a stroke affecting the left non-dominant side. The most recent comprehensive assessment for R3, dated 3/30/23, shows R3 is cognitively intact and requires extensive assistance from 2 persons for all transfers and for toileting. On 5/15/2023 at 10:45am, R3 stated he would like to use the toilet but the staff have told him they don't have time. R3 stated the response to the call light is slow, sometimes it's the next day. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 5 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 provide services and treatment to promote healing of a pressure injury by not providing timely incontinent care, following treatment order and maintained maximum effect of pressure reduction mattress. Residents Affected - Few This applies to 1 of 1 (R74) reviewed for pressure injury in the sample of 14. The findings include: The EMR (Electronic Medical Record) shows that R74 is a [AGE] year-old with diagnoses of non-displaced cervical fracture, restlessness, anxiety, dysphagia, need assistance for personal care, anxiety disorder, major depressive disorder, neuralgia, dementia, and psychosis. The wound assessment dated [DATE] shows that R74 has an unstageable pressure injury to the sacrum and was described as length 5 cm x 7 cm, drainage with serous drainage, declined wound. The POS (Physician Order Sheet) for May 2023 shows an order dated 4/26/2023 for an air mattress therapy every shift. On 5/12/2023, an order to clean sacral wound with wound cleanser, pat dry and quarter strength Dakins solution, wet to moist packing and cover with foam dressing daily. (Dakin is a solution used as antiseptic to prevent infection). The care plan dated 5/9/2023 shows that for skin integrity, R74 has an actual impaired skin integrity, unstageable pressure ulcer to sacrum. The care plan goal was for R74 to be free of serious complications, have decreased potential for development of pressure injuries, will heal and (R74) will have clean, dry, intact skin. Interventions includes treatments as ordered, incontinence care with incontinent brief changes, pressure reduction mattress on bed. On 05/15/23 at 10:30 A.M., R74 was observed lying in his bed. R74 was restless, moans and groans and repeatedly saying I am dying. R74 was lying in an air loss mattress that was padded with multiple layers such as fitted sheet, draw sheet and incontinence cloth pad. In addition, R74 was already wearing an incontinence brief. The intent of the air loss mattress was to provide maximum pressure reduction. V14 (CNA/Certified Nurse Assistant) was at R74's bedside and said, I just provided an incontinence care to (R5). Upon request, skin checked was done with V14's assistance. R74's peri area was observed with accumulation of dried and caked yellowish substance. R74 was also noted wearing an incontinence brief that was saturated with brownish drainage coming off from a loose wound dressing from R5's pressure injury of the sacrum. R74's brief was soaked with urine. V14 said I will provide him incontinence care now. V14 also called V16 (License Practical Nurse) to change the wound dressing. V16 came to change the wound dressing from R5's pressure injury. V16 donned on gloves and proceeded to provide wound dressing changed to R74. V16, cleansed the wound bed with saline soaked gauze, then applied Santyl ointment (chemical debridement) and cover the wound with a foam dressing. R74's pressure injury to the sacrum was shape like a crater, approximately an inch deep, 4-inch width and 4-5 inch in length. The wound bed was approximately 90 % slough, grayish/yellowish leathery looking dead tissues. V16 did not implement current physician treatment order when she used Santyl instead of the Dakins solution. On 5/17/2023 at 2:15 P.M., V2 (Director of Nursing) stated that the facility does not have the air (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 6 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 0686 Level of Harm - Minimal harm or potential for actual harm loss mattress manufacturer's specification. V2 added that the air loss mattress was to provide maximum pressure reduction and should only use one piece of bedding which was a draw sheet. V2 added that if there were multiple layers of pads applied to the air mattress, this defeats the purpose of the air loss mattress and maximum effect for pressure reduction cannot be maintained. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 7 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide incontinence care in a manner that would prevent urinary tract infection (UTI). This applies to 3 of 3 (R4, R5, R74) reviewed for incontinence care in the sample of 14. The findings include: 1. On 05/15/23 at 02:00 PM, while surveyor was in the residents' hallway, R4 was heard from her room yelling I need a change, I smell, do not like this feeling, I am wet, my diaper is wet. V15 (CNA/Certified Nurse Assistant) came in to R4's room and said I am waiting for (V14/another CNA) to come help get up (R4) from wheelchair to standing positions to change diaper. V14 came in, and they both lifted R4 from her wheelchair to standing position. R4 was soaked with urine. V14, with gloves on had wiped R4's buttocks. V14 and V15 applied a new diaper without wiping R4's frontal aspect of her peri area that included groins and labial folds. The EMR shows that R4, a female resident is an [AGE] year-old with diagnosis CVA (cerebral vascular accident) with hemiparesis and hemiplegia. The MDS (Minimum Data Set) assessment dated [DATE] shows R4's BIMS (Brief Interview Mental Status) of 7/10 (severely impaired in cognition); 3/3 (extensive assist with 2 plus person assist) for mobility, transfer, dressing, toilet, hygiene. R4 also with upper and lower limb impairment in range of motion and is always incontinent of bladder and bowel function. The care plan for ADL dated 4/26/2023 shows that R4 is an actual and at risk and is potential for complications with deficits with ADL's and bladder and bowel related to right hemiparesis, weakness, history of falls, decreased strength, endurance, and functional mobility. The intervention was to provide assistance and incontinence care with each incontinent episode. 2. On 05/15/23 at 10:30 A.M., R5 was observed lying in bed. R5 was restless, moaning and groaning. V14 (CNA/Certified Nurse Assistant) was prompted. V14 was asked to view R5's incontinence brief. R5's incontinence brief was soaked with urine. V14 donned on gloves, proceeded to provide incontinence care to R5. V14 wiped R5's buttocks area, the groins and failed to clean labial folds. Furthermore, V14 started cleaning from buttocks/behind towards the front area. V14 with same soiled gloves had touched the privacy curtain, open drawers and proceeded to go to R5's roommate and took the roommate's tube of skin barrier cream. V14 applied the skin barrier cream to R5, still with same soiled gloves and placed the tube of skin barrier cream into her pants' pocket. The EMR (Electronic Medical Record) shows that R5, a [AGE] year old female was admitted to the facility on [DATE] R5's diagnoses included but not limited to cellulitis of right lower limb, MRSA (Methicillin Resistant Staphylococcus Aureus) of the right foot ulcer, acute hematogenous osteomyelitis of right ankle/foot, DM2 (diabetes mellitus), TIA (transient ischemic heart attack), needs assist personal care, difficulty walking, muscle weakness, CKD (chronic kidney disease) and anemia, The MDS assessment dated [DATE], shows BIMS (Brief Interview Mental Status) score 14/15 (cognitively intact); behavior was 0 for rejection of care, bed mobility 3/2 (extensive with 1person assistance); transfers (3/2); dressing (2/2); toilet use including changing of incontinence pads (3/2) and hygiene 2/2 (limited assistance with 1 person assist). The care plan dated 4/5/2023 for ADL shows that R5 is an actual and at risk and for potential complications with deficits with ADL's related to current medical / physical statusimpaired mobility, generalized weakness. The care plan shows that R5 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 8 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 - Few will be maintained clean, dry, dressed appropriately and maintain ability to participate in ADL's. Other interventions included assistance to be provided for hygiene, toileting needs, transfers and repositioning. 2. On 05/15/23 at 10:30 A.M., R74 was observed lying in his bed. R74 was restless, moans and groans and repeatedly saying I am dying. V14 (CNA/Certified Nurse Assistant) was at R74's bedside and said, I just provided an incontinence care to (R5). Upon request, skin checked was done with V14's assistance. R74's peri area was observed with accumulation of dried and caked yellowish substance. R74 was also noted wearing an incontinence brief that was saturated with brownish drainage coming off from a loose wound dressing from R5's pressure injury of the sacrum. V14 said I will provide him incontinence care now. V14 also called V16 (License Practical Nurse) to change the wound dressing. V16 came to change the wound dressing from R5's pressure injury. V14 proceeded to cleanse R74's buttocks area, and failed to wipe R74's penile area, groins and removed the dried yellow substance. V14 said the dried