Wentworth Rehab & Hcc

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

of dementia. When a person's dementia is progressing, there may be behavioral issues such as psychotic symptoms and delusions because some parts of the brain is damaged. At a stage 5 dementia, a person may not know where they are and are not in reality. It is obvious that they cannot consent to medical procedures, psychotropic medication, or make financial decisions on their own regarding paying bills. They would need a more in depth assessment on their decision- making abilities.On 11/24/25 at 2:25 pm, V1 (Administrator) stated the following, We do not have Sexual Assessment forms that I know of.On 11/24/25 at 2:50 pm, V2 (DON/ Director of Nursing) stated the following, Resident R14 has not had any neuro psychiatric evaluations as far as I know while he was here. We don't have an assessment to measure a resident's capability to consent to sex. Yes, a patient's care plan should be updated after observed having sexual intercourse in his room with a male visitor.Facility Staff schedule dated 11/01/25 documents, V19 CNA (Certified Nurse Assistant) working the 3pm- 11pm shift on the third floor. The Initial Investigation report was faxed to IDPH on 11/19/25 at 2:24 pm and documents an allegation of sexual abuse involving Resident R14 and V20.The Initial Investigation report was faxed to IDPH on 11/20/25 at 5:49 pm and documents an allegation of financial abuse involving Resident R14 and V20.Resident R14's Memory Care Initial assessment dated [DATE REDACTED] documents

the following; Resident R14 is only oriented to person (knows self); Resident R14 is not oriented to place, time or situation (does not know where he is, does not know why he is here, and does not know the current day/ month); Resident R14 has short-term and long-term memory problems; Resident R14's FAST (Functional Assessment Staging Tool for Dementia) scale is Stage five of Seven. Resident R14's Care Plan dated 10/03/25 documents, Resident R14 is at risk for abuse related to cognitive impairment and diagnosis of dementia; Resident R14 has an ADL (Activity of Daily Living) Functional deficit related to dementia, impaired cognition, incomplete performances and periods of confusion.Facility Abuse policy documents the following: This facility affirms the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment and involuntary seclusion; the facility will report reasonable suspicion of a crime; the purpose of this policy is to assure that

the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect or abuse of our residents. This is done by immediately protecting residents involved in identifying reports possible abuse; implementing systems to investigate all reports and allegations of mistreatment promptly and aggressively, and making the necessary changes to prevent future occurrences; filing accurate and timely investigative reports.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wentworth Rehab & Hcc

201 West 69th Street Chicago, IL 60621

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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

while he was here. We don't have an assessment to measure a resident's capability to consent to sex. Yes,

a patient's care plan should be updated after observed having sexual intercourse in his room with a male visitor.On 11/24/25 at 2:25 pm, V1 (Administrator) stated the following, We do not have Sexual Assessment forms that I know of. I would expect for the sexual act between Resident R14 and V20 to be documented. If someone is restricted from the facility. It is expected that staff document the ban in the resident's chart and at the front desk and nurse's stations.Resident R14's Care Plan dated 10/03/25 documents, Resident R14 is at risk for abuse related to cognitive impairment and diagnosis of dementia; Resident R14 has an ADL (Activity of Daily Living) Functional deficit related to dementia, impaired cognition, incomplete performances and periods of confusion. Resident R14's Memory Care Initial assessment dated [DATE REDACTED] documents the following; Resident R14 is only oriented to person (knows self); Resident R14 is not oriented to place, time or situation (does not know where he is, does not know why

