Ryze At Homewood

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

important predictor of risk for future falls. The fall may be witnessed, reported by the resident or an observer or identified when a resident is found on the floor or ground. Record review of CMS's RAI (Resident Assessment Instrument) Chapter 4: CAA Process and Care Planning, dated [DATE REDACTED], documents, in part, A fall refers to unintentionally coming to rest on the ground, floor, or other lower level but not as a result of an external force (e.g., being pushed by another resident). A fall without injury is still a fall. Falls are a leading cause of morbidity and mortality among the elderly, including nursing home residents.Facility policy titled, Fall Prevention and Management, dated 7/2025, documents, This facility is committed to maximizing each resident's physical, mental, and psychosocial well-being. While preventing falls is not possible, the facility will identify and evaluate those residents at risk for falls, plan for preventative strategies, and facilitate as safe an environment as possible. All residents shall be reviewed, and the residents existing plan of care shall be evaluated and modified as needed. A fill risk assessment is completed on admission, readmission, and quarterly, significant change and after each fall. Residents at risk for falls will have fall risk identified on

the interim plan of care with interventions implemented to minimize fall risk.Review of pamphlet titled, RESIDENTS' RIGHTS' For People In Long-Term Care facilities, revised date 11/18, documents, Your facility must treat you with dignity and respect and must care for you in a manner that promotes your quality of life.

Your facility must provide equal access to quality care regardless of diagnosis. You must not be abused, neglected, or exploited by anyone - financially, physically, verbally, mentally, or sexually. Your facility must be safe, clean, comfortable, and homelike. You may participate in developing a person-centered care plan which states all the services your facility will provide to you and everything you are expected to do. This plan must include your personal and cultural choices. Your facility must make reasonable arrangements to meet your needs and choices. You should receive the services and/or items included in the plan of care.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ryze at Homewood

19000 South Halsted Homewood, IL 60430

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

residents existing plan of care shall be evaluated and modified as needed. A fill risk assessment is completed on admission, readmission, and quarterly, significant change and after each fall. Residents at risk for falls will have fall risk identified on the interim plan of care with interventions implemented to minimize fall risk.Review of pamphlet titled, RESIDENTS' RIGHTS' For People in Long-Term Care facilities, revised date 11/18, documents, Your facility must treat you with dignity and respect and must care for you in

a manner that promotes your quality of life. Your facility must provide equal access to quality care regardless of diagnosis. You must not be abused, neglected, or exploited by anyone - financially, physically, verbally, mentally, or sexually. Your facility must be safe, clean, comfortable, and homelike. You may participate in developing a person-centered care plan which states all the services your facility will provide to you and everything you are expected to do. This plan must include your personal and cultural choices.

Your facility must make reasonable arrangements to meet your needs and choices. You should receive the services and/or items included in the plan of care.

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

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ryze at Homewood

19000 South Halsted Homewood, IL 60430

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

passes will be restricted for 30 Days. Passes will be reinstated at the discretion of the Administration Team.2. The resident will be suspended from the day program (as applicable) at the discretion of the Administration Team. After two weeks, the Administration Team will assess if the resident is ready to return to the day program.3. Home passes with family will be restricted at the discretion of the administration. After two weeks, the administration team will assess the resident's progress to determine if the resident is appropriate to go home with family.4. The resident will be placed on a behavior contract coinciding with their specific substance abuse issues and treatment plan.Resident Signature/date:Staff/Witness Signature/Date

The Immediate Jeopardy that began on 09/19/25 was removed on 12/30/2025 when the facility took the following actions to remove the immediacy. On 12/30/25 the survey team verified by observation, interview, and record review, that the facility implemented the following to remove the immediacy.1. Regional Director of Operations in-serviced the Administrator, V1, regarding the facility's Resident Possession & Use Policy

on 12/23/2025 and the Illicit Drug Use Program. The Administrator will be responsible for overseeing the Social Service Director, in ensuring all residents identified with a history of substance abuse and drug seeking behaviors are closely monitored with appropriate and effective interventions.The Regional Nurse Consultant in-serviced the Director of Nursing, regarding the facility's Resident Possession & Use Policy on 12/23/2025 and also the Illicit Drug Use Program. The Director of Nursing will be responsible for overseeing nursing staff in ensuring all residents identified with a history of substance abuse and drug seeking behaviors are closely monit[TRUNCATED]

Event ID:

Facility ID:

If continuation sheet