Evercare at Edwardsville: Nurse Staffing Cut Delays Meds - IL
The issue was medication. Specifically, the fact that residents at the 100-bed facility were waiting until after 11 o'clock at night to receive medications scheduled for the evening shift. The Resident Council Memorandum from August 4th documented the complaint plainly: "waiting till after 11 PM for meds. Residents getting very upset about it."
The Director of Nursing was aware of the problem. Her response, recorded in those same minutes, was that she would review staffing with the administrator and the owner to see if a fourth nurse could be added to the evening shift until 10 PM.
A month later, at the September 8th council meeting, residents were still raising the same complaint. Meds were still not arriving on time. Nurses were getting angry at night. Call lights weren't being answered.
Nothing had changed.
Federal inspectors arrived at the facility on September 16th and spent the early morning hours interviewing nurses coming off the overnight shift. What they heard was consistent, and it pointed in one direction.
A licensed practical nurse identified in the report as V15 told inspectors it was "rough with just 3 nurses," that medications were sometimes late, and that the three nurses on the evening shift had to share a single medication cart for D hall because residents were divided among all three of them. V15 said the owner had cut the fourth nurse from the 6 PM to 10 PM window to save money.
Another LPN, V16, interviewed at 5:25 AM, said the same thing. Four nurses used to work that shift. The owner cut one. Resident 12, she said, had complained about her medications being late.
V17, a third LPN, spoke to inspectors five minutes later. "They really need 4 nurses for the 6 PM to 10 PM med pass to ensure quality of care," the nurse said.
The wound care nurse, interviewed at 6:10 AM, said three nurses from 6 PM to 10 PM was not enough.
When inspectors sat down with the administrator at 7:37 AM, she confirmed that residents had raised the medication delay issue at the most recent Resident Council meeting. She told inspectors she expected nurses to sign off on medications at the time they were administered. When the surveyor asked whether she believed medications were administered late when nurses charted them as late, she said yes.
The Director of Nursing, interviewed at 9:27 AM, acknowledged it was difficult for three nurses to complete all tasks during that four-hour window.
The facility's own staffing policy states that Evercare Skilled Nursing LLC will provide sufficient nursing staff on each shift to attain or maintain the highest practical physical, mental, and psychosocial well-being of each resident, and that staffing levels will be calculated based on resident census and needs.
On the day inspectors arrived, there were 100 residents in the building.
The inspection, a complaint survey, cited the facility under F0725, covering sufficient nursing staff, with a finding of minimal harm or potential for actual harm affecting some residents. That designation reflects the regulatory floor for the citation, not the ceiling of what residents described. A person waiting past 11 PM for a scheduled medication is not, by any ordinary measure, receiving their medication on time. Multiple people waiting, night after night, while their nurses share a single cart across an entire hall, is something the facility's own director of nursing had been aware of since at least early August.
Resident 12 had been complaining about her medications being late. The nurses said they needed four people to do the job safely. The owner had decided three was enough.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Evercare At Edwardsville from 2025-09-16 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 28, 2026 · Our methodology
EVERCARE AT EDWARDSVILLE in EDWARDSVILLE, IL was cited for violations during a health inspection on September 16, 2025.
The Resident Council Memorandum from August 4th documented the complaint plainly: "waiting till after 11 PM for meds.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.