Inspection·December 18, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm does not have documentation to show R2's nails were trimmed or R2 refused to have her nails trimmed during any of her other showers or baths. 2. R9 had multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting left dominant side, based on the face sheet. Residents Affected - Some R9's quarterly MDS (minimum data set) dated September 10, 2023 showed that the resident was severely impaired with cognition and required extensive assistance from the staff with regards to personal hygiene. The same MDS showed that R9 had functional limitation in range of motion on both sides of her upper extremities. On December 11, 2023 at 11:15 AM, R9 was in bed, alert and verbally responsive. R9 was unable to extend her left hand fingers without the assistance of V6 (Licensed Practical Nurse). R9 had a palm protector on her right hand. R9's fingernails were long, jagged and with black substances underneath several of her fingers. R9 stated that she wanted the staff to trim and clean her fingernails. V6 was present during the observation. R9's active care plan initiated on December 7, 2023 showed that the resident was dependent on staff for ADL (activities of daily living) task. The same active care plan showed multiple interventions including provision of assistance with all ADLs including personal hygiene. Further review of R9's active care plan initiated on December 7, 2023 showed that the resident had self-care deficit related to hemiparesis and hemiplegia. The same care plan showed multiple interventions including, [R9] is dependent with ADL care; provide total assistance in all aspects of hygiene. 3. R45 had multiple diagnoses including chronic obstructive pulmonary disease and dementia without behavioral disturbance, based on the face sheet. R45's quarterly MDS dated [DATE] showed that the resident was severely impaired with cognition and required substantial/maximal assistance from the staff with regards to personal hygiene. On December 11, 2023 at 11:44 AM, R45 was sitting in his wheelchair inside the unit activity/dining area. R45 had overgrown facial hair. R45 wanted the staff to shave him. R45 commented, Yes, I need shaving, it is time after resident felt his facial hair. R45's active care plan initiated on October 8, 2023 showed that the resident had self-care deficit. The same care plan showed multiple interventions including provision of extensive staff assistance for grooming. On December 12, 2023 at 5:55 PM, V2 (Director of Nursing) stated that it is part of the nursing care and service to assist in shaving resident's needing assistance. V2 acknowledged that the nursing staff should have assisted R45 with shaving to prevent overgrown facial hair and to maintain personal hygiene. 4. R58 had multiple diagnoses including generalized muscle weakness and dementia with mood disturbance, based on the face sheet. R58's significant change in status MDS dated [DATE] showed that the resident was cognitively impaired and required substantial/maximal assistance from the staff with regards to personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 2 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On December 11, 2023 at 10:22 AM, R58 was in bed sleeping. R58's fingernails were long, jagged and with black substances underneath several of his fingernails. V6 (Licensed Practical Nurse) was present and was aware of the condition of R58's fingernails. R58's active care plan initiated on November 6, 2023 showed that the resident had self-care deficit. The same care plan showed multiple interventions including, [R58] is dependent with ADL care; provide total assistance in all aspects of hygiene/dressing. On December 12, 2023 at 5:50 PM, V2 stated that it is part of the nursing care and services to assist residents needing assistance with ADLs (activities of daily living), like trimming and cleaning the fingernails, and shaving to ensure cleanliness and maintain hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 3 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 provide supportive devices to residents to prevent further reduction in ROM (Rand of Motion). This applies to 3 of 3 residents (R2, R9, and R57) reviewed for range of motion in the sample of 19. The findings include: 1. The EMR (Electronic Medical Record) showed R2 was admitted to the facility on [DATE], with multiple diagnoses including dementia, hemiplegia and hemiparesis from a stroke affecting the right dominant side, and depression. R2's MDS (Minimum Data Set) dated September 29, 2023, showed R2 had moderate cognitive impairment, and required extensive to total assistance from facility staff for most ADLs (Activities of Daily Living). The MDS continued to show R2 had a functional limitation in range of motion in one upper extremity. R2's care plan dated October 26, 2023, showed, [R2] requires