Inspection visit

Health inspectionJanuary 31, 2024

WESTWOOD VLGE NRSG AND RHB CTRCMS #14614914 citations on this visit

14 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 14 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 a call light device was within a dependent resident's reach to call for staff assistance which affected one resident (R52) in the total sample of 55 residents when reviewed for accommodation of needs. Residents Affected - Few Findings include: On 1/28/24 at 10:38 am, R52 observed in R52's room in a reclining personalized wheelchair with a mechanical lift pad under R52's body. R52's wheelchair was positioned on the left side at the end of R52's bed (towards the center of the room). No call light observed near R52. Surveyor asked R52 how R52 requests for staff assistance. R52 stated, I (R52) do need help. But I don't have my call button. I can't reach it. This surveyor walks around R52's wheelchair and observes R52's call light string hanging from the wall call light unit onto the floor. This surveyor stepped outside R52's room and requested that V10 (Agency Registered Nurse/RN) come into R52's room to see where R52's call light was. V10 entered R52's room and walked around R52's wheelchair, bent down to the floor, reached, and moved R52's green bed spread hanging off of the bed and brought up R52's white call light string which was wrapped around R52's bed control cable. V10 said, the CNA (Certified Nursing Assistant) has a certain way to connect the call light with a clip and would have to check to see how it's normally done with R52. R52 stated that R52 has been up for a while in my chair without R52's call light within reach. When asked V10 where should call lights be located, V10 stated, Within the reach of the resident. Within arm's reach of self if (resident) needs assistance. On 1/29/24 at 12:01 pm, R52 observed in R52's room laying in R52's bed with R52's head of bed elevated and R52's bedside table positioned over R52's lap. R52's call light string observed coiled up at the foot of R52's bed under a green comforter, out of R52's reach. R52 stated that R52 cannot see or reach R52's call light. This surveyor stepped outside R52's room and requested that V14 (CNA) come into R52's room to see where R52's call light was. V14 walked to the foot of R52's bed and retrieved the call light string from under the green comforter at the foot of the bed and stretched the call light string over R52's bedside table on left side over R52's lap. R52 stated, R52 could not see the call light string, and then V14 placed R52's glasses on R52 and moved R52's call light to the center of the bedside table. R52 verified, R52 could see and reach the call light string now. R52's Face Sheet documents, in part, diagnoses of Parkinson's disease, cardiomegaly, absolute glaucoma bilateral, type 2 diabetes mellitus, hypertension, chronic embolism or thrombosis of other specified deep vein of lower extremity bilateral, pain in unspecified joint and hyperlipidemia. R52's Minimum Data Set, dated [DATE], documents, in part, a Brief Interview for Mental Status (BIMS) score of 14 which indicates that R52 is cognitively intact. For R52's Functional Abilities and (continued on next page) 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 26 Event ID: 146149 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Goals for Mobility, R52 is coded for staff assistance as substantial/maximal assistance for roll left and right in bed and sit to lying position and as dependent for chair/bed-to-chair transfer. R52's Care Plan, dated 12/12/23, documents, in part, that for R52's immobility problems, an approach to be utilized is to be sure (R52's) call light is within reach and encourage the resident to use it for assistance as needed. (R52) needs prompt response for all requests for assistance. On 1/31/24 at 1:39 pm, V2 (Director of Nursing/DON) stated, call lights are to be answered as soon as the resident pulls it. V2 stated, the purpose of a call light is for a residents to call when they need assistance. Surveyor asked V2 where the call light should be placed. V2 stated, It should be placed by the resident where the resident can reach it. Facility policy dated August 2008 and titled Answering the Call Light, documents, in part, Purpose: The purpose of this procedure is to respond to the resident's requests and needs. General Guidelines: . 5. When the resident is in bed or confined to a chair, be sure the call light in within easy reach of the resident. Facility job description titled C.N.A. and undated documents, in part, Purpose: The primary purpose of this position is to: Assist nursing personnel in providing nonprofessional nursing care and simple technical nursing services under the direction and supervision of an R.N. or L.P.N. (Licensed Practical Nurse) . Duties/Responsibilities/Function: . 10. Ensure that all C.N.A. care plan approaches and interventions are being utilized as planned . 24. answers call lights immediately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 2 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident's Practitioner Order for Life-Sustaining Treatment (POLST) form was completed properly which affected one resident (R79) in the total sample of 55 residents reviewed for advance directives. Findings include: On [DATE] at 10:17 am, R79 stated, R79 filled out advance directive's (POLST) form with a lady (V21, Social Worker) and R79 is a full code. R79's Face Sheet documents, in part, diagnoses of bipolar disorder, major depressive disorder, asthma, cerebrovascular disease, hyperlipidemia, osteoarthritis, and chronic obstructive pulmonary disease. R79's Minimum Data Set, dated [DATE], documents, in part, a Brief Interview for Mental Status (BIMS) score of 15 which indicates that R79 is cognitively intact. R79's Practitioner Order for Life-Sustaining Treatment (POLST) form, dated [DATE] and signed by R79, documents, in part, in Section A (Required to Select One) for Orders for Patient in Cardiac Arrest (follow if patient has NO pulse), and R79 selected YES CPR: Attempt cardiopulmonary resuscitation (CPR). Utilize all indicated modalities per standard medical protocol. (Requires choosing Full Treatment in Section B). In Section B, Full Treatment: Primary goal is attempting to prevent cardiac arrest by using all indicated treatments. Utilize intubation, mechanical ventilation, cardioversion, and all other treatments as indicated is not marked with an X by R79. However, Comfort-Focused Treatment to allow for natural death is selected by R79. No other additional orders are marked or selected in sections C or D on R79's POLST form. On [DATE] at 11:41 am, V21 (Social Worker) stated, one of V21's responsibilities is reviewing, educating, and assisting residents on completing the POLST form in the facility. V21 stated, V21 read and reviewed the POLST form with R79 on [DATE], and R79 marked yes for full code. V21 stated, V21 then discussed the different options going forward with R79, and R79 marked yes for comfort measures. V21 again stated, V21 explained the options and read the form with R79. V21 then retrieved a blank copy of the POLST form and reviewed it with this surveyor. V21 stated, in section A, V21 asked R79 if R79 would like CPR done, yes or no? R79 can decide if R79 wants CPR as part of the resuscitation process and R79 was familiar with what CPR was. R79 selected yes. V21 stated, V21 then went to the next section B, read to R79 the three options, and asked R79 to select if R79 wanted the full treatment, the selective treatment, or the comfort measures. V21 stated, And (R79) chose comfort. V21 