Aliya Of Oak Lawn

F 0600 Level of Harm - Actual harm Residents Affected - Few

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

laying down, Resident R2 entered Resident R1's room in a wheelchair. Resident R1 rolled his wheelchair next to Resident R1's bed and came to

a stop. Resident R2 then stood up and opened Resident R1's diaper. Resident R1 related that Resident R2 placed his right hand in Resident R1's adult brief and began to groan. Resident R1 does not have any sense of feeling below the waist and did not know exactly what Resident R2 was doing to his genitals. Resident R1 began to call for a nurse while Resident R2 was moving his hand around Resident R1's genitals. Resident R3 entered the room and began to shout at Resident R2 to stop. Abuse policy dated 10/2022 documents:

The facility affirms the right of our residents to be free from abuse, neglect or exploitation. Sexual abuse includes but is not limited to sexual harassment, sexual coercion or sexual assault including non-consensual or non-competent to consent sexual activity.

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

08/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aliya of Oak Lawn

6300 West 95th Street Oak Lawn, IL 60453

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 - Few

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

8/18/25. V5 said, Resident R1 reported, that Resident R2 touch his butt hole. Facility reportable date of the incident 8/19/25 documents: Time of incident: 2:30pm: Sexual: Describe Alleged Incident: Nurse Practitioner who reported

the resident, Resident R1 reports to her that another resident (Resident R2) was sexually inappropriate towards him, Hospital Paperwork dated 8/19/25 documents: Patient (Resident R1) present to emergency department for evaluation after an assault. Emergency Department diagnoses: Sexual assault of adult.Police report dated 8/19/25 documents: office responded to nursing home in regard to a criminal sexual abuse report. Resident R1 was lying in bed alone.

While laying down, Resident R2 entered Resident R1's room in a wheelchair. Resident R1 rolled his wheelchair next to Resident R1's bed and came to a stop. Resident R2 then stood up and opened Resident R1's diaper. Resident R1 related that Resident R2 placed his right hand in Resident R1's adult brief and began to groan. Resident R1 does not have any sense of feeling below the waist and did not know exactly what Resident R2 was doing to his genitals. Resident R1 began to call for a nurse while Resident R2 was moving his hand around Resident R1's genitals. Resident R3 entered the room and began to shout at Resident R2 to stop. Abuse policy dated 10/2022 documents: Internal reporting requirement and identification of allegations. Employee are required to report any incident, allegation or suspicion of potential abuse, neglect, exploitation, mistreatment or misappropriation of resident property they observed, hear about, or suspect to the administrator or the compliance officer. In the absence of the administrator, reporting can be made to an individual who has been designated to act in the administrator's absence. Any allegation of abuse or any incident that results in serious bodily injury will be reported to Illinois Department of Public Health immediately, but not more than two hours after the allegation of abuse. Any incident that does not involve abuse and does not result in serious bodily injury shall be reported with in twenty-four hours.

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

08/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aliya of Oak Lawn

6300 West 95th Street Oak Lawn, IL 60453

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

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

being petitioned to the hospital for inappropriate sexual behavior towards his peer. On 8/20/25 at 2:31pm, V3 (nurse practitioner) said, she was informed on Monday 8/18/25 that another resident touched Resident R1. V3 said, she saw Resident R1 on Tuesday. V3 said, Resident R1 reported Resident R2 lifted his gown and grabbed his penis. Resident R1 reported

he can't get erect because he is parlayed. Resident R1 said, he was not gay. Resident R1 was crying. V3 said, she suggested Resident R1 go to the hospital. On 8/20/25 at 12:39pm, V8 (cna) said, she heard Resident R3 telling Resident R2 to get out of Resident R1's room. Resident R1 is contracted with his hands stuck behind his head. Resident R1's legs are contracted opened. V8 said, Resident R1 is dependent on staff for assistance. Resident R2 is a wander. Resident R2 should not have been in Resident R1's room. Hospital Paperwork dated 8/19/25 documents: Patient (Resident R1) present to emergency department for evaluation after an assault. Resident R1 does not feel safe. Emergency Department diagnoses: Sexual assault of adult. Per emergency service: Resident R1 was manually grouped by another resident, allegedly witness by another resident. (8/21/25) Case manager spoke with patient (Resident R1) at bedside who was alert and orient time four declined to discharge to long term care facility, states he just left a facility where he was molested. Police report dated 8/19/25 documents: office responded to nursing home in regard to a criminal sexual abuse report. Resident R1 was lying in bed alone. While laying down, Resident R2 entered Resident R1's room in a wheelchair. Resident R1 rolled his wheelchair next to Resident R1's bed and came to a stop. Resident R2 then stood up and opened Resident R1's diaper. Resident R1 related that Resident R2 placed his right hand

in Resident R1's adult brief and began to groan. Resident R1 does not have any sense of feeling below the waist and did not know exactly what Resident R2 was doing to his genitals. Resident R1 began to call for a nurse while Resident R2 was moving his hand around Resident R1's genitals. Resident R3 entered the room and began to shout at Resident R2 to stop.

Event ID:

Facility ID:

If continuation sheet