placement of palm protector to the right hand daily as tolerated related to diagnosis of hemiplegia and hemiparesis following other cerebrovascular disease affecting right dominant side. The care plan continued to show multiple interventions dated October 26, 2023, including, Staff will place palm protector on right hand in the morning and remove at bedtime as tolerated. R2's Order Summary Report dated December 13, 2023, showed R2 had an order to apply a right palm protector daily as tolerated. On December 11, 2023, at 10:19 AM, R2 was lying in bed. R2 did not have a right palm protector in place. On December 12, 2023, at 10:41 AM, R2 was lying in bed. R2 did not have a right palm protector in place. On December 13, 2023, at 8:58 AM, R2 was lying in bed. R2 did not have a right palm protector in protector in place. On December 13, 2023, at 9:16 AM, V10 (Director of Rehab) said R2 received Occupational Therapy from October 9, 2023, to November 19, 2023. V10 said R2 had a contracture of her right wrist and would benefit from an orthotic. V10 said on October 26, 2023, therapy applied a palm protector on R2's right hand due to a contracture and R2's nails digging into her palm. V10 continued to say R2 allowed therapy to apply the palm protector during therapy sessions. V10 said once R2 was finished with therapy, it was restorative's responsibility to apply or delegate for someone to apply R2's palm protector daily. On December 13, 2023, at 9:44 AM, V11 (Restorative Nurse) said restorative is responsible for applying palm protectors. V11 continued to say application of R2's palm protector should be documented in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 4 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 the medical record. Level of Harm - Minimal harm or potential for actual harm As of December 13, 2023, at 9:44 AM, the facility does not have documentation to show facility staff applied R2's palm protector or R2 refused to have her right palm protector applied. Residents Affected - Few On December 13, 2023, at 12:37 PM, V11 said there is no documentation of facility staff applying R2's right palm protector before today. On December 13, 2023, at 2:05 PM, V10 said R2 could not wear an orthotic brace so therapy recommended a right palm protector. R2's right palm protector will help prevent R2 from getting a worsening contracture. 2. R9 had multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting left dominant side, based on the face sheet. R9's quarterly MDS (minimum data set) dated September 10, 2023 showed that the resident was severely impaired with cognition and required extensive to total assistance from the staff with her ADLs (activities of daily living). The same MDS showed that R9 had functional limitation in range of motion on both sides of her upper extremities. On December 11, 2023 at 11:15 AM, R9 was in bed, alert and verbally responsive. R9 was unable to extend her left hand fingers without the assistance of V6 (Licensed Practical Nurse). R9 had a palm protector on her right hand but no device/splint on the left hand. V6 stated that R9 only uses a palm protector on her right hand and no device being used on the left hand because R9 cannot extend her left hand fingers. On December 11, 2023 at 1:20 PM, R9 was in bed, alert and verbally responsive. R9 was unable to extend and/or open her left hand fingers. R9 had a palm protector on her right hand but no device/splint on the left hand. On December 12, 2023 at 9:20 AM with V3 (Assistant Director of Nursing), R9 was in bed, alert and verbally responsive. R9 was unable to extend and/or open her left hand fingers. V3 stated that R9's left was contracted. R9 had no device/splint on the left hand. R9's active order summary report showed an order dated December 7, 2023 to, Apply palm protector to left hand. Check skin for redness, irritation, or skin breakdown. On at 11am Off at 3pm. On December 13, 2023 at 9:52 AM, V10 (Director of Rehab) stated that the staff should apply the left hand palm protector to R9 as ordered for comfort, skin protection (prevent digging of the nails to the palm) and to prevent further contracture of the left hand. 3. R57 had multiple diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. R57's quarterly MDS dated [DATE] showed that the resident was moderately impaired with cognition and required substantial/maximal assistance from the staff with regards to personal hygiene. The same MDS showed that R57 had functional limitation in range of motion to one side of her upper extremities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 5 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 On December 11, 2023 at 10:45 AM, R57 was in bed, alert and verbally responsive. R57 had visible right arm and hand weakness. R57 stated that she cannot move the right side of her body, including her right arm and hand due to stroke. R57 had no splint