Aperion Care West Chicago

F 0600

includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment

Level of Harm - Actual harm Residents Affected - Few

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

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care West Chicago

201 West North Avenue West Chicago, IL 60185

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

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to identify abuse, investigate an incident of resident-to-resident abuse, implement interventions to prevent further recurrence, and report the incident. This applies to 2 of 2 residents (Resident R131 and Resident R200) reviewed for abuse in a sample of 38. The findings include: On 1/27/2026 at 10:37 AM, Resident R131 was observed sitting in bed, holding his left shoulder and wincing in pain. Resident R131 stated he was experiencing severe left shoulder pain that began on 1/18/2026 when

he was physically attacked by Resident R200. According to Resident R131, Resident R200 suddenly charged at him, grabbed him, and placed both arms around his upper torso, putting him in a headlock. On 1/28/2026 at 3:12 PM, V1 (Administrator/Abuse Coordinator) stated he had reviewed the facility's security camera footage from 1/18/2026 and confirmed he was made aware of the incident that night. V1 described the footage showed Resident R200 approaching Resident R131 from behind and placing both arms around his upper torso. V1 stated he did not report the incident to the Illinois Department of Public Health (IDPH) at that time because he did not believe

it met the facility's definition of abuse, reasoning there was no serious injury, bodily harm, or psychosocial effects. V1 further acknowledged the incident was not reported to IDPH until 1/27/2026, nine days later. He indicated an internal investigation had not yet been conducted but would be initiated. Requests for staff statements, interviews and/or any other documentation related to the incident (including incident reports), had been made; however, the facility was not able to provide any of these records prior to the end of the survey. Review of Resident R131's EMR (Electronic Medical Record) shows following the 1/18/2026 incident, Resident R131 did not have new care plan interventions or protective measures initiated to address the outcomes of the incident, including severe left shoulder pain and psychosocial distress (which he verbalized experiencing on 1/29/2026 at 12:45 PM). Resident R131's care plan had not been updated following the incident. Care plan sections related to abuse (created 1/29/2026) and psychosocial wellbeing, including mood triggers (created 1/27/2026), were added only during the survey. Review of Resident R200's EMR shows diagnoses including anxiety disorder, insomnia, schizophrenia, and schizoaffective disorder. Resident R200's care plan had not been updated

after the incident involving Resident R131. Care plan sections related to mood triggers (created 1/30/2026), abuse (created 1/28/2026), behaviors (created 1/28/2026), and physical and verbal aggression (created 1/28/2026) were added during the survey. The facility's policy titled Abuse and Retaliation Prevention and Reporting (effective 1/8/2026) states The purpose of this policy is to ensure that the facility is doing all that is within its control to prevent occurrences of abuse.and mistreatment of residents This will be done by: identifying occurrences and patterns of potential mistreatment immediately protecting residents involved in identified reports of possible abuse .implementing systems to promptly and aggressively investigate all reports and allegations of abuse .and making necessary changes to prevent future occurrences .filing accurate and timely investigative reports The policy further states: Any allegation of abuse, retaliation, or any accident resulting in serious bodily injury be reported to IDPH immediately, but no more than two hours

after the allegation, [and that] any incident that does not involve abuse and does not result in serious bodily injury shall be reported within 24 hours. Residents who allegedly abused another resident shall be immediately evaluated to determine the most suitable therapy, care approaches, and placement considering his or her safety, as well as the safety of other residents and employees of the facility. In addition, the facility shall take all steps necessary to ensure the safety of residents.

Residents Affected - Few

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

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care West Chicago

201 West North Avenue West Chicago, IL 60185

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

Based on observation, interview, and record review, the facility failed to conduct a thorough investigation of physical abuse between 2 residents. This applies to 2 of 2 residents (Resident R131 and Resident R200) reviewed for abuse in

a sample of 38. The findings include: On 1/27/2026 at 10:37 AM, Resident R131 was observed sitting in bed, holding his left shoulder and wincing in pain. Resident R131 stated he was experiencing severe left shoulder pain that began

on 1/18/2026 when he was physically attacked by Resident R200. According to Resident R131, Resident R200 suddenly charged at him, grabbed him, and placed both arms around his upper torso, putting him in a headlock. On 1/28/2026 at 3:12 PM, V1 (Administrator/Abuse Coordinator) stated he reviewed security camera footage from 1/18/2026 and confirmed awareness of the incident that night. V1 stated he did not report the incident to IDPH (Illinois Department of Public Health) at that time because he did not believe it met the definition of abuse, reasoning there was no serious injury, bodily harm, or psychosocial effects. V1 further acknowledged the incident was not reported to IDPH until 1/27/2026. Review of V1's Initial Report to IDPH regarding the physical altercation involving Resident R131 and Resident R200 included a fax confirmation sheet indicating it was sent on 1/27/2026 at 2:59 PM. The report confirmed a date of occurrence of 1/18/2026 and stated the incident category as Resident Abuse. The reported also stated, Facility will conduct a thorough investigation with complete report to follow, indicating an investigation had been initiated 9 days later. The facility's policy titled Abuse and Retaliation Prevention and Reporting (effective 1/8/2026) states, The purpose of this policy is to ensure that the facility is doing all that is within its control to prevent occurrences of abuse.and mistreatment of residents. The policy also states: All incidents will be documented, whether or not abuse, neglect.was alleged or suspected as any incident or allegation involving abuse. will result in an investigation and that upon learning of the report, the administrator or designee shall initiate an incident investigation.