he is here, and does not know the current day/ month); Resident R14 has short-term and long-term memory problems.Resident R14's Care Plan and Memory Care Assessments were last updated on 10/03/2025.The Initial Investigation report was faxed to IDPH on 11/19/25 at 2:24 pm and documents an allegation of sexual abuse involving Resident R14 and V20.The Initial Investigation report was faxed to IDPH on 11/20/25 at 5:49 pm and documents an allegation of financial abuse involving Resident R14 and V20.Resident R14's Physician Order Sheet, Care Plan, Face sheet, and Medical Record exclude any orders regarding V20's visitation restrictions.Facility Abuse policy documents the following: This facility affirms the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment and involuntary seclusion; the facility will report reasonable suspicion of a crime; the purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect or abuse of our residents. This is done by immediately protecting residents involved in identifying reports possible abuse; implementing systems to investigate all reports and allegations of mistreatment promptly and aggressively, and making the necessary changes to prevent future occurrences.Facility Abuse policy excludes verbiage related to assessing the sexual activity or capacity for sexual consent in residents with cognitive impairment. Facility Visitation policy documents, the facility permits visitation at all times and will not restrict visitation without a reasonable clinical necessity or safety restriction.Facility Visitation policy excludes any protocol or required documentation regarding visitors' restrictions and abuse.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wentworth Rehab & Hcc

201 West 69th Street Chicago, IL 60621

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to report allegations of sexual and financial abuse involving one resident Resident R14. This failure has the potential to affect 191 residents that reside at the facility.Based on interviews and record review, the facility failed to report allegations of sexual and financial abuse involving one resident Resident R14. This failure has the potential to affect 191 residents that reside at the facility.Findings include:Resident R14 is [AGE] year old with diagnosis including but not limited to: Alzheimer's disease, moderate dementia, essential hypertension, type 2 diabetes mellitus without complications and benign prostatic hyperplasia with lower urinary tract symptoms. Resident R14's BIMS (Brief Interview for Mental Status) dated 10/3/25 resulted in a score of 7, which indicates severe cognitive impairment. On 11/19/25 at 11:14 am, V1 (Administrator) stated the following, V18 (Memory Care Director) informed me that a CNA (Certified Nurse Assistant) had reported to her (V18), that Resident R14 was observed in his room with his visitor (V20) without clothes and engaging in sexual intercourse sometime last month. We did our investigation by asking Resident R14 if

he consented to the sexual act and he said yes. Just because he (Resident R14) has dementia doesn't mean that he lost his desire to have sex. However, we have banned V20 from visiting Resident R14 at this time per Resident R14's family request. V23 (Resident R14's family) did not want V20 visiting Resident R14 because she felt that there was some financial abuse going on. On 11/19/25 at 1:50 pm, V18 (Memory Care Director) stated the following, After the alleged sexual act, I assessed to see if (Resident R14) was in distress. I also asked Resident R14 about what happened and

he (Resident R14) stated that it was consensual sex. I notified V1 via telephone about the sexual incident, also that Resident R14's family (V23) was concerned about possible financial abuse. Resident R14's family had made me aware on 11/1/25, that she was concerned with V20 possibly taking advantage of Resident R14 and receiving money from him.

V20 was restricted from visiting Resident R14. The block was for safety reasons, for possible financial abuse. I (V18) didn't document that V20 was banned, I just added him to the list at the front desk. I didn't document the sexual incident that occurred on 11/1/25, but I had planned to document and forgot.On 11/24/25 at 2:25 pm, V1 (Administrator) stated the following, I did not report the incident between Resident R14 and his friend (V20) because he (Resident R14) stated that the sex was consensual. I didn't report the suspected financial abuse because V20's visiting privileges were banned.Resident R14's Care Plan dated 10/03/25 documents, Resident R14 is at risk for abuse related to cognitive impairment and diagnosis of dementia; Resident R14 has an ADL (Activity of Daily Living) Functional deficit related to dementia, impaired cognition, incomplete performances and periods of confusion. The Initial Investigation report was faxed to IDPH on 11/19/25 at 2:24 pm and documents an allegation of sexual abuse involving Resident R14 and V20.The Initial Investigation report was faxed to IDPH on 11/20/25 at 5:49 pm and documents an allegation of financial abuse involving Resident R14 and V20.Facility Census dated 11/17/25 documents 191 residents.Facility Abuse policy documents the following: This facility affirms

the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment and involuntary seclusion; the facility will report reasonable suspicion of a crime; the purpose of

this policy is to assure that the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect or abuse of our residents. This is done by immediately protecting residents involved

in identifying reports possible abuse; implementing systems to investigate all reports and allegations of mistreatment promptly and aggressively, and making the necessary changes to prevent future occurrences; filing accurate and timely investigative reports.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wentworth Rehab & Hcc