and/or adaptive device on her right arm and/or hand. R57 stated that staff sometimes apply the splint on her right hand, but not on a daily basis. R57 then pointed at the location where her right hand splint was placed, which was on top of her bedside table. Residents Affected - Few On December 12, 2023 at 9:24 AM, R57 was in bed, alert and verbally responsive. R57 had visible right arm and hand weakness. R57 had no splint and/or adaptive device on her right arm and/or hand. According to R57, the facility staff did not apply the splint on her right hand on December 11, 2023 and pointed at the location where her right hand splint was placed, which was on top of her bedside table. V3 (Assistant Director of Nursing) was present during the entire observation and interview of R57. R57's active order summary report dated October 9, 2023 showed an order for, pt (patient) will wear right resting hand splint as tolerated for 4-6 hours a day after hygiene and ROM (range of motion) to R (right) hand. Check at least every 2 hours for proper fit/positioning, skin integrity/redness and comfort. R57's active care plan initiated on November 14, 2023 showed that the resident will benefit from application of the right hand resting splint related to hemiplegia and hemiparesis affecting the right dominant side. The same care plan showed multiple interventions including, [R57] to wear splint everyday as tolerated. On December 13, 2023 at 9:50 AM, V10 (Director of Rehab) stated that based on the occupational therapy notes dated September 6, 2023, R57 needed to wear her right resting hand splint to improve her ROM in the metacarpals (palm bones) and prevent further contracture. According to V10, the staff should follow the physician's order to apply the right resting hand splint because R57 had right hand contracture. On December 13, 2023 at 9:56 AM, V2 (Director of Nursing) stated that resident's with ordered splints or any adaptive devices should be applied as ordered to prevent further contracture of the affected site. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 6 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to follow their policy to supervise a resident that is identified needing supervision for smoking and ensure that direct care staff are trained and aware of R50's smoking interventions. The facility also failed to ensure that a resident (R181) that is identified as a high risk for fall is supervised and monitored to prevent falls. This applies to 2 of the 3 residents (R50 and R181) reviewed for accidents/hazards in the sample of 19. The findings include: 1. Face sheet shows that R50 was admitted to the facility on [DATE], with multiple diagnoses including cerebral infarction (stroke), hemiplegia and hemiparesis (paralysis) following cerebral infarction affecting the right dominant side, nicotine dependence, and depression. The MDS (Minimum Data Set) dated 9/30/23, shows R50 is cognitively intact. The same MDS shows R50 requires total dependence on facility staff for transfers between surfaces and requires extensive assistance from facility staff for bed mobility. Review of R50's record indicates numerous examples of noncompliance with the facility's smoking policy. R50's noncompliance was documented as incidents of smoking in his room to carrying his own smoking supplies (facility was to hold cigarettes and lighter) to smoking unsupervised on the smoking patio. R50 was provided education about the policy and staff have attempted numerous times to remove smoking materials. R50 often refuses to give up materials to staff. In addition, the facility served R50 with an involuntary discharge order for smoking violations that was denied by the administrative law judge. On December 12, 2023, at 11:51 AM, R50 was resting in bed. R50's bedroom was cold with the window opened. There was a smell of cigarette smoke in his room. R50 said that he smokes half a pack of cigarettes a day, he is allowed to keep his cigarettes and lighter, and he could smoke anytime he wants to. On December 12, 2023, at 2:30 PM, R50 was propelling in the hallway. R50 stated that he came from the patio where he smoked. R50 was noted with his box of cigarette and his lighter. R50 also said that he keeps his own cigarette and lighter at bedside. On December 12, 2023, at 5:20 PM, V1 (Administrator) and surveyor observed R50 in his room. R50 admitted that he has cigarettes but refused to tell where he gets his cigarette from. R50 also said that he keeps his cigarette at bedside. V1 opened the bedside drawer and found 2 boxes of cigarettes in R50's bedside drawer. One box was empty, and the other box had 4 or 5 sticks of cigarettes. V1 told R50 that he cannot keep it in his bedroom. R50 got upset and became loud. R50 refused to surrender his lighter. On December 12, 2023, at 3:25 PM, V2 (Director of Nursing/DON) stated that he shouldn't have the smoking materials with him. He was educated multiple times but was non-compliant. R50 does not voluntarily give it to the staff (smoking materials). Staff does frequent rounding. Facility already brought R50 to court for involuntary discharge, but the facility was denied the ability to discharge the resident. According to V2, R50 would find a way to get a cigarette somewhere. As additional precautionary measure, they placed a smoke detector in his bedroom. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 7 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On December 12, 2023, at 4:53 PM, V1 (Administrator) stated that he told his staff to do random check of R50's bedroom. R50 doesn't have money. The staff is supposed to give him 1 stick of cigarette at a time. According to V1, R50 does not surrender to staff his cigarettes. V1 added that he believed that one of the other residents is giving the cigarettes to R50. V1 also stated that the family are the one who buys cigarettes for the residents, and it is not possible to monitor R50 24/7. He gets very aggressive when staff take the cigarette from him. On December 13, 2023, at 10:36 AM, V14 (Activity Aide) said R50 resides on the second floor and no residents on the second floor require supervision while smoking. V14 continues to say R50 can keep his cigarettes and his lighter and go down whenever he wants to smoke. On December 13, 2023, at 10:50 AM, V15 (Activity Aide) said R50 is not a resident they supervise for smoking. On December 13, 2023, at 10:47 AM, V13 (Social Services Director) stated that R50 needs assistance to get out of the bed. R50 has right sided weakness. When R50 sits on the wheelchair, he could propel himself everywhere. R50 has history of not following smoking rules. He was smoking in his room and smoking in non-designated smoking area. But that was in the past. He smokes half a pack a day. V13 had never seen R50 buy cigarettes outside, but V13 was not sure where R50 got the cigarettes. V13 also said that he did R50's smoking assessment today, there was an error with the assessment, it should have been updated. V13 based his assessment from November 8, 2023, to the present and since then, R50 did not have incident of unsafe smoking. The basis of quarterly assessment is to monitor a resident's behavior for 3 months. The intervention placed for R50's smoking behavior is to meet with R50 to review and discuss smoking rules, 30 days of suspended smoking, supervised smoking, finding the root cause of the problem, and another positive intervention is meet the ombudsman and see if the ombudsman can talk to R50 the importance of safe smoking. September 28, 10:15 PM: V13 (Social Service Director) went to R50's bedroom to speak with him regarding the smell of cigarette smoke coming from his bedroom. R50 responded Yes, I have been smoking in my room, I only took a few puffs of the cigarette. V13 reminded R50 that there is no smoking allowed in the facility and V13 reviewed the smoking policy with R50. September 29, 2023: V12 (Infection Preventionist Nurse) smelled cigarette smoke and saw haze in hallway. Upon opening the bedroom door, smoke billowed out of the room, R50 was sitting in bed with a smile on his face. Reminded R50 that he is not to smoke in his room. V12 attempted to remove smoking materials and R50 gripped in hand and became verbally aggressive. November 2, 2023: V13 (Social Service Director) found R50 with cigarette butts and ashes on his breakfast tray, R50 admitted to V13 that he was smoking in his room. V13 discussed how unsafe smoking in his room is, R50 said he would try harder. Continue to monitor as needed. November 8, 2023: V1 (Administrator) found cigarette butt on R50's bedside table and ashes on the floor. R50 admitted to V1 he was smoking in his room. Administrator confiscated cigarettes and lighter. R50 educated on smoking policy again. November 15, 2023, 11:35 AM: V19 (Nurse) educated R50 about facility rules and times regarding smoking, R50 verbalized understanding. R50's smoking care plan revised on 8/3/22, shows R50 has a diagnosis of nicotine dependence and a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 8 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few history of smoking in his room on 7/21/22. The same care plan continues to show multiple interventions dated 8/9/22, including Offer/provide a copy of the facility safe-smoking policy and explain the policy so the resident is fully aware of all obligations and conduct a 'Smoking Safety Assessment' as necessary. Facility documentation titled Smoking Risk Review dated 7/3/23, shows R50 was assessed he may not be capable of handling/carrying any smoking materials and requires supervision when smoking. V14 or V15 (Activity Aides) were not aware that R50's smoking materials needed to be kept with the facility and R50 needed to be supervised while smoking. The facility's undated policy titled, Facility