Nexus At Alton

ordered and would be documented on the TAR or in the progress notes.The Abuse Prevention

abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents.

Neglect

resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

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Nexus at Alton 3523 Wickenhauser Alton, IL 62002

underneath her right breast. (V26) advised the right side of (R2's) body near her injuries was cold to

advised during her assessment, although (R2) is nonverbal, she noticed (R2) to be in excruciating pain

Registered Nurse (RN), stated she was asked by a CNA if she was aware of R2's shoulder and chest area being swollen. V26 stated she did not see anything noted in R2's report sheets or nurses notes.

V26 stated when she assessed R2, she noticed a large, raised area under R2's breast and bruising with discoloration to R2's arm and under arm, V26 stated she does not remember what side of R2's body this was on. V26 stated she was not informed of any bruising of discoloration when she received report on R2. V26 stated she called V1, Administrator, regarding the bruising and V1 stated she was not aware. V26 stated V1 informed V26 to start an investigation and interview staff. V26 stated the local police department was notified and R2 was sent to the local hospital for evaluation.On 5/28/26 at 12:18 PM V30, RN, stated she noticed some bruising on the night of 5/10/26 when she worked with R2. V30 stated she observed bruising under R2's right arm by R2's breast, to the top and middle of R2's right breast that extended to R2's left breast. V30 stated the worst bruise was on R2's right side and it extended to R2's bend of her arm. V30 stated the bruises were green and yellow in color, in different stages of healing, and looked as though they had been there awhile. V30 stated she is not sure if she documented the bruising and if she did not, she meant to. V30 stated she did not report the bruising to V1, Administrator, because she assumed another staff member already did.On 5/28/26 at 2:03 PM V24, CNA, stated she was not working on R2's hall on the night of 5/10/26, but remembers V30 coming to the nurse's station showing pictures of bruises on R2. V24 stated V30 asked if any staff knew of the bruises on R2 and no staff members were aware. V24 stated she asked V30 what the next step was regarding the bruises and V30 mentioned contacting V1. V24 stated she knows staff is supposed to report any bruising or injuries to V1 immediately, but she was not going to tell V30 what to do, since V30 is the nurse and was in charge. V24 stated V30 did not report the bruises to V1 that night.On 5/28/26 at 4:00 PM V1 stated allegations of abuse, neglect, or injuries of unknown origin, are to be reported to her immediately.On 5/29/26 at 9:16 AM V1, Administrator, stated she was first notified of the bruising to R2 on 5/13/26. V1 stated she expects her staff to follow the facility policy on reporting any allegation of abuse, neglect, or injury of unknown origin. V1 stated she was not aware of any staff member noticing the bruising on R2 on 5/10/26, and if she was notified then, she would have reported it right away.The Facility's Abuse Prevention Program Date Reviewed 9/2017 documents Policy: This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property or mistreatment.

Internal Reporting Requirement and Identification of Allegations: Employees are required to report any incident, allegation or suspicion of potential abuse, exploitation, mistreatment or misappropriation of resident property they observe, hear about, or suspect to the administrator immediately, to an immediate supervisor who must then immediately report it to the administrator or to a compliance hotline or compliance officer.

The nursing staff is responsible for reporting the appearance of suspicious bruises, lacerations, or other abnormalities of an unknown origin as soon as it is discovered.

The report is to be documented on a facility incident report and provided to the nursing supervisor, administrator or designated individual.

Following the discovery of any suspicious bruises, lacerations, or other abnormalities of unknown source the nurse shall complete a full assessment of the resident for other bruises, laceration, or pain.