yellow substance was an old skin barrier cream. The EMR shows that R74 is a [AGE] year-old with diagnoses of non-displaced cervical fracture, restlessness, anxiety, dysphagia, need assistance for personal care, anxiety disorder, major depressive disorder, neuralgia, dementia, and psychosis. The MDS dated [DATE] shows R74's BIMS score of 8/15 (moderate cognitive impairment); 3/3 (extensive assistance with 2 plus person assist) for bed mobility, transfer, dressing, toilet use, hygiene, and 3/2 for eating (extensive with 1 person assist). The care plan for ADL and B/B (bowel and bladder) dated 5/9/2023 shows that R74 is an actual/risk and potential for complications with deficits with ADL's related to current medical / physical status. The intervention was to provide R74's incontinence care with each episode of incontinence. On 5/17/2023 at 2:15 P.M., V2 (Director of Nursing) stated that standard of practice for appropriate incontinence care was to timely provide incontinence care and thoroughly cleanse the peri area by wiping from inner to outer motion, making sure to clean the labial folds for female residents and retract the penile skin for male residents for thorough cleansing to prevent infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 9 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to serve pureed portion sizes in accordance with the planned menu for the lunch meal. This applies to 1 of 1 resident (R74) reviewed for pureed diets in the sample of 14. The findings include: On 05/15/23 at 11:17 AM, V7 (Cook) stated that for the pureed diets he prepared pureed meat, pureed peas and mashed potatoes and showed a sample plated version of the same that was placed in the steamer. On 05/15/23 at 12:51 PM, V6 (Server) was at the tray line platting the food. R74's diet card showed pureed diet, nectar thick liquids and R74 received one (blue colored) scoop each of peas and mashed potatoes and one and half (blue colored) scoop of pureed meat, a bowl of thickened soup and nectar thick liquid cranberry juice. Facility menu diet spread sheet for Week 2, Monday for pureed diets showed #6 scoop for pureed [NAME] sandwich, #8 scoop for pureed potato salad and #12 scoop for pureed seasoned peas. When V5 (Server) who was in the area was notified of the same, V5 stated that V6 was supposed to use scoop size as shown on the spread sheet. V5 and V6 were unsure of the size of the blue colored scoop used. Facility Disher Capacity Chart showed that the blue colored scoop was #16 =2 oz/ounce portion. The same chart showed that #6 scoop (white color)=5 1/3 oz, #8 (gray color)=4 oz, #12 (green color)=2 2/3 oz. On 05/17/23 at 1:07 PM, V8 (Dietitian) stated that the facility should follow the diet spreadsheet to serve serving portions as shown on the spreadsheet to meet the proper protein and nutrient contents as planned. Facility Diet Order Category Report showed that R74 was on pureed consistency diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 10 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow standard infection control practices related to hand hygiene and glove change during provisions of care. The facility also failed to ensure that donning of PPE (Personal Protective Equipment) was implemented when a resident who is on contact isolation was provided with personal care. Residents Affected - Some This applies 4 of 14 (R4, R5, R74, R126) reviewed for infection control in the sample of 14. The findings include: 1. On 05/15/23 at 02:00 PM, while surveyor was in the residents' hallway, R4 was heard from her room yelling I need a change, I smell, do not like this feeling, I am wet, my diaper is wet. V15 (CNA/Certified Nurse Assistant) came in to R4's room and said, I am waiting for (V14/another CNA) to come help get up (R4) from wheelchair to standing positions to change diaper. V14 came in, and they both lifted R4 from her wheelchair to standing position. R4 was soaked with urine. V14, with gloves on had wiped R4's buttocks. V14 wearing same soiled gloves, had proceeded to go to the soiled utility room, disposed R4's soiled diaper, and then enter another resident (R5) room. V14, still with same soiled gloves and no hand hygiene, had touched R5's nutritional supplement (Glucerna) that was at R5's bedside table and assisted R5 to drink the supplement. The EMR shows that R4, a female resident is an [AGE] year-old with diagnosis CVA (cerebral vascular accident) with hemiparesis and hemiplegia. 