stated, R79 did not selection any further options in sections C or D on the POLST form. When asked what the code status for R79 is, V21 stated, full code, pretty much what is outlined on (R79's) form. This surveyor then read R79's POLST form to V21 with R79 choosing CPR and allow for natural death with comfort measures. V21 stated, the options R79 chose are conflicting and that V21 will address this right away. On [DATE] at 1:39 pm, V2 (Director of Nursing) stated, for a full code order, the nurses will do CPR as appropriate, call 911 and transfer the resident to the hospital for further evaluation. When asked about comfort measures option on the POLST form, V2 state, nurses would not perform CPR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 3 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interventions and nothing invasive. This surveyor showed R79's POLST form to V2 who read the form with R79 choosing CPR and allow for natural death with comfort measures. V2 stated, if a resident would have cardiac arrest with these two options selected on the POLST form, V2 stated, V2 would expect that the nurses perform CPR, call 911 and transfer the resident to the nearest hospital for further treatment. Facility policy dated [DATE] and titled Advance Directives, documents, in part, Policy: To assure each resident is provided with written information on advance directives in accordance with State laws, including the facility's policies for implementing these requirements. Policy Specifications: . 7. Social Service and/or the interdisciplinary care team will review the resident's advance directive status as documented. Facility job description titled Psychiatric Rehabilitation Service Coordinator (Social Worker) and undated documents, in part, Purpose: The primary purpose of this position is to provide . case management services to adults with a history of multiple psychiatric hospitalization and in need of long term care stabilization. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 4 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews, the facility failed to ensure staff logged off the computer clinical record system prior to leaving the medication cart and failed to ensure empty medication dispensing cards which contained resident's health information were not left unattended. These failures affected 2 (R63 and R70) residents reviewed for confidentiality of records and has the potential to affect all the residents on Side 2 of the facility. Residents Affected - Some Findings include: The (1/28/2024) census documented that there were 28 residents residing in rooms XXX - YYY. On 01/28/24 at 10:37am, R63's and R70's medications dispensing cards were facing upward and were left unattended on top of a medication cart. R63's medication dispensing card contained the name of medication, description, dose, frequency of the medication, route of administration, R63's room number, and Medical Doctor. R70's medication dispensing card contained the name of the medication, description, dose, frequency of the medication, route of administration, R70's room number and medical doctor. Also observed the computer screen, on the same medication cart, with residents' identifiers, was on and was left unattended. The computer screen was facing the hallway within the view of the surveyor. V4 (Registered Nurse) was exiting a resident's room and walked towards the medication cart. These observations were pointed out to V4. V4 stated, he (V4) was assigned to the medication cart. V4 also stated I (V4) started 3 weeks ago, and nobody showed me (V4) how to lock the computer screen. I (V4) know I (V4) need to lock the computer screen because of HIPAA (Health Insurance Portability and Accountability Act of 1996). And I (V4) also need to put the B**** C*** (medication dispensing cards) face down so nobody can see them for the same reason, due to HIPAA. Of note, there was only one residents' floor at the facility. On 01/29/24 at 12:31PM, V1 (Administrator) stated on Side 3 and Side 4, most residents are walking. They (residents) are ambulatory. On 01/29/2024 at 3:58pm, V2 (Director of Nursing) stated the medication cart should always be on visual field of the nurse when passing the medication. If they are going to leave the medication cart, make sure to lock the cart and the medication dispensing card should be inside the medication cart. If the medication dispensing card is empty, we remove the label and put them in the shredding bag. They cannot leave the medication dispensing card with the resident information and name of medication in plain view where other people can read it because of the HIPAA rules. On 01/29/2024 on 4:07pm, V2 stated whenever the nurse is not using the computer, the screen should be off to protect resident's information and also because of HIPAA. The computer should be off when left unattended. On 01/31/2024 at 10:05am, V2 verified on 01/28/2024 V4 was assigned on side 2 which include rooms XXX - YYY. On 01/31/2024 at 1:38pm, V2 stated there is only one residents' floor at the facility. R63's (01/17/2024) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 15. Indicating R63's mental status as cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 5 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some R63's (Physician Order report: 12/29/2023 - 01/29/2024) documented, in part Diagnoses: (include but not limited to) Neuromuscular dysfunction of bladder. Medication flow sheet. Prescription. Start Date: 05/01/2023. End Date: Open Ended. Description: Myrbetriq tablet extended release 24hr (hour); 50mg; amt (amount) 1 tab (tablet). (DX (diagnosis): neuromuscular dysfunction of bladder). R70's (01/09/2024) Minimum Data Set documented, in part Section C. Cognitive Patterns. C0500. BIMS (Brief Interview for Mental Status) Summary Score: 15. Indicating R70's mental status as cognitively intact. R70's (Physician Order Report: 12/29/2023 - 01/29/2024) documented, in part Diagnoses: (include but not limited to) Benign prostatic hyperplasia with lower urinary tract symptoms. Medications flow sheet. Prescription. Start Date: 09/08/2023. End Date: Open Ended. Description: bethanechol chloride tablet; 25mg; amt: 1 tab. (DX: benign prostatic hyperplasia with lower urinary tract symptoms). The (01/30/2024) email correspondence with V2 documented, in part It is the facility expectation for the staffs to abide by the HIPAA rules when providing care to the residents. The computer screen must be off when not in use by the Nurse. The used medications dispensing cards should not be left unattended and they should be discarded appropriately by placing the labels to be shredded. The (undated) RN (Registered Nurse) job description documented, in part Purpose: the primary purpose of this position is to: Provide licensed nursing care to resident on assigned unit in accordance with current federal, state and local standards, guidelines and regulations. DUTIES/RESPONSIBILITIES/FUNCTION. 26. Ensures HIPPA HIPAA (Health Insurance Portability and Accountability Act of 1996). Compliance is maintained at all times. 27. Understands the importance of logging on and off the computer clinical record system and will consistently maintain all computer protocols. The (undated) Residents' Rights for people in Long-Term Care Facilities documented, in part Your rights to privacy. You have a right to privacy and confidentiality of your personal and medical records. Your medical and personal care are private. The (03/2014) HEALTH INFORMATION MANAGEMENT - RESIDENT INFORMATION PRIVACY PROTECTION documented, in part To assure that all resident - identifiable information maintained by the facility shall be confidential and disclosed only to authorized individuals. Policy specifications: 1. Resident record information will be made available only to legitimate requestors, those individual/parties, both inside and external to the facility having an authorized need-to-know. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 6 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents have a home like environment. This failure affected 2 residents (R75 and R86), reviewed for resident's rights to have a comfortable home like environment, in a total sample of 55 residents. Findings Include: On 1/28/24 at 10:30am, R86 pointed at the window next to (R86's) bed which had towels secured to the bottom of the window with clear tape and stated that (R86) had to do that about a week ago because the wind blows through the closed window. R86 stated that the wind coming through the closed window even moves the blinds. R86 stated (R86) reported it to the nurses a few times and all the nurses did was turn up the heat. R86 stated, The wind coming through gives me a chill. I am going to get pneumonia. R86's admission Record documents, in part, R86's diagnoses including but not limited to chronic obstructive pulmonary disease, major depressive disorder, lupus erythematosus, hypertensive heart disease without heart failure and asthma. R86's Minimum Data Set (MDS), dated [DATE], documents in part, that R86's BIMS (Brief Interview for Mental Status) score is 13, which indicates that R86 is cognitively intact. On 1/28/24 at 10:35am, R75 (R86's roommate) stated It's ridiculous that they haven't fixed this window yet. I am constantly having to put my sweater on and take it off because the temperature in our room changes throughout the day. It's annoying. R75's admission Record documents, in part, R75's diagnoses including but not limited to: major depressive disorder, Multiple sclerosis, asthma, epilepsy, and portal hypertension. R75's Minimum Data Set (MDS), dated [DATE], documents, in part, that R75's BIMS (Brief Interview for Mental Status) score is 15, which indicates that R75 is cognitively intact. On 1/29/24 at 12:14pm, V25 (Maintenance Supervisor) stated that this is the first time V25 has seen towels secured to the bottom of the window with clear tape in R75's and R86's room. V25 stated, We have a winterizing policy, and this is not the way we winterize. V25 stated that (V25) does not do rounds throughout the facility to check for issues, that (V25) receives a paper every morning with a list of things that need to be done or repaired. V25 stated that the list is put together by all the staff at the facility. V25 stated that (V25) never received a work order for this issue. On 1/30/24 at 11:25am, this surveyor observed, in R86's and R75's room, the window still towels secured to the bottom of the window with clear tape taped with towels in room. Facility policy undated and title Extreme Weather Temperature Policy, documents, in part, Policy specifications: To assure all departments assist in implementing appropriate interventions to maintain resident comfort . when relocation is not practical, . moving beds away from drafts and eliminating drafts via caulking or temporary coverings. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 7 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0584 Level of Harm - Minimal harm or potential for actual harm Facility policy undated and title Environment of Care Policy, documents, in part, Policy: It is the policy of this facility to provide an environment . as near a home-like environment as possible. Facility policy undated and title Residents' Rights for People in Long-Term Care Facilities, documents, in part, Your facility must be safe, clean, comfortable and homelike. Residents Affected - Few Facility job description undated and titled Position title: Maintenance Supervisor documents, in part, Ensure the facility environment, . is maintained in good, safe operating order. Monitor that all doors and windows are operating properly. Via regular rounds and inspections . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 8 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 ensure a resident who depends on staff assistance for ADL (Activities of Daily Living) care and grooming receive nail care. This affects 1 resident (R80) reviewed for accommodation of needs in the total sample of 55 residents. Residents Affected - Few Findings include: On 01/28/24 at 11:00 AM, R80 was observed in bed with long fingernails on both hands and brown substances underneath the nail beds. R80 stated, she would like her fingernails trimmed and has asked staff multiple times to have her nails trimmed, but they still have not trimmed them. R80's admission Record documents, in part, diagnoses of moderate protein-calorie malnutrition, dermatitis, hypertension, schizophrenia, and major depressive disorder. R80's Minimum Data Set (MDS), dated [DATE], documents, in part, a Brief Interview of Mental Status (BIMS) score of 10 which indicates that R80's cognition is moderately impaired. On 1/28/24 at 11:14am, while in R80's room observing her (R80) nails, V2 (Director of Nursing) stated, R80's nails are long and discolored and should be trimmed. V2 stated, the staff do nail care periodically and as needed. V2 stated, there are not certain days of the week or specific times when nail care is performed on the residents. V2 stated the restorative nurse and restorative assistant are responsible for nail care. On 1/28/24 at 11:22am, while in R80's room observing her (R80) nails, V11 (Restorative Nurse) stated, I definitely think (R80's) nails were ready to be clipped. V11 stated, there are no set days and times for nail care. V11 stated, I (V11) and the restorative assistant do a weekly walk through and check residents' length and condition of nails. R80's Care Plan, date initiated 3/7/22, documents, in part, that R80 has an ADL self-care performance deficit related to morbid obesity and major depressive disorder. Facility policy undated and title Care of Fingernails/Toenails, documents, in part, Nail care includes daily cleaning and regular trimming. Proper nail care can aid in the prevention of skin problems around the nail bed. Trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin. Facility policy undated and title Residents' Rights for People in Long-Term Care Facilities, documents, in part, Your facility must provide services to keep your physical and mental health, at their highest practical levels. Facility job description undated and titled Position title: RN, documents, in part, Ensure that all aspects of resident care plans are implemented and maintained. Facility job description undated and titled Position title: LPN, documents, in part, Ensure that all aspects of resident care plans are implemented and maintained. Facility job description undated and titled Position title: Rehab/Restorative Nurse, documents, in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 9 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 part, Directing C.N.A.'s to ensure compliance with all elements of the nursing restorative program. Level of Harm - Minimal harm or potential for actual harm Facility job description undated and titled Position title: C.N.A., documents, in part, Ensure that all residents are . well groomed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 10 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that an adaptive device (splint/palm grip) was in place for a contracted hand which affected one resident (R57) in the total sample of 55 residents when reviewed for limited mobility. Findings