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Nexus at Alton 3523 Wickenhauser Alton, IL 62002

armpit, and purple bruising down her side and underneath her right breast. (V26) advised the right side

side were much weaker than the left. (V26) advised during her assessment, although (R2) is

right extremities.On 5/27/26 at 11:10 AM V26, Registered Nurse (RN), stated she was asked by a CNA if she was aware of R2's shoulder and chest area being swollen. V26 stated she did not see anything noted in R2's report sheets or nurses notes. V26 stated when she assessed R2, she noticed a large, raised area under R2's breast and bruising with discoloration to R2's arm and under arm, V26 stated she does not remember what side of R2's body this was on. V26 stated she was not informed of any bruising of discoloration when she received report on R2. V26 stated she called V1, Administrator, regarding the bruising and V1 stated she was not aware. V26 stated V1 informed V26 to start an investigation and interview staff. V26 stated the local police department was notified and R2 was sent to the local hospital for evaluation.On 5/28/26 at 12:18 PM V30, RN, stated she noticed some bruising on the night of 5/10/26 when she worked with R2. V30 stated she observed bruising under R2's right arm by R2's breast, to the top and middle of R2's right breast that extended to R2's left breast. V30 stated the worst bruise was on R2's right side and it extended to R2's bend of her arm.

V30 stated the bruises were green and yellow in color, in different stages of healing, and looked as though they had been there awhile. V30 stated she is not sure if she documented the bruising and if she did not, she meant to. V30 stated she did not report the bruising to V1, Administrator, because she assumed another staff member already did.On 5/28/26 at 2:03 PM V24, CNA, stated she was not working on R2's hall on the night of 5/10/26, but remembers V30 coming to the nurse's station showing pictures of bruises on R2. V24 stated V30 asked if any staff knew of the bruises on R2 and no staff members were aware. V24 stated she asked V30 what the next step was regarding the bruises and V30 mentioned contacting V1. V24 stated she knows staff is supposed to report any bruising or injuries to V1 immediately, but she was not going to tell V30 what to do, since V30 is the nurse and was in charge. V24 stated V30 did not report the bruises to V1 that night.On 5/28/26 at 4:00 PM V1 stated allegations of abuse, neglect, or injuries of unknown origin, are to be reported to her immediately.On 5/29/26 at 9:16 AM V1, Administrator, stated she was first notified of the bruising to R2 on 5/13/26. V1 stated she was not aware of any staff member noticing the bruising on R2 on 5/10/26, and if she was notified then, she would have reported it right away.The Facility's Abuse Prevention Program Date Reviewed 9/2017 documents Policy: This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property or mistreatment.

Internal Reporting Requirement and Identification of Allegations: Employees are required to report any incident, allegation or suspicion of potential abuse, exploitation, mistreatment or misappropriation of resident property they observe, hear about, or suspect to the administrator immediately, to an immediate supervisor who must then immediately report it to the administrator or to a compliance hotline or compliance officer.

The nursing staff is responsible for reporting the appearance of suspicious bruises, lacerations, or other abnormalities of an unknown origin as soon as it is discovered.

The report is to be documented on a facility incident report and provided to the nursing supervisor, administrator or designated individual.

Following the discovery of any suspicious bruises, lacerations, or other abnormalities of unknown source the nurse shall complete a full assessment of the resident for other bruises, laceration, or pain.

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Nexus at Alton 3523 Wickenhauser Alton, IL 62002

like to have showers everyday and need standby assistance, to wash back and dry back.

Resident only had one shower last week.The Facility's Grievance Form dated 1/21/26 documents

dated 5/4/26 documents Issue with getting showers.On 5/28/26 at 1:06 PM V3, Director of Nursing, stated the shower sheets she has provided are the only shower sheets and documentation she has that showers were given and done.On 5/28/26 at 4:00 PM V1, Administrator, stated showers are to be given at least weekly, they try to give them twice weekly, it depends on the resident's preference, some request it more often.The Facility's Activities of Daily Living Dependent Residents Policy Date Revised 1/2023 documents Purpose: to ensure that dependent residents in the facility receive regular, safe, and respectful bathing assistance as part of their Activities of Daily Living (ADLs), in alignment with their care plan, preferences, and clinical needs.

