Evercare at University: Sexual Assault Unreported to Police - IL
The complaint that triggered a federal inspection of Evercare at University came from an outside caller who told investigators that sexual assaults were happening inside the facility and that administrators were not reporting them to police. The caller knew the name of the victim, a resident identified in inspection records as R2. The caller did not know the name of the person doing it. What the caller knew was that the facility knew, and that nothing was happening.
Inspectors arrived on October 21, 2025. What they found confirmed the core of what the caller had described.
Surveillance footage from October 6, 2025, showed a male resident identified as R3 wheeling himself down a hallway and turning into R2's room at 8:59 in the morning. Five minutes later, at 9:04, he wheeled himself back out. In between, a staff member identified as V7 had entered the room and found him there.
R3 was not in his wheelchair when V7 walked in. He was out of his chair and lying in bed with R2.
A staff member identified as V18, who responded when V7 called for help, described what the room looked like. R2 was lying on her left side, facing the wall. She had shaving cream on her right buttock. V18 said R3 still had shaving cream on him as well, and that as staff entered, he said: "You stopped me before I started."
That sentence, recorded in the inspection report, is the only thing R3 is quoted as saying. It implies this was not the first time he had tried.
V1, identified in the report as a facility official who had been made aware of the incident, confirmed to inspectors that it had occurred. V1 showed them the surveillance footage. The video was there. The staff accounts were there. The physical evidence, shaving cream on a woman lying in her bed with a man who had wheeled himself uninvited into her room, was there.
What was not there was a police report.
The facility's own written abuse prevention policy, last reviewed on June 1, 2025, runs through language that would be familiar at any nursing home. Zero tolerance for abuse. Every resident has the right to be free from sexual abuse. Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse. The administrator is personally responsible for coordinating and implementing the abuse prevention program. The facility promptly and thoroughly investigates reports of abuse.
The policy was four months old when R3 wheeled into R2's room.
Federal inspectors cited the facility at the F0607 level, which covers a facility's obligation to protect residents from abuse and to report and investigate abuse allegations. The citation was tagged at "Actual Harm," meaning inspectors determined that what happened to R2 was not a near-miss or a paperwork failure. It was harm that occurred to a real person.
The "Residents Affected" designation in the report reads "Few," which in CMS inspection language means between one and two residents.
What the inspection report does not say is what happened to R2 after V7 and V18 found her that morning. It does not say whether she was examined, whether she was asked what she wanted, whether anyone sat with her, whether she understood what had happened or was able to communicate about it. It does not say what R3's history at the facility looked like, or whether there had been prior incidents involving him, or what the phrase "you stopped me before I started" was understood to mean by the staff who heard it.
It does not say whether police were ever called after inspectors arrived.
The facility's policy says the administrator is responsible for coordinating the abuse prevention program. The inspection report does not name the administrator. It does not quote them. It records that V1, a facility official, was aware of the incident and showed inspectors the surveillance footage. Whether V1 is the administrator, a supervisor, or someone else in the chain of command, the report does not specify.
What the report makes clear is that the system designed to protect R2 did not protect her. A man entered her room. He got into her bed. He had shaving cream on his hands. Staff found him there and he told them they had stopped him before he started, and the facility's response, in the days between October 6 and October 21 when inspectors arrived, did not include a call to police.
It took an outside caller, someone who knew enough to be alarmed and knew enough to go outside the facility to say so, to put federal inspectors in that building.
The caller told investigators the facility administrators were not doing anything about the incidents. Plural. Incidents, not incident.
The inspection report does not elaborate on that. It documents October 6. It documents the footage, the shaving cream, the statement, the failure to report. It does not say how many times something may have happened before that morning, or how many times R3 had wheeled down that hallway, or whether R2's room had ever been flagged as a place that needed watching.
What it says is that on the morning of October 6, 2025, R2 was lying on her left side facing the wall of her room, and a man was in her bed, and she had shaving cream on her body, and the people responsible for her safety had known about it for two weeks before anyone with federal authority walked through the door.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Evercare At University from 2025-10-21 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 24, 2026 · Our methodology
EVERCARE AT UNIVERSITY in EDWARDSVILLE, IL was cited for violations during a health inspection on October 21, 2025.
The caller knew the name of the victim, a resident identified in inspection records as R2.
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.