include: On 1/28/24 at 10:42 am, R57 observed sitting in R57's reclining, personalized wheelchair in the small television room. R57's left hand is contracted with left arm bent towards R57's upper body. No hand assistive device (splint/palm grip) was on R57's left contracted hand. On 1/29/24 at 10:01 am, R57 observed sitting in R57's reclining, personalized wheelchair in the large dining room for activities with no splint/palm grip noted on R57's left contracted hand. On 1/30/24 at 11:16 am, R57 observed sitting in R57's reclining, personalized wheelchair in R57's room with no splint/palm grip noted on R57's left contracted hand. Surveyor stepped out of R57's room and requested V11 (Restorative Nurse) come to R57's room. On 1/30/24 at 11:18 am, prior to entering R57's room, surveyor asked V11 (Restorative Nurse) about R57's restorative needs, and V11 stated, R57 is ordered for a carrot (splint/palm grip) that is applied by the restorative aide in the morning and to be removed at nighttime by CNA (Certified Nursing Assistant). V11 and surveyor then enter in R57's room and observe R57 without the carrot applied to R57's left contracted hand. V11 asked R57 where was R57's carrot, and R57 stated that it's in the laundry. V11 stated, R57 would have two carrots for this purpose if one is being laundered, and V11 begins to search R57's room for the other carrot by opening the 4 dresser drawers, by looking behind the dresser drawers and under R57's bed, by looking inside R57's closet and by searching R57's toiletries bin with no success in locating R57's carrot hand splint. R57's Face Sheet documents, in part, diagnoses of hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left non-dominant side, wrist drop left wrist, type 2 diabetes, chronic obstructive pulmonary disease, hyperlipidemia and hypertension. R57's Minimum Data Set, dated [DATE], documents, in part, a Brief Interview for Mental Status (BIMS) score of 15 which indicates that R57 is cognitively intact. For R57's Special Treatments, Procedures, and Programs for Restorative Nursing Programs, R57 is coded for splint or brace assistance for 6 days in the last 7 calendar days. R57's Physician's Order Sheet (POS) documents, in part, an order (dated 7/21/23) for Restorative Program - Splint - Apply splint/palm grip to left hand in the AM (before midday) and remove at HS (hour of sleep) daily. May removed when in bed, during meals, or during ADL (activities of daily living) care as tolerated. R57's Care Plan, dated 7/21/23, documents, in part, a problem of (R57) has a splint/brace to left hand r/t (related to) contracture and requires a restorative splint/brace program with an approach of apply splint/brace per physician's orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 11 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 Residents Affected - Few On 1/31/24 at 1:39 pm, V2 (Director of Nursing) stated, the purpose of assistive devices, like splints, are to prevent any further contractures and help position the area (body part) appropriately. Facility undated policy titled Splint Policy documents, in part, Policy: Adaptive devices will be used as ordered by the physician/NP (nurse practitioner) to prevent deformities or further contractures. Procedure: . 3. Splints will be applied per physician's/NP orders. Facility job description titled Rehab Aid and undated documents, in part, that the Rehab Aid reports to the Restorative Nurse, and Purpose: The primary purpose of this position is to: Carry out the programs for each individual resident as set forth, and as assigned in the Restorative Nursing Program Care Plan . Duties/Responsibilities/Function: . 4. Follow facility policy regarding MD (doctor) orders for programs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 12 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure oxygen tubing and humidifier bottle was changed weekly and labeled with the date for two residents (R19 and R72). These failures have the potential to affect 2 residents (R19, R72) out a total of 12 residents who receive oxygen therapy. Residents Affected - Few Findings include: R19 has a diagnosis of but not limited to Chronic Obstructive Pulmonary Disease, COPD Exacerbation, Schizophrenia, Type 2 Diabetes Mellitus and Hypertensive Heart Disease. R19's has a Brief Interview of Mental Status score of 14. R72 has a diagnosis of but not limited to Chronic Obstructive Pulmonary Disease, Acute and Chronic Respiratory Failure, Chronic Bronchitis, Emphysema and Dependence on Oxygen. R72 has a Brief Interview of Mental Status score of 12. On 1/28/2024 at 11:06am surveyor observed R72's oxygen tubing without a date and R72's humidifier container with a date of 1/19/2024. On 1/28/2024 at 11:07am R72 shook his head and said no, they are not changing my oxygen tubing weekly. On 1/28/2024 at 11:11am surveyor observed R19 oxygen tubing with no date and humidifier container with a date of 1/19/2024. On 1/28/2024 at 11:37am V9 (Licensed Practical Nurse/LPN) stated the oxygen tubing and humidifier container is changed weekly and the reason why there is no date on the oxygen tubing is because the tubing and humidifier container are changed at the same time. On 1/31/2024 at 10:05am V2 (Director of Nursing) stated, oxygen tubing and the humidifier container are changed weekly and labeled with the date it was changed. R19's Physician Order Report dated 12/30/2024-01/30/2024 documents Oxygen 2 Liters per minute by nasal cannula as needed for shortness of breath. R72's Physician Order Report dated 12/30/2023-1/30/2024 documents oxygen: change tubing and mask weekly and PRN, once a day on Wednesday. Oxygen 4 liters nasal cannula continuously. Policy on Care and Use of Oxygen Concentrator Humidifier Bottle with a revised date of 4/11/2023 documents, in part, humidifier bottles are changed weekly by Infection Preventionist/Charge Nurse, humidifier bottle will be labelled with the date that new humidifier bottle was placed. Policy on Care and Storage of Nasal Cannulas and Oxygen Masks with a revised date of 4/11/2023 documents, in part, nasal cannulas are changed weekly/as needed by Infection Preventionist/Charge Nurse, then placed into the zip lock bag with resident's name, date and room number. Undated Job Description for RN and LPN documents, in part, provide licensed care to assigned residents as ordered by physician and in accordance with facility, federal, state, and local standards, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 13 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0695 guidelines and regulations. 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: 146149 If continuation sheet Page 14 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to ensure two licensed nursing personnel conducted a physical inventory of controlled substances at each change of shift. This failure has the potential to affect three residents on side two medication cart who were prescribed controlled substances and eight residents on side one medication cart who are prescribed controlled substances. Findings include: On 01/30/2024 at 11:38 am review on side 2 medication cart with V22 (RN/Registered Nurse) surveyor observed the shift-to shift controlled substances check form for January 2024. The Nurse's Initials off box was blank for January 12, 2024 (3pm-11pm shift). The Nurse's Initials on box was blank January 15, 2024 (7am-3pm shift). The Nurse's Initials on box was blank January 15, 2024 (11pm-7am shift). On 01/30/2024 at 1:04pm review of the side 1 medication cart with V24 (RN) surveyor observed the shift-to-shift controlled substances check form for January 2024. The Nurse's Initials on box was blank for January 1, 2024 (11pm-7am shift). The Nurse's Initials on box was blank for January 3, 2024 (3pm-11pm shift). The Nurse's Initials on box was blank for January 5, 2024 (7am-3pm and 3pm-11pm shifts). The Nurse's Initials off box was blank for January 5, 2024 (3pm-11pm and 11pm-7am shifts). The Nurse's Initials on box was blank for January 6, 2024 (11pm-7am shift). The Nurse's Initials off box was blank for January 7, 2024 (7 am-3pm shift). The Nurse's Initials off box was blank for January 9, 2024 (3 pm-11pm shift). The Nurse's Initials on box was blank for January 11, 2024 (11 pm-7am shift). The Nurse's Initials off box was blank for January 12, 2024 (7am-3pm shift). The Nurse's Initials on box was blank for January 17, 2024 (3pm-11pm and 11pm-7am shifts). The Nurse's Initials off box was blank for January 17, 2024 (11pm-7am shift). The Nurse's Initials off box was blank for January 18, 2024 (7am-3pm shift). The Nurse's Initials on box was blank for January 18, 2024 (11pm-7am shift). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 15 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0755 The Nurse's Initials on/off boxes were blank for January 19, 2024 (11pm-7am shift). Level of Harm - Minimal harm or potential for actual harm The Nurse's Initials off box was blank for January 20, 2024 (7am-3pm shift). The Nurse's Initials on box was blank for January 22, 2024 (7am-3pm shift). Residents Affected - Some The Nurse's Initials off box was blank for January 22, 2024 (3pm-11pm shift). The Nurse's Initials off box was blank for January 24, 2024 (11pm-7am shift). The Nurse's Initials off box was blank for January 26, 2024 (3pm-11pm shift). The Nurse's Initials on box was blank for January 26, 2024 (11pm-7am shift). The Nurse's Initials off box was blank for January 27, 2024 (7am-3pm shift). The Nurse's Initials on box was blank for January 29, 2024 (11pm-7am shift). The blank spaces on the facility's-controlled substances check form indicate the controlled substances were not reconciled at the end and beginning of the shift on specified days. On 1/30/2024 at 11:38am V22 (RN) stated, the shift-to-shift controlled substances check form is signed on the day and shift you are working. V22 stated the nurse who is coming into work is to count the controlled substances with the nurse who is leaving. V22 stated, the nurse who is coming in to work and the nurse who is leaving for the day both count the number of controlled substance tablets in the bingo card. V22 stated the reason why the nurses are counting the number of controlled substance tablets in the bingo cards is to verify that the number of controlled substance tablets is correct. V22 stated if the count for the controlled substances tablets is not correct, then the nurses must notify the Director of Nursing. On 1/31/2024 at 12:23pm V2 (Director of Nursing) stated, when a nurse comes on duty the nurse will do a count of the controlled substance tablets and liquid with the nurse going off duty. V2 stated, the nurses are to initial the shift-to-shift controlled substances check form which indicates that the count for the controlled substances is correct. V2 stated, it is my expectation that the nursing staff are following the protocol regarding signing the controlled substance shift to shift count sheets. On 1/31/2024 reviewed the facility's policy titled Controlled Substances with an effective date of 10/25/2014 and a revision date of 09/01/2016, which documents, in part: The facility shall comply with all laws, regulations, and other requirements related to handling, storage, disposal, and documentation of Schedule II (two) and other controlled substances. 9. Nursing staff will count controlled medications at the end of each shift. The Nurse coming on duty and the Nurse going off duty will make the count together. They will document and report any discrepancies to the Director of Nursing Services. On 1/31/2024 reviewed the facility's policy titled Controlled Substance Storage with an effective date of 10/25/2014. This policy documents, in part: Medications included in the Drug Enforcement Administration (DEA) classification as controlled substances are subject to special handling, storage, disposal, and recordkeeping in the facility in accordance with federal, state, and other applicable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 16 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some laws and regulations. E. At each shift change a physical inventory of all controlled substances, including refrigerated items is conducted by two licensed nurses. On 1/31/2024 reviewed the facility's undated RN (Registered Nurse) job description which documents, in part: 12. Ensure that appropriate documentation/charting is completed as required and in accordance with established policies and procedures. 15. Ensure that narcotic records are accurate for your shift. Immediately notify the DON (Director of Nursing)/ADON (Assistant Director of Nursing) of any identified drug discrepancies. On 1/31/2024 reviewed the facility's undated LPN (Licensed Practical Nurse) job description which documents, in part: 10. Ensure that narcotic records are accurate for your shift, immediately notify the DON (Director of Nursing)/ADON (Assistant Director of Nursing) of any identified drug discrepancies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 17 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to have a five percent (5%) or lower medication error rate. There were four medication errors out of 28 medication opportunities, resulting in a 14.29% medication error rate and affected three residents (R50, R62 and R102) observed for medication pass. Residents Affected - Few Findings include: 1.) On 1/29/24 at 8:59am, V9 (Licensed Practical Nurse/LPN) was observed passing medications with the medication cart. Surveyor observed V9 prepare and count 9 pills total (Tizanidine 2mg-1 tablet, Amlodipine 5mg-1 tablet, Colace 100mg- 1 tablet, Escitalopram 10mg- 2tablets, Losartan 100mg- 1 tablet, Metformin 500mg- 1 tablet, Gabapentin 100mg- 1 tablet, and Rosuvastatin 5mg- 1 tablet) that were prepared to be administered to R102. When asked how many pills are in the medicine cup that are being administered to R102, V9 replied 9 pills. Upon surveyor reconciling R102's above medications that were ordered and scheduled for administration (total of 10 tablets) and the medications that were observed as administered and documented by V9 (total of 9 tablets) during this 1/29/24 medication pass, the following medication error was identified: Inaccurate Dose error: Amlodipine 5mg, 2 tablet, orally daily. R102's Medication Administration Audit Report (MAAR) documents that Amlodipine 5mg, 2 tablets, orally daily was administered at 9:00am, on 1/29/24 by V9. However, the preparation or administration of the full dose of this medication was not observed by surveyor. R102's Physician Order Report, dated 07/14/23, shows that R102 has an order for Amlodipine 5mg, 2 tablets, orally daily. R102's medication administration record documents, in part, Amlodipine tablet; 5mg; Amount to Administer: 2 tablets; oral. R102's Brief Interview for Mental Status (BIMS) dated 01/17/24 documents R102 with a score of 15 which indicates that R102 is cognitively intact. R102's face sheet documents, in part, R102's diagnoses including but not limited to: Type 2 diabetes mellitus, major depressive disorder, anxiety disorder, hyperlipidemia and hypertension. 