Health inspection·September 19, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few following day. V1 also said they reported it to (local) Police department.R3's Social service care plan on Abuse, initiated on 6/11/2024 states that R3 may be At risk for abuse due to confusion, memory loss, wandering and lack of safety awareness. R3's care plan goal on abuse sates that R3 will be free of abuse/neglect daily through next review.R4's Social service care plan on Abuse, initiated on 7/9/2025 states R4 is At risk for abuse. R4's care plan goal states, Staff will monitor well-being of others. Resident will have zero episodes of abuse and neglect throughout next review.On 8/25/2025, Nursing notes states R3 was sent out to the emergency department (ED) for further treatment after R4 struck her on the face. ED report stated, (R3) had blunt head trauma resulting to right eye blunt injury after being assaulted by another resident.On 8/27/2025' Nurse Practitioner's subsequent visit notes states R3 was recently seen at an acute care hospital on 8/25/25 and returned back to facility on 8/26/25 for Blunt Head Trauma. Blunt head trauma was sustained by another demented resident that punched her in the right side of her face. R3 was transferred to the Emergency Department immediately afterwards and underwent a Computed Tomography (CT) scan of facial bones and Head CT, both without contrast and both resulted negative for acute changes.This incident was reported by R3's daughter to (local) Police Department (H25-14043). The police report stated R3's daughter said she was notified by the facility on 8/25/2025 that R3 was involved in a battery and was transferred to the hospital via private ambulance. R3's daughter said she noticed R3 had sustained a swollen, black eye.R3's facility reported abuse incident to IDPH, dated 9/2/2025, states R3 was struck on the face by R4. The final report stated R4 abruptly walked around the table and swung at R3 before staff could intervene. R4 struck her on the right side of her face. R3 was sent out to the hospital for further evaluation due to blunt head trauma.Record review of R4's Social service assessment are as follows:R4's Behavior Assessment, dated on 8/25/2025, states R4 observed being verbally and physically aggressive towards another resident. Responding to internal stimuli R4 remains unable to be redirected.R4's Behavior Assessment, dated 8/25/2025, states in his Behavioral symptoms include physical aggression towards self/others, and verbal aggression. R4's Response to Interventions states that R4's behavior increased/escalated, and that R4 did not respond to interventions successfully.R4's Potential for Abuse and Neglect Assessment, dated 8/26/2025, stated R4's Mental/Emotional Challenges said R4 has persistent anger, fear and/or anxiety, poor judgment skills, and psychotic symptoms such as hallucinations or delusions. R4's Behavioral Challenges include history of aggressive, combative or abusive physical behaviors, and history of verbally threatening or verbally obnoxious behaviors.2. R1 is a [AGE] year old with the following diagnosis: type 2 diabetes, alcohol dependence, cocaine use, and intervertebral disc displacement in the lumbar region.R5 is a [AGE] year old with the following diagnosis: cerebral infarction and type 2 diabetes.R1 no longer resides in the facility.On 9/16/25 at 12:01PM, R5 stated R5's previous roommate (R1) slapped R5 in the head about one week ago. R5 reported R5 got up from bed, walked into the bathroom, and closed the door. R5 stated R1 began yelling and opened the door on R5 then slapped R5 on top of the head. R5 reported R5 then yelled at R1 to stop touching R5 and staff came into separate them. R5 stated R1 began yelling that R1 was going to use the bathroom and that is when R1 opened the door and slapped R5. R5 reported R1 was lying in R1's bed and said nothing to R5 while R5 walked to the bathroom. R5 said, I had no idea he needed to use the bathroom until he was screaming at me after I closed the door. R5 stated R1 has been verbally aggressive with R5 before but never physical until 9/11/25. R5 reported R1 would tell R5 that R5 was messy and make a big deal out of little stuff such as a paper towel left on the floor. R5 stated R1 would call R5 a slob. On 9/17/25 at 11:25AM, V2 (Social Service Director) stated a nurse texted V2 that R1 hit R5. V2 reported R1 was going to be petitioned out to the hospital for a psych evaluation but R1 left (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 2 of 4 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 09/19/2025 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 0600 Level of Harm - Actual harm Residents Affected - Few the facility against medical advice instead. V2 stated R1 is normally verbally aggressive and manipulative. V2 reported staff will redirect R1's behavior when possible but R1 cannot be redirected every time. V2 stated the police came to the facility and gave R1 a citation. V2 reported R5 told V2 that R5 went to the bathroom which is connected to R1's room and when R5 closed the door to R1's room, R1 opened the bathroom door and slapped R5 on top of the head with an open head. V2 stated this incident would be considered physical abuse because R1 