201 West 69th Street Chicago, IL 60621

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 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to conduct investigations for allegations of financial and sexual abuse for one resident Resident R14 in a sample of five reviewed for abuse. This failure has the potential to affect 191 residents that reside at the facility.Findings include:Resident R14 is [AGE] year-old with diagnosis including but not limited to: Alzheimer's disease, moderate dementia, essential hypertension, type 2 diabetes mellitus without complications and benign prostatic hyperplasia with lower urinary tract symptoms. Resident R14's BIMS (Brief Interview for Mental Status) dated 9/26/25 resulted in a score of 6, which indicates severe cognitive impairment. Resident R14's BIMS (Brief Interview for Mental Status) dated 10/3/25 resulted in a score of 7, which indicates severe cognitive impairment. On 11/19/25 at 11:14 am, V1 (Administrator) stated the following, V18 (Memory Care Director) informed me that a CNA (Certified Nurse Assistant) had reported to her (V18), that Resident R14 was observed in his room with his visitor (V20) without clothes and engaging in sexual intercourse sometime last month. We did our investigation by asking Resident R14 if he consented to the sexual act and he said yes. Just because he (Resident R14) has dementia doesn't mean that he lost his desire to have sex. However, we have banned V20 from visiting Resident R14 at this time per Resident R14's family's request. V23 (Resident R14's family) did not want V20 visiting Resident R14 because she felt that there was some financial abuse going on. On 11/19/25 at 1:50 pm, V18 (Memory Care Director) stated the following, After the alleged sexual act, I assessed to see if (Resident R14) was in distress. I also asked Resident R14 about what happened and

he (Resident R14) stated that it was consensual sex. I notified V1 via telephone about the sexual incident, also that Resident R14's family (V23) was concerned about possible financial abuse. Resident R14's family had made me aware on 11/1/25, that she was concerned with V20 possibly taking advantage of Resident R14 and receiving money from him.

V20 was restricted from visiting Resident R14. The block was for safety reasons, for possible financial abuse. I (V18) didn't document that V20 was banned, I just added him to the list at the front desk. I didn't document the sexual incident that occurred on 11/1/25, but I had planned to document and forgot.On 11/24/25 at 2:25 pm, V1 (Administrator) stated the following, Investigations should be documented via progress note or incident report in order to keep a written documentation of keeping track of what transpired. I would expect for the sexual act between Resident R14 and V20 to be documented.Resident R14's Care Plan dated 10/03/25 documents, Resident R14 is at risk for abuse related to cognitive impairment and diagnosis of dementia; Resident R14 has an ADL (Activity of Daily Living) Functional deficit related to dementia, impaired cognition, incomplete performances and periods of confusion. Resident R14's Medical Record excludes any investigation or documentation regarding the sexual incident on 11/1/25.The Initial Investigation report was faxed to IDPH on 11/19/25 at 2:24 pm and documents an allegation of sexual abuse involving Resident R14 and V20.The Initial Investigation report was faxed to IDPH on 11/20/25 at 5:49 pm and documents an allegation of financial abuse involving Resident R14 and V20.Facility Census dated 11/17/25 documents 191 residents.Facility Abuse policy documents the following: This facility affirms the right of our residents to be free from abuse, neglect, misappropriation of resident property, corporal punishment and involuntary seclusion; the purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of mistreatment, neglect or abuse of our residents. This is done by immediately protecting residents involved in identifying reports possible abuse; implementing systems to investigate all reports and allegations of mistreatment promptly and aggressively, and making the necessary changes to prevent future occurrences; employees are required to immediately report any occurrences of potential mistreatment they observe, hear about, or suspect to a supervisor or administrator; upon learning of the report, the administrator or designee shall initiate and incident investigation.

Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet