Health inspection·June 17, 2025

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many on them, sitting on food carts that were covered in plastic covers. V10 (Certified Nursing Assistant) stated, Those trays are for residents who eat in their rooms, and the trays normally have lids on them. Three meal trays were covered in plastic wrap with no lids and no meal tickets sitting on food cart. A steam table in the dining room not in use. V10 stated, The steam table is fairly new, they used to serve food from the steam tables months ago. R1's meal tray arrived 20 minutes after meal service began, and two other residents sharing the table with him had already received their meals. V10 stated, (R1's) meal tray just arrived and confirmed dining service has had some challenges since the Dietary Manager left. R4's and R1's meal tickets stated cheeseburger, and they received a hamburger. R1 and R4 stated they were supposed to get a cheeseburger. V5 (Dietary Regional Consultant) stated they do have cheese in the kitchen, and she isn't sure why R1 and R4 did not get cheese on their burgers. At 1:14 PM, a test tray was delivered to the 2nd floor dining area by V5. The fries, carrots and sloppy joe on the test tray were not warm or hot, and were nearly cold, and therefore not appetizing. At 1:27 PM, V5 stated this week's menus are from the third week in the monthly menu cycle; they had to change the menu from the original pork based meal because the pork had just come in. On 06/16/2025 from 8:29 AM - 9:30 AM, V7 (Head Cook) stated the breakfast meal was supposed to include toast, however, they are out of toast and biscuits were served instead. Meal trays being prepared with biscuits. 3-4 plates at a time were prepared by V8 (Dietary Aide) with bacon, eggs, and a biscuit sitting on a side prep table for up to a minute before being covered and placed on a tray cart by V9 (Dietary Aide). V6 (Cook) and V8 stated, The trays without tickets last Thursday were for newly admitted residents, they didn't have anyone to enter the dietary information for those residents. V6, V8, and V9 stated Dietary duties have been challenging without a Dietary Manager, and there hasn't been one in two weeks, and all emphasized they really need the assistance of a Dietary Manager. V6 and V8 stated they ran out of tray lids last Thursday. V6 stated maintaining inventory has been more challenging without a Dietary Manager, and they have run out of items. V6 stated, There is only one hot box for meal trays which is used for the locked unit. Having a Dietary Manager helps ensure everything gets done efficiently and properly in the kitchen. V9 left the kitchen multiple times during tray prep. V6 stated, (V9) went to deliver the trays, there's usually another staff available to assist with that. V9 re-entered the kitchen with plastic cups and supplies during tray prep. V8 was waiting with multiple uncovered prepared plates for V9 to return to the kitchen. V8 stated a Dietary Manager helps ensure tickets are prepared and ready for meal service. V9 stated having a Dietary Manager ensures they have everything they need and don't have any disruptions in their duties, such as tray lids, silverware, coffee etc. V8 stated she believes they are about to run out of dish soap. V6, V8, and V9 all expressed the Dietary Manager typically ensures all of the Dietary supplies are available so they can perform their duties efficiently, and this has been difficult to maintain since no longer having a Dietary Manager. V8 stated the Dietary Manager also ensures other kitchen duties such as cleaning is done, so they can focus on other duties and make sure they are performed efficiently. V9 stated, Bread is stored on the bread rack; typically it comes in on Saturdays, however, we had not received a shipment this Saturday, which is why there is not really any bread on the bread rack. 4 loaves of bread and one large pack of hot dog buns were sitting on the bread rack. V8 stated when they had a Dietary Manager, everything was stocked. During tray preparation, the lid of the storage bin with oatmeal in it was left open when not in use. A scoop was lying in the sugar stored in the bulk bin. A scoop was left sitting on top of the rice storage bin. No holders for the scoops were near or inside the bulk bins. V5 (Dietary Regional Consultant) did not arrive to the kitchen at any time during tray preparation for breakfast. The facility's breakfast menu for Monday (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 2 of 5 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 146132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at Homewood 19000 South Halsted Homewood, IL 60430 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 0802 Level of Harm - Minimal harm or potential for actual harm (06/14/2025) of the week four menu cycle includes Choice of Hot or Cold Cereal, Bacon, Scrambled Eggs, and Toast. On 06/16/2025 at 9:43 AM, R4's breakfast meal ticket notes included double portions at breakfast meal. R4's meal tray had one biscuit, two servings of eggs, multiple slices of bacon, and one bowl of grits. Residents Affected - Many On 06/16/2025 at 9:31 AM, R3's Meal Ticket notes included two bowls of cold cereal/yogurt/fruit. R3's breakfast included one bowl of cold cereal, one bowl of hot super cereal/oatmeal, and no yogurt or fruit. R3 confirmed she was supposed to have two bowls of cold cereal. On 06/16/2025 at 9:45 AM, R2 was in the lobby area after breakfast waiting to be transported for an appointment. R2 stated during breakfast his bacon was cold, but it always is. On 06/16/2025 at 1:29 PM, V5 (Dietary Regional Consultant) stated she believes yogurt is served upon request, and confirmed yogurt is stored in the cooler and there was none currently. Observed there was no yogurt in the kitchen cooler. V8 (Dietary Aide) stated she noticed the scoops stored inside the sugar bulk bin and on top of the rice bulk bin; they shouldn't be there, everyone is just moving too fast. V8 confirmed staff are overwhelmed and overlooking things without a Dietary Manager. On 06/16/2025 at 2:51PM, V5 (Dietary Regional