Smoking Safety Policy, shows residents who smoke are evaluated to determine their ability to comply with safety rules and their ability to carry smoking materials. The policy shows residents who are non-compliant, potentially dangerous, exercise poor judgement, and show a lack of concern for the welfare of others will be counseled and the facility can limit and restrict access to smoking products, matches, and lighters. The policy shows the following behaviors and/or conditions will jeopardize and cause revocations of independent privilege's: smoking in non-designated areas, such as resident rooms, and self-harmful behaviors, such as burning clothes. All residents interested in retaining smoking privileges must follow the guidelines set forth in this policy. 2. Face sheet shows that R181 is 73 years who has multiple medical diagnoses to include unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, schizophrenia, generalized muscle weakness, lack of coordination, and history of falling. R181's admission MDS dated [DATE], shows that R181 uses wheelchair for mobility and requires substantial/maximal assistance for sit to stand, ambulation, and toilet transfer. On December 11, 2023, at 10:44 AM, R181 was observed on the bathroom floor. R181 stated that she hit the left side of her face. There was discoloration noted on the peri-orbital area of her left eye. The call light in the bathroom was tied to the armrest of the raised toilet seat and was not within reached of R181 while she was lying on the floor. Nobody could tell how R181, got into the toilet by herself. On December 11, 2023, at 11:55 AM, R181 was resting in bed and was unable to tell how she fell and where she fell. V34 (CNA) stated that R181 is a risk for fall, she requires extensive assistance with activities of daily living care. On December 11, 2023, at 12:01 PM, V33 (Housekeeper) stated that she (V33) was cleaning the bedroom when she opened the bathroom door to empty the garbage can. V33 saw R181 sitting on the toilet asleep, there was no staff beside her or near her. When she returned the garbage can to the bathroom, as soon as she turned around and closed the door, V33 heard R181 fell on the floor. V33 opened the door and saw R181 on the floor. On December 12, 2023, at 1:58 PM, R181 was sitting on the toilet with V9 (CNA) by her side. At 2:00 PM, V9 left R181 alone on the toilet sitting. At 2:04 PM, R181 stood up from the toilet and walked unsteadily to her wheelchair. As R181 sat down, V9 came back to the room and assisted R181 back to the toilet to give her a peri-care. V9 assisted R181 to stand up, V9 was standing behind the wheelchair, while R181 was in front of the wheelchair. V9 did not put a gait belt around R181 when she stood up for peri-care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 9 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On December 12, 2023, at 3:40 PM, V2 (DON) stated that staff can't leave a resident alone in the bathroom at any given time, if a resident is identified as a high risk for fall. The staff should be with the resident during that time for safety measure. On December 13, 2023, at 12:57 PM, V16 (CNA) stated that R181 is confused, though she's able to verbalize needs, she would wake and think that she had to go to work. V16 saw R181 once getting up by herself. R181 was able to propel herself to different places. R181 would usually ask V16 to go to the bathroom with her. R181 could stand up and pivot to transfer from wheelchair to the bathroom. They are supposed to put gait belt around everyone who needs supervision or assistance with toileting, as safety precaution. A lot of the times R181 was sleepy. She falls asleep quickly. R181 is a high risk for fall. When V16 is assigned to R181 she does not leave R181 on her own even for a minute because R181 tends to stand up and walk back in the wheelchair. She has history of fall incidents. On December 13, 2023, at 1:20 PM, V19 (Nurse) stated that R181 is a high risk for fall. When V19 is assigned to R181, V19 keeps her at the desk because she is a high fall risk. R181 can't be left on her own especially in her room while she's sitting on her wheelchair. She would try to get up by herself which is unsafe. R181 can make her needs known but she is confused and forgetful. On December 13, 2023, at 1:53 PM, V8 (CNA) stated that R181 had fallen before near the nurses' station. V8 left R181 there at the nurses' station so the nurses can watch her while V8 attended to other residents. According to V8, R181 moves fast, she propels herself in her room and tends to transfer without calling for help. R181 is not aware of safety. Even when she's left in bed on her own, she could stand up and fall. R181's active care with revision date of December 11, 2023, shows that R181 has history of falls, believes she is more independent than capable and can be forgetful. R181 is up as tolerated, can benefit with staff assistance due to decreased balance and poor safety awareness. The same care plan shows multiple interventions which include to ensure call light is within reach and anticipate and meet individual needs of R181. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 10 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a sanitary urinary catheter insertion and failed to render peri-care in a manner that would prevent infection. This applies to 4 of 4 residents (R50, R58, R63, R181) reviewed for urinary catheter and peri-care in the sample of 19. The findings include: 1. Face sheet shows that R63 is 73 years-old who has multiple medical diagnoses which include urinary retention, neuromuscular dysfunction of the bladder, sepsis, unspecified organism, and type 2 diabetes. On December 12, 2023, at 1:04 PM, V7 (Nurse) changed R63's indwelling urinary catheter because it was clogged. V7 retracted the penile foreskin of R63. There were unidentified white substances/sedimentations surrounding the head and neck of the penis. V7 wiped the area with betadine swabs, however, V7 did not completely removed the white sediments. When the state representative inquired about the remaining residues around the penis, V7 stated that they don't have a lot of betadine swabs in the catheter set. V7 then picked up one of the soiled betadine swabs and re-used it to remove the remaining sediments. V7 inserted the catheter tube, and as the urine flowed out of the catheter, V7 injected the distilled water to inflate the balloon. When V7 attached the catheter to the urinary tube, the urine flow stopped. V7 repositioned the external catheter tube to see if the urine would come out but nothing happened. V7 proceeded to aspirate the distilled water from the balloon to deflate it, then she slightly slid the internal urinary catheter back and forth to reposition. There was a small amount of urine that flowed down to the catheter which was thick with sediments. V7 injected distilled water again to the balloon. During the catheter insertion, it was noted that the anchor was loose. V7 removed the loose anchor and did not place a new one. On December14, 2023, at 2:10 PM, R63 was resting in bed, his indwelling urinary catheter remained unsecured. On December 12, 2023, at 5:32 PM, V2 (Director of Nursing/DON) stated that staff must wash their hands prior to procedure. Clean the peri-area, prior to removal of the catheter, perform a sterile cleaning prior to insertion of catheter. The staff cannot move the catheter back and forth when it's already inserted to the resident. He has history of UTI; staff should perform a strict sterile technique during catheter insertion. To prevent infection. Facility's undated Policy and Procedure for Foley Catheterization and Removal shows: 5. Insertion Procedure: Follow approved sterile technique. 7. Secure catheter to drainage system and attached to thigh, for male resident, draped loosely and tape, or use leg strap to avoid pressure between thighs or tape on either side of lower abdomen to prevent [NAME]-scrotal fistula. 2. Face sheet showed that R50 is 63 years-old who has multiple medical diagnoses which include (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 11 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. Level of Harm - Minimal harm or potential for actual harm On December 12, 2023, at 1:33 PM, V8 (Certified Nursing Assistant/CNA) rendered incontinence care to R50 who was wet with urine and had a bowel movement. V8 wet half of the bath towel and handed it to R50 to wipe his frontal perineum. Using his left non-dominant side, R50 wiped his pubic, perineal, and scrotal area in an up and down stroke about 3 to 4 times, then he handed the towel back to V8. There was a strong urine odor that came from R50's peri-area. V8 used the same wet side of the towel to wipe R50's lower back, buttocks, and rectum. V8 did not offer or ensure to clean R50's groins. Residents Affected - Some 3. On December 12, 2023, at 1:58 PM, V9 (CNA) assisted R181 to the toilet where she had a bowel movement. After R181 used the toilet, V9 cleaned R181's rectum, then she pulled the incontinence brief back in place, assisted to put R181's pants back. V9 did not clean the frontal perineum of R181. On December 12, 2023, at 6:02 PM DON stated that staff should clean appropriately, do not use the same part of towel to clean a different part of the body. Ensure that all parts of the perineum were cleaned. This is to prevent infection, cross contamination, and skin breakdown. 