made physical contact with R5 that was unwanted by R5.On 9/17/25 at 1:17PM, V4 (LPN) stated V4 overheard R1 and R5 arguing so V4 went to see what happened. V4 reported R1 told V4 that R1 was going to the bathroom and left out to get a hand towel when R5 came in to use the bathroom when R1 wasn't done. V4 stated the CNA then reported that R5 told the CNA that R1 hit R5 on the head. V4 reported R1 has been verbally aggressive in the past so staff know how to redirect R1's behavior. V4 stated the police showed up to talk with both residents. V4 reported this incident would be considered physical assault.On 9/17/25 at 1:55PM, V5 (Director of Nursing/DON) stated the nurse reported R1 and R5 got into an altercation. V5 reported V5 explained to R1 that R1 would have to go to the hospital for a psych evaluation but R1 refused. V5 stated R1 told staff that R1 was using the bathroom and left to grab something out of R1's room when R5 entered the bathroom and shut R1's door. V5 reported R1 then told R5 that R1 wasn't finished in the bathroom and R5 grabbed something off the sink that belonged to R1 so R1 grabbed R5's arm. V5 stated R1 admitted to tussling with R5. V5 defined tussling as pushing back and forth. V5 reported R1 told V5 that the tussling continued until R5 called out for help. V5 stated that V5 wasn't exactly sure R5's side of the story but R5 did corroborate that R1 got physical with R5. V5 reported the police came to the facility to issue R1 a citation. V5 stated this incident would be considered physical abuse.On 9/18/25 at 12:00PM, V1 (Administrator) stated R5 reported R1 hit R5 on the top of the head and R1 reported R1 physically moved R5 out of the doorway. V1 reported the police were called at the request of R5 and they issued R1 a citation for slapping R5 without any legal justification.A Nursing note, dated 9/11/25, documents R1 presented with physical aggressive behavior towards a peer. R1 was not receptive to staff redirection. Social services attempted to petition R1 to the hospital for a psych evaluation. R1 refused to go to the hospital and wanted to sign out against medical advice (AMA) instead.A Nursing note, dated 9/11/25 documents R5 informed the nurse that R1 struck R5 on the head. The nurse assessed R5 and R5 was stable with no changes. The physician and emergency contact were notified.A Social Service note, dated 9/11/25, documents Social Services met with R5 following the altercation. R5 discussed with events leading up to the altercation with R1. Police were made aware.The Initial Incident Report, dated 9/11/25, documents R5 reported R1 slapped R5 on top of the head without justification. Residents were separated. Body assessment was completed with no injuries noted. R1 was put on 1:1 monitoring until R1 discharged . Police were notified. An investigation was initiated.The Ordinance Violation from the police, dated 9/11/25, documents R1 slapped R5 on top of the head without any legal justification. R1 must appear for an administrative hearing.The Potential for Abuse and Neglect Form, dated 9/11/25, documents R1 has poor judgement skills, a history of physical abuse, history of being verbally threatening, and history of being aggressive. R1 also has a history of substance abuse and alcoholism. R1 was involved in a physical altercation with a peer.R5's Potential for Abuse and Neglect Assessment, dated 9/11/25, documents R5 is at risk for abuse due to using a wheelchair.R1's Care Plan, dated 8/18/25, documents R1 is at risk for abuse. R1 was involved in a physical altercation with a peer on 9/11/25. This care plan also documents R1 presents with behavioral symptoms by becoming verbally aggressive with staff. R1 is not receptive to redirection. The Care Plan dated 9/9/25 documents R1 presents with manipulative behaviors and make false allegations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146132 If continuation sheet Page 3 of 4 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 09/19/2025 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 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete regarding staff. The Care Plan dated 9/11/25 documents R1 present with physically aggressive behavior. R1 was involved in a physical altercation with a peer on this day. R5's Care Plan, dated 9/11/25, documents R5 is at risk for abuse and neglect. R5 was involved in a physical altercation with a peer on this day.R1's Minimum Data Set (MDS), dated [DATE], documents a Brief Interview for Mental Status Score (BIMS) as a 15 (no cognitive impairment). Section E documents R1 has exhibited verbally aggressive behavior within one to three days from this assessment.The Minimum Data Set for R5 dated 8/22/25 documents a Brief Interview for Mental Status score as 15 (no cognitive impairment). A policy titled, Abuse Policy and Prevention Program, dated 10/2022 documents, This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents.Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish to a resident.Physical abuse is the infliction of injury on a resident that occurs other than by accidental means and that requires medical attention. Physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment. Event ID: Facility ID: 146132 If continuation sheet Page 4 of 4