2.) On 1/29/24 at 9:37am, V13 (Licensed Practical Nurse/LPN) was observed passing medications with the medication cart. Surveyor observed V13 pull out all R62's medication cards from the bottom drawer. V13 placed the pile of medication cards on top of the medication cart on the right side. V13 pushed the tablet/pill from the 1st medication dispensing card plastic bubble which makes a pop sound audible to surveyor when the tablet exits out of the sealed lining at the back of the medication dispensing card. V13 then dispensed the pill from the 1st medication card with a pop sound audible to surveyor when the pill exits out of the medication card (bubble). V13 placed the medication card in a pile on top of the left side of the medication cart. When V13 then picked up the Lisinopril card and placed it over the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 18 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pill cup, no popping sound heard, and no pill observed dropping into the cup. When V13 prepared the Loperamide (from a box containing individually wrapped 2 mg tablet packets), surveyor observed V13 opening one individually wrapped package with one 2 mg tablet being dropped into the medicine cup by V13. Surveyor observed dropping into R62's medicine cup: Three round white pills; One big oblong, white pill; one round, blue pill; one round, pink, pill; one round, green pill). Asked V13 the pill count of R62's pills. V13 counted the pills and stated 7. Surveyor counted pills and said 7. V13 then administered the 7 pills to R62. When returning to the medication cart, surveyor requested to see R62's medication card for Lisinopril. One small, oblong shaped pill is noted remaining in the #1 spot with the perforation remaining intact on the back of the medication card. No small, oblong shaped pill (Lisinopril) was observed in R62's medication cup on 1/29/24 during this medication pass. Upon surveyor reconciling R62's medication for medications that were ordered for administration and medications that were observed as administered and documented by V13, the following medication error was identified: Omission error: Lisinopril 5mg, 1 tablet, orally daily. Inaccurate Dose error: Loperamide 2mg, 2 tablets, orally daily. R62's Medication Administration Audit Report (MAAR) documents that: Lisinopril 5mg, 1 tablet, orally daily was administered at 9:00am, on 01/29/24. However, the preparation or administration of the full dose of this medication was not observed by surveyor. R62's Medication Administration Audit Report (MAAR) documents that: Loperamide 2mg, 2 tablets, orally daily was administered at 9:00am, on 01/29/24. However, the preparation or administration of the full dose of this medication was not observed by surveyor. R62's Physician Order Report dated 5/01/23 shows that R62 has an order for Lisinopril 5mg, 1 tablet, orally daily. R62's Physician Order Report dated 5/01/23 shows that R62 has an order for Loperamide 2mg, 2 tablets, orally daily. R62's Brief Interview for Mental Status (BIMS) dated 12/27/23 documents R62 with a score of 15 which indicates that R62 is cognitively intact. R62's face sheet documents, in part, R62's diagnoses including but not limited to gout, major depressive disorder, diabetes mellitus, congestive heart failure and hypothyroidism. 3.) On 1/29/24 at 11:38am, V13 (Licensed Practical Nurse/LPN) was observed preparing and administering insulin. V13 tested R50's blood sugar (glucose) reading, and the result was 340. V13 stated, Blood sugar is 340, she gonna get 5 units. V13 drew up 5 units of insulin. V13 showed surveyor the syringe, and surveyor observed 5 units of insulin in the syringe. V13 repeated, 5 units of insulin. V13 then administered the 5 units of insulin to R50. Upon surveyor reconciling R50's insulin medication that was ordered for administration and the insulin medication that was observed as administered and documented by V13, the following medication error was identified: Inaccurate Dose error: Novolog 4 units SQ per sliding scale if blood sugar reading is 301 to 351. R50's Medication Administration Audit Report (MAAR) documents that: 4 units of Novolog insulin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 19 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0759 Level of Harm - Minimal harm or potential for actual harm Subcutaneous (SQ) was administered at 11:00am, on 01/29/24. However, the preparation or administration of the accurate dose (Novolog insulin 4 units) for R50 was not observed by surveyor with V13 observed preparing and administering the inaccurate dose (Novolog insulin 5 units) for blood sugar reading of 340. R50's Physician Order Report dated 5/01/23 shows that R50 has an order for the following: Residents Affected - Few Novolog U-100 Insulin aspart (insulin aspart u-100) solution; 100 unit/mL; If Blood Sugar is less than 80, call MD. If Blood Sugar is 180 to 220, give 1 Units. If Blood Sugar is 221 to 260, give 2 Units. If Blood Sugar is 261 to 300, give 3 Units. If Blood Sugar is 301 to 351, give 4 Units. If Blood Sugar is 352 to 400, give 5 Units. If Blood Sugar is greater than 400, give 6 Units. If Blood Sugar is greater than 400, call MD. Subcutaneous three times a day: 6:00am, 11:00am, 4:00pm R50's Brief Interview for Mental Status (BIMS) dated 11/20/23 documents R50 with a score of 15 which indicates that R50 is cognitively intact. R50's face sheet documents, in part, R50's diagnoses including but not limited to diabetes mellitus, hyperlipidemia, obesity, anxiety and spinal stenosis. On 01/31/24 at 10:10am, V2 (Director of Nursing) stated, Look at the MAR and administer the medication to the resident per the order on the MAR. When asked if the medication should be followed per the physician order, V2 stated, Absolutely. V2 stated, Insulin should be followed by sliding scale parameters based on the blood sugar. Facility policy undated and title Medication Administration Policy documents, in part: Drugs will be administered in accordance with orders of licensed medical practitioners of the state in which the facility operates. Facility job description undated and titled Position title: LPN, documents, in part, Dispense medications as ordered by the attending physician in accordance with facility policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 20 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review the facility failed to ensure two medication carts out of the three medication carts reviewed were free of loose tablets. This deficient practice has the potential to affect 27 residents who receive medications from side two medication cart and 22 residents who receive medications from side one medication cart. Findings include: On 1/30/2024 at 11:38AM surveyor accompanied by V22 (RN/Registered Nurse) inspected the side 2 medication cart. The following was observed: V22 pulled all the medication bingo cards from the drawers containing medication bingo cards and placed the medication bingo cards on the top of the medication cart. V22 pulled a total of (2) ½ white tablets, 6 white tablets, 1 brown tablet, 3 pink tablets and 1 yellow tablet from the bottom of the drawers of the side 2 medication cart. On 1/30/2024 at 11:45am V22 (RN) stated the nurses are supposed to clean the medication cart drawers. V22 stated the cleaning of the medication cart is to be done every day, the nurse should clean the medication cart before going off duty for the day so that the nurse coming on duty has a clean cart. On 01/30/2024 at 1:04 pm surveyor accompanied by V24 (RN) inspected the side 1 medication cart. V24 pulled all the medication bingo cards from the drawers containing medication bingo cards and placed the medication bingo cards on the top of the medication cart. The surveyor observed V24 pull (8) ½ white tablets, 1 ½ orange tablets, 1 ruby colored tablet, 1 pink tablet, 1 gold tablet, 1 tan tablet and 1 yellow tablet from the bottom of the drawers of the side 1 medication cart. On 01/30/2024 at 1:15pm V24 (RN) stated I would have to ask the Director of Nursing who is responsible for cleaning the medication cart, I work for the agency. On 1/31/2024 at 12:23pm V2 (DON/Director of Nursing) stated the nurses are responsible for cleaning the medication carts out. V2 stated the medications carts should be cleaned out every shift. V2 stated it is my expectation that the nurses keep the medication carts clean. V2 stated there should not be any loose tablets/pills in the medication carts at any time. V2 stated if the nurses remove the tablets/pills from the bingo cards appropriately, there should not be any loose tablets in the medication carts. On 01/31/2024 reviewed the Facility's document, with an effective date of 10/25/2014 and a revision date of 05/01/2018 titled ID1: Storage of Medications which documents in part, I. Medication storage areas are kept clean, well-lit, and free of clutter and extreme temperature and humidity. On 01/31/2024 reviewed the facility's undated RN (Registered Nurse) job description which documents in part, Duties/Responsibilities/Function 28. All other duties as assigned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 21 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure the container of the multi blood glucose test strips were labeled with the open date. This failure has the potential to affect 15 residents who receive blood glucose monitoring. Residents Affected - Some Findings include: On 1/29/24 at 11:40am, with V13 (Licensed Practical Nurse/LPN), during medication pass, an opened container of the multi blood glucose test strips with no open date labeled was observed in the medication cart. The label on the container of multi blood glucose test strips states open date with a blank place to write the open date on the container. On 1/30/24 at 10:56am, with V16, (LPN), during observation of medication cart storage, an opened container of the multi blood glucose test strips with no open date labeled was observed. The label on the container of multi blood glucose test strips states open date with a blank place to write the open date on the container. When asked if there should be an open date on the container of the multi blood glucose test strips, V16 stated, No. V16 referenced the manufacturing manual inside the container of multi blood glucose test strips title (Blood Glucose Monitoring System) Blood Glucose Test Strips documents, in part, the bottle should be labeled once first opening and use within 3 months of first opening or the expiration date on the label, whichever comes first. On 1/31/24 at 10:10am, V2 (Director of Nursing) stated, It is a good practice to put the open date on the blood glucose test strip bottle once opened, to be aware of the expiration date. When asked if the nurse should perform a blood sugar reading using a multi blood glucose test strip from an undated container, V2 stated, the nurse must Follow manufacturer's recommendation for expiration once the bottle is opened. Facility policy undated and title Obtaining a Fingerstick Glucose Level, documents, in part, If using the blood glucose monitoring system (meter with test strips), use test strips before their expiration date. Facility presented document report titled, Insulin, with a date of 1/30/2024. This document report lists the 15 residents who receive blood glucose monitoring. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 22 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 Residents Affected - Many 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 prevent the spread of foodborne illnesses by improperly thawing meat and not securing bulk item scoops. This failure has the potential to affect all residents receiving oral nutrition. Findings include: On 1/28/2024 at 9:22am surveyor observed a large package of chicken in a steel pan thawing on the top shelf of the refrigerator. Surveyor also observed a roll of ground beef in a steel pan thawing on the bottom shelf in the refrigerator. On 1/28/2024 at 9:25am V15 (Dietary Manager) stated, both meats (referring to chicken and beef) are raw so how they thaw in the refrigerator should not matter. On 1/28/2024 at 9:30am surveyor observed the serving scoop for the oatmeal, rice and flour was inside of the large container for each item. On 1/28/2024 at 9:35am V15 stated, he was told last year that it was ok to put the serving scoop inside of the large bulk containers. On 1/31/20224 at 10:45am V26 (Dietician) stated, chicken should not thaw out over ground beef in the refrigerator because the two items have different internal temperatures. V26 further stated, the serving scoop should be kept on the outside of the bulk storage container contained in a bag to prevent any physical contaminants from getting into the sealed bag. Undated policy title Thawing Hazardous Food documents, in part, potentially hazardous food will be thawed in a safe and sanitary manner. Undated Handling Clean Equipment and Utensils documents, in part, utensils will be handled to prevent contamination, other stored utensils should be covered whenever possible and clean utensils will be stored in a clean location in a way that protects them from contamination. Job Description titled Food Service Supervisor documents, in part, to develop, implement and maintain, with facility administration approval, policies and procedures to assure compliance with all federal, state and local regulations and supervise and direct all food service components this includes, but not limited to proper food storage procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 23 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, interview and record review the facility failed to secure the lid on the outside garbage dumpster to prevent pest and rodents from entering into the facility. This failure has the potential to affect all the residents residing in the facility. Residents Affected - Many Findings include: On 1/28/2024 at 11:05am and 11:32am surveyor observed the lid open on the garbage dumpster. On 1/29/2024 at 12:04am V15 (Dietary Manager) stated, the lid should be closed to keep the rodents and critters out of the dumpsters. Undated Garbage Disposal policy documents, in part, keep dumpster closed at all times. Undated Housekeeping Services Policy documents, in part, trash will be deposited in outside covered refuse containers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 24 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 to properly disinfect shared equipment used on three residents (R62, R83, and R98) and failed to safely handle a needle for one resident (R50). These failures affected four (R50, R62, R83, and R98) residents in the sample of 55 residents in preventing the spread of microorganisms when reviewed for infection control. Residents Affected - Some Findings include: 1.) On 1/29/24 at 9:25am, V13 (Licensed Practical Nurse/LPN) walked in hallway to retrieve the electronic vital signs machine which is housed on a pole with roller wheels. V13 then wheeled the blood pressure machine into R98's room and applied the blood pressure cuff on R98's upper arm without sanitizing the blood pressure cuff. R98's Brief Interview for Mental Status (BIMS) dated 11/29/23 documents R98 with a score of 15 which indicates that R98 is cognitively intact. R98's face sheet documents, in part, R98's diagnoses including but not limited to schizophrenia, dementia, major depressive disorder, and obesity. 2.) On 1/29/24 at 9:37am, V13 (LPN) walked in hallway to retrieve the same electronic vital signs machine and the dark blue, blood pressure cuff attached to the black tubing from the machine was hanging down touching the floor in the hallway. V13 lifted the blood pressure cuff off the floor and placed it in the basket on the pole. V13 then wheeled the blood pressure machine into R62's room and applied the blood pressure cuff on R62's left upper arm without sanitizing the blood pressure cuff before or after use on R62. R62's Brief Interview for Mental Status (BIMS) dated 12/27/23 documents R62 with a score of 15 which indicates that R62 is cognitively intact. R62's face sheet documents, in part, R62's diagnoses including but not limited to gout, major depressive disorder, diabetes mellitus, congestive heart failure and hypothyroidism. 3.) On 1/29/24 at 9:52 am, V13 (LPN) performed a blood pressure reading on R83's left arm without sanitizing the blood pressure cuff which was just used on R62. V13 exited out of room with electric vital signs machine. When asked what the process is with sanitizing the blood pressure cuff in between resident usage, V13 stated, I clean it after two people. V13 then put on gloves and removes disinfectant wipes from the container in the bottom drawer and wiped both sides of the blood pressure cuff. V13 stated, the (sanitizing) wipes are stored in each medication cart. When asked the purpose of sanitizing the blood pressure cuff in between residents, V13 stated, Infection Control. R83's Brief Interview for Mental Status (BIMS) dated 12/29/23 documents R83 with a score of 15 which indicates that R83 is cognitively intact. R83's face sheet documents, in part, R83's diagnoses including but not limited to chronic obstructive pulmonary disease, pulmonary embolism, hypotension and anemia. 4.) On 1/29/24 at 11:38 am, V13 (LPN) cleaned by wiping the blood glucometer with sanitizing wipes from 11:38:33 to 11:39:11 (38 seconds); discarded the sanitizing wipes; the blood glucose machine (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 25 of 26 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 146149 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westwood Vlge Nrsg and Rhb Ctr 2444 West Touhy Avenue Chicago, IL 60645 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 was not observed visibly wet for 2 minutes on top of the medication cart. While standing in the hallway at the medication cart across from R50's room, V13 prepared Novolog insulin to administer to R50 by injecting the needle on the syringe into the Novolog septum of the vial. After pulling back on the plunger to fill the syringe with 5 units of Novolog insulin, V13 removed the needle from the insulin vial, and V13 did not pull up safety guard over needle; and placed the filled insulin syringe inside a white, foam cup with the exposed needle facing upwards which was leaning towards the side of the cup; and the exposed needle was observed in contact touching the white, foam cup. V13 carried this cup containing the insulin syringe with an exposed needle touching the inside of the cup into R50's room. V10 then administered R50's insulin with this same needle into R50's right upper arm. R50's Brief Interview for Mental Status (BIMS) dated 11/20/23 documents R50 with a score of 15 which indicates that R50 is cognitively intact. R50's face sheet documents, in part, R50's diagnoses including but not limited to diabetes mellitus, hyperlipidemia, obesity, anxiety and spinal stenosis. On 1/31/24 at 10:10am, V2 (Director of Nursing) stated, it is not standard practice to have an exposed needle touching anything including a foam cup. V2 stated, the facility nurse is expected to cover the needle of a medication prepared syringe when transporting the filled syringe from the hallway into a resident's room. V2 stated, multi-use equipment, like the blood pressure cuff, should be cleaned after each resident use to prevent transmission of any type of infection. Facility label from the germicidal disposable wipes container used in the facility (undated) documents, in part, To disinfect and deodorize hard, nonporous surfaces: If present, use a wipe to remove visible soil prior to disinfecting. Unfold a clean wipe and thoroughly wet surface. Allow surface to remain wet for two (2) minutes. Let air dry. Facility policy undated and titled Glucometer Cleaning Policy, documents, in part, . 3. Blood Glucose Monitoring System must be clean/disinfect after each use with disinfectant wipes . If visibly soiled, clean gross soil with one wipe. 4. Use a second wipe to disinfect the surface. 5. Blood Glucose Monitoring System is to remain visibly wet according to manufacturing policy. 6. Use additional wipes if needed to assure manufacturing recommended wet time (must be visually wet). 7. Let air dry. Facility policy undated and titled Infection Control Policy and Procedure, documents, in part, Policy: It is the policy of this facility to utilized standard precautions facility-wide . 5. Process Surveillance reviews practices directly related to resident care in order to identify where the practices comply with established prevention and control procedures and policies based on recognized guidelines . Process Surveillance monitoring includes: . e. Cleaning / Disinfecting / Reprocessing. Facility policy dated 3/19/12 and titled Infection Control Process Surveillance Monitoring, documents, in part, that a surveillance item that reusable equipment such as B/P (blood pressure) cuffs are appropriately cleaned, disinfected or reprocessed after use? . Needle Handling: Are needles recapped? Facility job description undated and titled Position title: LPN, documents, in part, Ensure compliance with infection control standards. Immediately correct/address identified instances of non-compliance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146149 If continuation sheet Page 26 of 26

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Citations

14 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0558GeneralS&S Dpotential for harm
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0583GeneralS&S Epotential for harm
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
0584GeneralS&S Dpotential for harm
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0688GeneralS&S Dpotential for harm
F688 - Mobility
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.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0755GeneralS&S Epotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
0759GeneralS&S Dpotential for harm
F759 - Medication Errors
Ensure medication error rates are not 5 percent or greater.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0770GeneralS&S Epotential for harm
F770 - Laboratory Services
Provide timely, quality laboratory services/tests to meet the needs of residents.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0814GeneralS&S Cno actual harm
F814 - Food Safety Requirements
Dispose of garbage and refuse properly.
0880GeneralS&S Epotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.

FAQ · About this visit

Common questions about this visit

What happened during the January 31, 2024 survey of WESTWOOD VLGE NRSG AND RHB CTR?

This was a inspection survey of WESTWOOD VLGE NRSG AND RHB CTR on January 31, 2024. The surveyor cited 14 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at WESTWOOD VLGE NRSG AND RHB CTR on January 31, 2024?

Yes, 14 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Reasonably accommodate the needs and preferences of each resident."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·January 31, 2024