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Nexus at Alton 3523 Wickenhauser Alton, IL 62002

CKD, Anemia, and HTN.R4's MDS, dated [DATE], documents R4 has a BIMS score of 15. R4's Care

orders: 1/27/26 Cleanse wound with wound cleaner, pat dry.

Apply Medi honey to sacrum area with

Apply Medi honey to right heel and with bordered gauze one time a day.R4's Nursing admission Observation, dated 12/31/25, has no documentation that R4's skin was assessed.R4's Nursing admission Assessment, dated 2/19/26, documents R4 has skin conditions that require monitoring/treatment, however there were no measurements, locations, or description documented.R4's Skin Assessment, dated 2/19/26, documents there were no new findings.

There wasn't any documentation of the current areas.There wasn't any documentation in R4's records that the facility had documented measurements or a description of the wounds from 1/15/26 through her discharge to the hospital on 2/25/26.On 5/28/26 at 1:06 PM, V3, DON (Director of Nurses), stated the treatments should be completed as ordered and would be documented on the TAR or in the progress notes.The Skin Management: Pressure Injury, Lower Extremity Ulcer Evaluation, and Documentation, policy, dated 6/2015, documents, in part, pressure injuries will be evaluated, a picture taken and the following areas documented weekly: location, stage, size, depth, presence and location of undermining/tunneling/sinus tract, exudate, pain, wound bed, and wound edges.

Wounds will be measured on a weekly basis. If a wound shows no signs of healing after three weeks, a reevaluation of the wound will be done.

Reevaluation of the treatment plan including determining whether to continue or modify the current treatment interventions.

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Nexus at Alton 3523 Wickenhauser Alton, IL 62002

needed while residents are in their room, including a call light for 2 (R7, R12) of 6 residents in a

on [DATE] with medical diagnoses of Type 2 Diabetes Mellitus, Hypertension, Chronic Kidney Disease, and Muscle Weakness.R7's Minimum Date Set (MDS) dated [DATE] documents R7 is cognitively intact, needs partial/moderate assistance with toileting hygiene, showering/bathing, needs supervision or touching assistance with chair/bed to chair transfers, and is occasionally incontinent of bladder.R7's Care Plan Date Initiated 1/27/26 documents Activities of Daily Living (ADL): R7 requires assist with daily care needs related to muscle weakness.On 5/26/26 at 9:21 AM R7 stated she does not have a call light in her room. R7 denied having a bell or device to use to let staff know she needs assistance. R7 stated if she needs to get staff's attention, she will yell for the staff and hope they hear her and come help.On 5/26/26 at 9:21 AM no call light was observed for R7 to use.On 5/26/26 at 3:22 PM no bell observed on R7's table or in R7's room for R7 to use.2.) R12's Undated Face Sheet documents R12 was admitted to the facility on [DATE] with medical diagnoses of Pulmonary Embolism without Acute Cor Pulmonale, Prediabetes, and Personal History of Other Venous Thrombosis and Embolism.R12's MDS dated [DATE] documents R12 is cognitively intact, uses a wheelchair, needs partial/moderate assistance with toileting hygiene, showering/bathing, sitting to standing, chair/bed to chair transfers, and is always continent of bladder and bowel.R12's Care Plan Date Initiated 9/10/25 documents ADL: R12 requires assist with daily care needs related to weakness after recent hospitalization.On 5/27/26 at 8:48 AM R12 stated he doesn't have access to his call light or a bell and doesn't know what to do if he needs help since he doesn't have access to that.On 5/26/26 at 10:05 AM V1, Administrator, stated she ordered a 3rd call light for the rooms with 3 residents, and the call lights should be in today. V1 stated she did purchase a bell for the residents to use while they wait for the call lights to come in.The Facility's Call Light Response Policy Date Revised 9/2025 documents Ensure call light is within resident's reach at all times.