4. On December 12, 2023 at 9:40 AM, V5 (Certified Nursing Assistant) and V4 (wound care nurse) turned and repositioned R58. R58's disposable brief was wet with urine. V5 used a hand towel wet with water to clean R58. V5 wiped from the pubic area down to the penis and scrotal area, once in a quick downward motion, wiping only one side, then to the rectal and buttocks. V5 did not clean R58's urethral opening, entire penis and entire scrotum. After V5 provided incontinence care to R58, V4 proceeded to provide wound treatment to the resident, then V4 and V5 applied a new disposable brief to R58. On December 12, 2023 at 5:44 PM, V2 (Director of Nursing) stated that all residents should be provided with appropriate bladder incontinence care to ensure cleanliness, maintain hygiene and to prevent odor. According to V2 for male resident's regardless, if circumcised or not, the resident's penis should be cleaned properly during incontinence care by making sure that it is cleaned from the tip of the penis using circular motion and working outward. V2 also stated that not only one side but the entire penile shaft and scrotum should also be cleaned. V2 added that wiping the male perineal area including the penis and the scrotum once with a quick downward motion does not ensure that the resident was properly cleaned. Thee facility's policy and procedure regarding perineal/incontinence care last reviewed by the facility on November 2023 showed under purpose, To provide cleanliness and comfort to the resident, prevent infections and skin irritation, and observe the resident's skin condition. The same policy under procedure showed in-part, 10 .b. For male residents, retract the foreskin if uncircumcised then clean the tip of the penis using a circular motion starting with the urethra and working outward. i. The shaft, scrotum, rectal area and buttocks should be cleansed as well. 11. Use a clean area of cloth for each area cleansed. 12. Assure all areas affected by incontinence have been cleansed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 12 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 follow standard infection control practices related to hand hygiene and gloving during provisions of catheter and incontinence care. Residents Affected - Some This applies to 4 of 4 residents (R50, R58, R63, R181) reviewed for infection control in the sample of 19. The findings include: 1. On December 12, 2023, at 1:04 PM, V7 (Nurse) changed R63's indwelling urinary catheter. V7 inserted the catheter tube and injected distilled water to the balloon. When the flow of urine stopped, V7 repositioned the external catheter but nothing happened. V7 aspirated the distilled water to deflate the balloon and re-adjusted the catheter. While wearing same gloves, V7 opened a sealed bottle of distilled water then V7 changed her gloves without hand hygiene. V7 took the used syringe and use it to aspirate from the clean distilled water bottle to re-inflate the catheter balloon. V5 adjusted the external catheter tube, arranged the toiletries, and distilled water on top of the bedside table, touched the rolling table, touched the side rails, and straightened bed linen and blanket while wearing same gloves. 2. On December 12, 2023, at 1:33 PM, V8 (Certified Nursing Assistant/CNA) rendered incontinence care to R50 who was wet with urine and had a bowel movement. V8 wiped R50's back perineum, removed soiled incontinence brief and bed linens, cleaned the soiled mattress, and applied clean incontinence brief. V8 carried the soiled linen to the soiled hamper, then she changed her gloves without hand hygiene and assisted to dress and transfer R50 to the wheelchair. V8 did not perform hand hygiene during the process of incontinence care and in between task. 3. On December 12, 2023, at 1:58 PM, V9 (CNA) assisted R181 to the toilet where she had a bowel movement. After R181 used the toilet, V9 cleaned R181's rectum, then she pulled the incontinence brief back in place, assisted to put R181's pants back on, removed her gloves and propelled R1 to the hallway without hand hygiene. On December 12, 2023, at 6:04 PM, V2 (Director of Nursing/DON) stated that the staff must wash hand and change gloves in between task during provisions of ADL care to prevent infection. 4. On December 12, 2023 at 9:40 AM, V5 (Certified Nursing Assistant) and V4 (wound care nurse) turned and repositioned R58. R58's disposable brief was wet with urine. With her gloved hands, V5 provided incontinence care to R58. After providing incontinence care to R58, V5 did not remove her used gloves and proceeded to assist with turning and repositioning R58 in bed for the wound treatment. After the wound treatment, V4 and V5 turned and repositioned R58. V5 also straightened R58's linens, assisted in changing R58's gown and placed pillow under R58's left side to position the resident, while using the same soiled gloves that she used to provide incontinence care to R58. On December 12, 2023 at 5:44 PM, V2 (Director of Nursing) stated that when nursing staff are performing dirty to clean task, the staff should always remove their used gloves, perform hand hygiene by either handwashing or use of alcohol-based hand rub, then apply a new pair of gloves before proceeding to perform