Consultant) stated she came in to the facility last Monday (06/09/2025) to assist since they let the Dietary Manager go. V5 stated V5 had concerns as well about the staff using plastic wrap to cover the meal trays; they were used because of the limited space on the top of the speed racks used for transporting meals. V5 stated she was only concerned about staff wasting plastic wrap, but didn't have any food safety concerns because the aides pass the trays very quickly. V5 stated a steam table is normally used for meal service ,however, the one in the dining area has the wrong voltage, so they are waiting for it to be replaced. V5 stated the steam table keeps the food nice and warm. V5 stated the speed racks don't hold temps as well as the hotbox, however they are passed out really quickly. V5 stated food temps should be palatable; it is subjective. V5 stated, If there is no holder inside the dry storage bins they should get a clean scoop every time. Technically, if the scoop handle is up, it's ok to store it inside the bulk bins, but it should not be sitting on top of the bin, and the bulk bin lid needs to be closed. When asked what might have contributed to staff making these errors in Dietary practices, V5 stated, I'm guessing they're in a hurry, not paying attention, and if the Dietary Manager observed these things, they would do in-services. V5 stated this last week has been kind of tumultuous because they lost a staff member and manager. V5 stated, I assume the Dietary meal tickets should be prepared right away after admission; this is done by nursing staff. If a resident was supposed to receive double portions for breakfast, this would include double portions of all meal items, so they should have had two biscuits, double the bacon portion, double the egg portion, and a double cereal portion of cereal, which includes two bowls. On 06/16/2025 at 3:55 PM, V1 (Administrator) informed that V14's (Former Dietary Manager) last working day was 06/04/2025. On 06/16/2025 at 5:47 PM, V1 (Administrator) reported the facility has total of 131 residents who are served food from the facility, and a total of 4 residents who do not receive foods orally. On 06/17/2025 at 2:33 PM, V5 (Dietary Regional Consultant) stated the notes section on a meal ticket is for general information such as double portions, likes and dislikes. V5 stated the Dietary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 3 of 5 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 146132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at Homewood 19000 South Halsted Homewood, IL 60430 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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many staff needs the oversight of a Dietary Manager for kitchen operations, which is different from the medical side of signing diet orders. When asked what Dietary operations require the Dietary Manager's oversight, V5 replied, For example, I am filling in as a Dietary Manager, which includes ordering food supplies and dishware, monitor inventory and ordering these supplies as needed, making staff schedules, general day to day kitchen inspections including, ensuring general cleanliness is taken care of, food is stored correctly, menus and meal tickets are being followed, and making sure meals are served at an appropriate temperatures. V5 confirmed substitutions are listed on the meal tickets. The facility's Dietary Manager Job Description, received 06/17/2025, states: The CDM (Certified Dietary Manager) is responsible fore the daily operations of dietary department in accordance with facility policy and procedures as well as federal and sate regulations. They provide leadership and guidance to ensure that food quality, safety standards, and client expectations are satisfactorily met. They also maintain records of food, supplies, inventory levels, and equipment. These duties are also listed under the Essential Functions section of the Dietary Managers job duties. Food Service Management duties include: Inspect meals and ensure that standards for palatability, temperature, and serving times are met. Assure that foods are prepared according to menus. Sanitation and Food Safety duties include: Manage staff to ensure compliance with safety and sanitation regulations including safe storage of food. The Facility's Competency Check List for Dietary Manager, received 06/16/2025, includes: Ensures dietary staff are performing assigned tasks appropriately. Ensures dietary staff follow established infection control guidelines and food safety regulations. Ensures alternate meals are available upon request. Supervises the preparation and service of regular and therapeutic diets. Ensures foods served are palatable, and at the appropriate temperature. Ensures nutrition documentation/data collection is timely, accurate, appropriate, and in accordance with company guidelines and state requirements. The facility's Dry Food Storage Policy, received 06/16/2025, states: The purpose of the policy is To ensure dry food is stored in a safe, sanitary manner to provide the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 4 of 5 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 146132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ryze at Homewood 19000 South Halsted Homewood, IL 60430 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 0802 best food quality. Level of Harm - Minimal harm or potential for actual harm Bins for food storage (flour, cornmeal, etc.) should be with tight fitting lids to prevent contaminations. No scoops are to be stored with food bins. Residents Affected - Many The facility's Holding Foods Policy received, 06/16/2025, states: In part, Foods should be held at proper temperatures while remaining palatable. The facility's Resident Dining Services Policy, received 06/16/2025, states: The purpose of the policy is To ensure foods are appropriate temperatures, and meet the individual resident's needs. Residents seated together should receive meals at the same time (served by table) so that they may dine together. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 5 of 5