Investigation Procedures: The appointed investigator will, at a minimum, attempt to interview the person who reported the incident, anyone likely to have direct knowledge of the incident, and the resident, if interviewable. Any written statements that have been submitted will be reviewed, along with any pertinent medical record or other documents.

Residents Affected - Few

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

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care West Chicago

201 West North Avenue West Chicago, IL 60185

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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

that the pain was not relieved by Resident R131's current pain regimen, adding she would ask about an Occupational Therapy (OT) evaluation. On 1/30/2026 at 10:14 AM, V2 (DON) stated her expectation is for nursing staff to assess residents' pain levels, including determining whether the pain is new and whether it is relieved by current interventions. V2 further stated any pain rated above 6 out of 10 on the pain scale is considered severe and requires immediate action. She explained if the current medications are insufficient, nursing staff are expected to offer available PRN (as needed) medications as appropriate and notify the provider. The facility's policy titled Pain Management Program (Revised 7/6/2018) states the purpose of the policy is to establish a plan to manage pain in order to reduce adverse physiologic and psychological effects of unrelieved pain and to develop an optimal pain management plan to enhance healing and promote physiological and psychological wellness. The policy further outlines that the pain management program includes the following components:Documentation of pain assessment and ongoing monitoring;Informed resident participation in care decisions, including decisions related to pain management;Recognition of pain as the fifth vital sign, along with temperature, pulse, respiration, and blood pressure. The facility's policy also specifies that the pain assessment protocol must be initiated whenever there is a change in the resident's condition that requires pain control or when there is a change

in the identification of pain. Per policy, care plans must be reviewed and updated whenever the resident's pain management plan is found to be ineffective and at least during each quarterly care conference. Lastly,

the policy requires documentation of the resident's response to the pain management plan to ensure ongoing evaluation and effectiveness.

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care West Chicago

201 West North Avenue West Chicago, IL 60185

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 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to serve meals at palatable temperatures.This applies to all residents who receive food from the kitchen.The findings include:The CMS (Centers for Medicare and Medicaid Services) shows the survey start date of 1/27/26 and a resident census of 211. On 01/30/2026 at 2:39 PM, V2, DON (Director of Nursing), confirmed all residents residing

in the facility at the time of survey start on 01/27/26 receive services from the Dietary department.On 01/27/2026 at 12:19 PM during the dining observation, Resident R118 stated the food isn't always served to them while it is hot.Resident R207 stated the food served is usually barely warm.Resident R100 stated the meals are usually not served hot.On 01/27/2026 at 12:51 PM, Resident R40 stated the food isn't usually served hot. Resident R40 stated she will request staff to reheat her food, but she is told they can't reheat if for her. Resident R40 stated staff will not get her a new tray from the kitchen, so she must eat it cold.On 01/28/2026 at 12:23 PM, food holding temperatures were done with V4, Dietary Director and V39 Cook. The following foods were noted held in degrees Fahrenheit (F): Broccoli- 100 degrees FSweet and Sour Pork carbohydrate-controlled Low Concentrated Sweets- 95 degrees FPlain Rice- 100 degrees FGrilled Cheese Sandwiches- 90 degrees FPureed Grilled Cheese- 120 degrees FCarrots- 120 degrees FPureed Broccoli- 120 degrees F On 01/27/2026 at 1:05 PM,

the test tray sent to the conference room had two cookies, chili in a bowl, carrots, and crumbly corn bread

on a Styrofoam plate.On 01/28/2026 at 12:23 PM, V4, Dietary Director, stated because of budget constraints, he is unable to purchase real plates, so the residents' meals are served on Styrofoam. V4 stated Styrofoam impacts how food temperatures are maintained. V4 stated there is no plate warmer and

the delivery carts are not insulated, which also makes it difficult to maintain food temperatures. V4 stated there have been occasions he has gone to the units and meal trays are left unpassed up 20 minutes after being sent from the kitchen.The facility provided an undated policy which stated foods that are meant to be served and displayed for a long time require elevated temperatures for storage. Foods are held at 135 degrees F or above to stop the growth of harmful microorganisms and preserve food safety

Residents Affected - Many

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

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Aperion Care West Chicago

201 West North Avenue West Chicago, IL 60185

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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

request logs for the call lights. The facility's untitled document, dated 1/26/2026, said staff rounded every 30 minutes on 1/26/2026 from 3 PM-6 PM. The document does not provide information regarding the type of rounds completed and for which residents. The document also does not show further entry logs from when

the call light system stopped working again on the evening of 1/26/2026 through the morning of 1/27/2026.The facility's Daily Census report, dated 1/27/2026, showed Resident R102, Resident R6, Resident R156, Resident R103, Resident R77, Resident R47, Resident R202, Resident R4, Resident R206, Resident R13, Resident R209, Resident R171, Resident R96, Resident R108, Resident R177, Resident R52, Resident R24, Resident R25, Resident R31, Resident R44, Resident R8, Resident R19, Resident R109, Resident R183, Resident R10, Resident R90, Resident R113, and Resident R210 resided in the hall with the faulty call light system.The facility's policy titled Call Light, dated 2/2/2018, said the facility was to respond to residents' requests and needs in a timely and courteous manner. If needed, hand bells will be provided for alert dependent residents when positioned out of reach of the permanent call light when needed. Call bell system defects will be reported promptly to the Maintenance Department for servicing, and room checks will be done until the system is repaired.

Event ID:

Facility ID:

If continuation sheet