clean task. According to V2, after V5 performed incontinence care to R58, V5 should remove her used/soiled gloves, perform hand hygiene, then put on a new pair of gloves before handling (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 13 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 the resident and resident's linens, gown and pillow, to prevent cross contamination and potential infection. Level of Harm - Minimal harm or potential for actual harm The facility's policy and procedure regarding perineal/incontinence care reviewed by the facility in November 2023 showed in-part under procedure, that after providing incontinence care to the resident, 13. Remove gloves and perform hand hygiene and 14. Apply clean gloves then proceed with the resident's care. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 14 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to offer residents the pneumococcal vaccine according to CDC (Centers for Disease Control and Prevention) guidelines. Residents Affected - Few This applies to 2 of 5 residents (R22 and R39) reviewed for immunizations in the sample of 19. The findings include: 1. The EMR showed R22 was a [AGE] year-old resident, admitted to the facility on [DATE], with multiple diagnoses including chronic obstructive pulmonary disease, chronic kidney disease, heart failure, heart disease, and alcohol abuse. On December 12, 2023, at 1:23 PM, V12 said R22 has only received the PPSV23 (Pneumococcal Polysaccharide Vaccine) in 2018. V12 continued to say R22 had not been offered another pneumococcal vaccine because R22 received the PPSV23 after he was 65-years-old and did not need another vaccination. R22's Immunization Report dated December 13, 2023, showed R22 received the PPSV23 on August 29, 2018. As of December 13, 2023, at 12:30 PM, the facility does not have documentation to show R22 had been offered an additional pneumococcal vaccine. 2. The EMR showed R39 was an [AGE] year-old resident, admitted to the facility on [DATE], with multiple diagnoses including chronic obstructive pulmonary disease, chronic heart failure, cardiomyopathy, type 2 diabetes mellitus, and heart disease. On December 12, 2023, at 1:29 PM, V12 said R39 has only received the PPSV23 and has not been offered another pneumococcal vaccine because his pneumococcal vaccinations are complete. R39's Immunization Report dated December 13, 2023, showed R39 received the PPSV23 on March 30, 2021. As of December 13, 2023, at 12:30 PM, the facility does not have documentation to show R39 had been offered an additional pneumococcal vaccine. On December 13, 2023, at 12:30 PM, V12 said the facility follows CDC recommendations for pneumococcal vaccinations. V12 continued to say R22 and R39 should have been offered an additional pneumococcal vaccination. The CDC's Pneumococcal Vaccine Timing for Adults dated March 15, 2023, showed adults over [AGE] years old who have only received PPSV23 should receive either the PCV20 (Pneumococcal 20-valent Conjugate Vaccine) or the PCV15 (Pneumococcal 15-valent Conjugate Vaccine). The facility's policy titled Pneumococcal Vaccination dated October 2023, showed, General: The most effective way to treat pneumococcal disease is to prevent it through immunization . Guideline: 1. Nursing will assess the pneumococcal vaccination status of each resident upon admission/readmission, and as necessary. It is recognized that the immediate admission period is one of high complexity and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 146172 If continuation sheet Page 15 of 16 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 146172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Spring Creek 777 Draper Avenue Joliet, IL 60432 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 0883 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete potentially complicated by resident instability. For these reasons, a flexible approach should be taken regarding timing of vaccination. The assessment of a resident regarding their immunization status (and determination of vaccine need) should be initiated at the time of admission and completed as soon as possible following the assessment. Administration could potentially be delayed due to issues of medical stability. In any event, it is reasonable to expect administration and documentation of pneumococcal vaccine by the first quarterly assessment OR patient discharge, WHICHEVER COMES FIRST. Document any refusal and historical information, if any. 2. Nurse will provide education regarding pneumococcal vaccination, and administer the vaccine when indicated, unless refused by the resident or responsible party. Facilities must document the resident was assessed, educated, offered the vaccine, or declined due to refusal or contraindication. The consent serves as the education tool for the vaccine . Event ID: Facility ID: 146172 If continuation sheet Page 16 of 16