2. On 05/15/23 at 10:30 A.M., R5 was observed lying in bed. R5 was restless, moaning and groaning. R5's was wearing heel protectors to her feet. R5's right foot was pushed against the footboard. R5's left foot was dangling to the floor. V14 (CNA/Certified Nurse Assistant) was called to repositioned R5. V14 was asked to view R5's incontinence brief. R5's incontinence brief was soaked with urine. V14 donned on gloves, proceeded to provide incontinence care to R5. V14 wiped R5's buttocks area and the groins. V14, wearing same soiled gloves had proceeded and touched the privacy curtain, open drawers and proceeded to go to R5's roommate and took the roommate's tube of skin barrier cream. V14 applied the skin barrier cream to R5, still with same soiled gloves and placed the tube of skin barrier cream into her pants' pocket. V14, then removed her gloves and failed to implement hand hygiene. The EMR (Electronic Medical Record) shows that R5, a [AGE] year old female was admitted to the facility on [DATE] R5's diagnoses included but not limited to cellulitis of right lower limb, MRSA (Methicillin Resistant Staphylococcus Aureus) of the right foot ulcer, acute hematogenous osteomyelitis of right ankle/foot, DM2 (diabetes mellitus), TIA (transient ischemic heart attack), needs assist personal care, difficulty walking, muscle weakness, CKD (chronic kidney disease) and anemia, 3. On 05/15/23 at 10:30 A.M., R74 was observed lying in his bed. R74 was restless, moans and groans and repeatedly saying I am dying. V14 (CNA/Certified Nurse Assistant) was at R74's bedside and said, I just provided an incontinence care to (R5). Upon request, skin checked was done with V14's assistance. R74's peri area was observed with accumulation of dried and caked yellowish substance. R74 was also noted wearing an incontinence brief that was saturated with brownish drainage coming off from a loose wound dressing from R5's pressure injury of the sacrum. V14 said I will provide him incontinence care now. V14 also called V16 (License Practical Nurse) to change the wound dressing. V16 came to change the wound dressing from R5's pressure injury. V16 donned on gloves and proceeded to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 11 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 - Some provide wound dressing changed to R74. After the wound dressing changed, V16, removed her gloves, no hand hygiene, donned on a new pair of gloves and then assisted V14 during provision of incontinence care to R74. V16, who failed to wash her hands or implement hand hygiene had touched R74's face, arms and body while assisting V16. The EMR shows that R74 is a [AGE] year-old with diagnoses of non-displaced cervical fracture, restlessness, anxiety, dysphagia, need assistance for personal care, anxiety disorder, major depressive disorder, neuralgia, dementia, and psychosis. 4. On 5/16/2023 at 2:04pm, R126 was in the room, on contact isolation with clostridium difficile infection. R126 has an indwelling urinary catheter. At 2:08pm, V15 (CNA - Certified Nurse Assistant) entered the room wearing gloves and without a gown. V15 performed care with R126, emptying the urinary catheter collection bag. Signage on the door to R126's room is clearly visible explaining the isolation status of the room and indicating the proper personal protective equipment required. On 5/16/2023 at 2:20pm, V15 stated she realized she should have worm a gown in the room due to the contact isolation status. V15 stated she hurried because it was the end of her shift. On 5/17/2023 at 2:15 P.M., V2 (Director of Nursing) stated that standard of practice for infection control was to always wash hands/hand hygiene be implemented after removal of gloves, handling soiled or contaminated objects to prevent spread of infection. V2 also added that their policy was so generalized so they must use acceptable standard of practice. V2 added that PPE (protective gown/gloves) should be worn during provision of care to a resident who in on contact isolation. Facility's Policy and Procedure for Hand Hygiene/PPE use dated May 2023 shows: PPE is used to prevent the spread of infection, including gloves, gowns, facial protection. PPE is a barrier that protects the health care worker from exposure to infectious agents and prevents the transmission of microorganisms to other individuals including staff, patients and visitors. Gloves are disposable, one time use covering that protects hands of a health care worker from coming into contact with client's potentially infected body fluids and to protect patients from coming into contact with several contaminants on health care workers' hands during certain procedures and treatments. Gloves should always be used in combination with proper hand hygiene that is performed prior to applying gloves and repeated again after gloves are removed. Gloves are task-specific and should not be worn more for more than one task or procedure on same client because some tasks may have a greater concentration of microorganisms than others. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 12 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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 maintain a working call light system. Residents Affected - Many This applies to 19 of 19 residents reviewed for call lights living in the facility. R7 was admitted to the facility 3/14/23 with spinal abscess and other diagnoses. On 5/15/2023 at 2:15pm, R7 stated it often takes a long time to get a response to the call light. R7 stated it can take up to 2 hours to get help. R7 stated he would prefer not to evacuated feces in a diaper. R7 stated he had to go in his pants a couple of days ago. The most recent comprehensive assessment for R3, dated 5/4/2023, shows R7 is cognitively intact and requires assistance from 1 person for transfers and for toileting. R3 was admitted to the facility 2/6/2019 with hemiplegia and hemiparesis following a stroke affecting the left non-dominant side. The most recent comprehensive assessment for R3, dated 3/30/23, shows R3 is cognitively intact and requires extensive assistance from 2 persons for all transfers and for toileting. On 5/15/2023 at 10:45am, R3 stated he would like to use the toilet but the staff have told him they don't have time. R3 stated the response to the call light is slow, sometimes it's the next day. R1 is [AGE] years old and was admitted to the facility 9/22/2021. The most recent comprehensive assessment for R1, dated 4/29/2023, and shows R1 is cognitively intact and requires some assistance from 1 person for transfers and for toileting. On 5/15/2023 at 11:12am, R1 stated the staff are very good but it takes them a long time to answer the call light. R1 stated it is rarely more than one hour. R126 was admitted to the facility on [DATE] needing physical therapy after hospitalization. R126 had a diagnosis of clostridium difficile infection and was on contact isolation. On 5/16/2023 at 2:04pm, R126 stated, the only problem I've had is not answering the call light. R126 stated it took 2 hours this morning and someone brought lunch but didn't help me to the bathroom! During the survey, the electronic banner at the Nurse's station showed R3's call light as activated during every observation, even when R3 was not in the room. On 5/17/2023 at 2:40pm, V18 (Director of Maintenance) went into R3's room to reset the call lite then went to call lite computer station at Nurses station. R3's call lite was still showing as activated on banner. Also, V18 stated the call lite system is supposed to make a loud noise while call lights are activated. The call light system was making no sound. V18 expressed surprise and made several attempts to restore the sound alarm function to the call light system but was unable to do so. V18 stated, whoever disabled the system really knew what they were doing. At no time during the Survey did the call light system make a sound of any sort. 05/15/23 at 2:15pm, there was 1 electronic banner at back of desk and 1 over the double door to hall containing rms 100 - 109 which cannot be seen from the desk. There are no lights over the doors nor any other indicators for a resident calling for assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 13 of 14 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 146094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Vista Burr Ridge 6801 Highgrove Boulevard Burr Ridge, IL 60527 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 5/17/2023 2:45pm, V17 (Licensed Practical Nurse) stated the banner is ok if you're close enough to see it but at the other end of the hall you really can't so you have to walk up here and that takes more time. Then you still have to wait through the scroll. 5/17/023 12:18pm, V2, (Director of Nurses) stated the call lite system is not the best, other buildings she has worked in have lights over the door. The staff would have to stop and read the electronic banner through its entirety to know who is on the call lights. When asked about the occupied rooms where the banner notice has been on constantly for 3 days, the DON nodded at the question of the confusion cased by the lights system not working. The facility provided a print-out from the call light system showing long periods of call light activation including very long times for R3, R7, R126 and others in the unit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146094 If continuation sheet Page 14 of 14