Evercare Of Collinsville
Inspection Findings
F-Tag F0580
F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to notify a residents family of a fall in 1 of 4 residents (Resident R8) reviewed for falls in the sample of 8.Findings Include:Resident R8's Face Sheet, undated, documents Resident R8 has the following diagnoses: Catatonic Schizophrenia, Anxiety Disorder, Repeated Falls, Hypertension, Major Depressive Disorder, and Type II Diabetes. Resident R8's Minimum Data Set, dated [DATE REDACTED], documents Resident R8 has a BIMS (Brief Interview of Mental Status) score of 6, which indicates Resident R8 has severe cognitive impairment. Resident R8's Progress Notes document Resident R8 had a fall on the following dates: 6/15/25; 7/4/25; 7/26/25; 7/27/25; 8/5/25; 8/7/25; 8/12/15; and two falls on 8/16/25. Resident R8's progress notes fail to document that V18, Resident R8's Family, was notified of these falls and any injuries sustained due to the fall.On 8/18/25 at 10:17 AM, V18, Resident R8's Family, stated the facility used to notify him when Resident R8 had fallen but they have not been doing that recently.
V18 stated when he came in to see Resident R8 the last time, Resident R8 had a cut above his eye, and he asked the nurse what happened and that was how he found out Resident R8 had fallen. V18 stated they haven't been notifying him of any changes with Resident R8.On 10/18/25 at 10:35 AM, V3, Registered Nurse/Assistant Director of Nurses, stated
they notify the family and physician when a resident falls.On 10/18/25 at 11:00 AM, V1, Administrator, stated they notify the physician family when a resident falls.The Fall Policy, undated, documents to complete the Accident/Incident report and notify the physician and responsible party.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
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
08/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Evercare of Collinsville
614 North Summit Collinsville, IL 62234
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-Tag F0725
Federal health inspectors cited EVERCARE OF COLLINSVILLE in COLLINSVILLE, IL for a deficiency under regulatory tag F-F0725 during a complaint investigation conducted on 2025-08-18.
Category: Nursing and Physician Services Deficiencies
The facility was found deficient in the following area: Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 2 deficiencies cited during this inspection of EVERCARE OF COLLINSVILLE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-08-19.
EVERCARE OF COLLINSVILLE in COLLINSVILLE, IL inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in COLLINSVILLE, IL, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from EVERCARE OF COLLINSVILLE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.