Evercare At University

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

documents Resident R2 was admitted to the facility on [DATE REDACTED] with diagnoses including frontal lobe and executive function deficit following cerebral infarction and unspecified psychosis.Resident R2's Minimum Data Set (MDS) dated [DATE REDACTED] documented Resident R2 was severely cognitively impaired, dependent with mobility and ambulated by wheelchair.Resident R2's Care Plan does not address risk of abuse and neglect.Resident R3's Face Sheet documents Resident R3 was admitted to the facility on [DATE REDACTED] with diagnoses including cerebral infarction, major depressive disorder, and generalized anxiety disorder.Resident R3's MDS dated [DATE REDACTED] documented Resident R3 was cognitively intact and ambulated via wheelchair.Resident R3's Care Plan initiated 9/29/25 documents Resident R3 has a history of inappropriate contact with peers and staff.Resident R3's Progress Note by V2 dated 10/6/25 at 9:00 AM documents, Resident was found in another resident's room. Resident was removed from female resident's room and moved to another hallway.Resident R3's Psychiatry Note by V24, Nurse Practitioner (NP) note dated 10/9/25 documents, Per staff patient entered into female peer room, got into her bed remove(d) her (incontinent brief) and put shaving cream on her. Admits to going into peer room states he wanted to have sex.Local Police Report printed 10/16/25 documents on 10/6/25 at 10:56 AM, dispatch forwarded an anonymous caller regarding an alleged rape occurring today at (Facility). The caller stated multiple incidents were happening at the facility, but the administrators were not reporting them to the police. The caller stated a resident staying at the facility was sexually assaulting another individual by the name of (Resident R2) but did not know the suspect's name.

The caller stated the facility administrators were not doing anything about the incidents. V1 had been made aware of the alleged occurrence and stated than an incident had occurred. V1 showed surveillance video which showed Resident R3 moving his wheelchair down the hallway and entering Resident R2's room at 8:59 AM on 10/6/25.

V7 was seen entering Resident R2's room and calling for V18. At 9:04 AM on 10/6/25, Resident R3 was seen wheeling himself out of the room. V18 stated V7 entered the room to find Resident R3 out of his chair and lying in bed with Resident R2. V18 said Resident R3 had shaving cream on Resident R2's right butt check and heard him say, You stopped me before I started.

V18 said Resident R2 was found lying on her left side, facing the facility wall, and had shaving cream on her right butt cheek. The Facility's Abuse Prevention and Prohibition Program Reviewed 6/1/25 documents Each resident has the right to be free from mistreatment, neglect, abuse, involuntary seclusion and misappropriation of property. The facility has zero-tolerance for abuse, neglect, mistreatment, and/or misappropriation of resident property. Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse., neglect, mistreatment. The facility is committed to protecting residents from abuse by anyone, including but not limited to facility staff, other residents, consultants, volunteers, staff from other agencies serving residents, family members, legal guardians, surrogates, sponsors, friends, and visitors. The Administrator is responsible for coordinating and implementing the facility abuse prevention policies, procedures, training programs, and systems. The Facility promptly and thoroughly investigates reports or resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts.The Immediate Jeopardy and deficiency practice that began on 10/5/25 was corrected/removed on 10/17/25 after the Facility took the following actions to correct the noncompliance: V1 and V2 were in-serviced on abuse and neglect by V41, department heads were in-serviced on abuse and neglect policy and procedure by V1, 24 hour reports for

the last seven days were reviewed, 24 hour report audits were initiated, interviews with 5 staff members 5x/week x 4 weeks were initiated to ensure staff know who to report abuse and neglect to, and root cause analysis was completed for abuse and neglect. The abatement was validated by review of abuse policy,

review of root cause analysis and interviews from V3, V22, V25, V29, V32, V33, V35, V36, V37, V38, V39, V40.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Evercare at University

1095 University Drive Edwardsville, IL 62025

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 Level of Harm - Actual harm Residents Affected - Few

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

were happening at the facility, but the administrators were not reporting them to the police. The caller stated

a resident staying at the facility was sexually assaulting another individual by the name of (Resident R2) but did not know the suspect's name. The caller stated the facility administrators were not doing anything about the incidents. V1 had been made aware of the alleged occurrence and stated than an incident had occurred. V1 showed surveillance video which showed Resident R3 moving his wheelchair down the hallway and entering Resident R2's room at 8:59 AM on 10/6/25. V7 was seen entering Resident R2's room and calling for V18. At 9:04 AM on 10/6/25, Resident R3 was seen wheeling himself out of the room. V18 stated V7 entered the room to find Resident R3 out of his chair and lying in bed with Resident R2. V18 said Resident R3 had shaving cream on Resident R2's right butt check and heard him say, You stopped me before I started. V18 said Resident R2 was found lying on her left side, facing the facility wall, and had shaving cream on her right butt cheek. The Facility's Abuse Prevention and Prohibition Program Reviewed 6/1/25 documents Each resident has the right to be free from mistreatment, neglect, abuse, involuntary seclusion and misappropriation of property. The facility has zero-tolerance for abuse, neglect, mistreatment, and/or misappropriation of resident property. Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse., neglect, mistreatment. The facility is committed to protecting residents from abuse by anyone, including but not limited to facility staff, other residents, consultants, volunteers, staff from other agencies serving residents, family members, legal guardians, surrogates, sponsors, friends, and visitors. The Administrator is responsible for coordinating and implementing the facility abuse prevention policies, procedures, training programs, and systems. The Facility promptly and thoroughly investigates reports or resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Evercare at University

1095 University Drive Edwardsville, IL 62025

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the Facility failed to report allegation of sexual abuse for 1 of 3 residents (Resident R2) reviewed for abuse in the sample of 6. Findings include:Resident R2's Face Sheet documents Resident R2 was admitted to the facility on [DATE REDACTED] with diagnoses including frontal lobe and executive function deficit following cerebral infarction and unspecified psychosis.Resident R2's Minimum Data Set (MDS) dated [DATE REDACTED] documented Resident R2 was severely cognitively impaired, dependent with mobility and ambulated by wheelchair.Resident R2's Care Plan does not address risk of abuse and neglect.Resident R3's Face Sheet documents Resident R3 was admitted to the facility on [DATE REDACTED] with diagnoses including cerebral infarction, major depressive disorder, and generalized anxiety disorder.Resident R3's MDS dated [DATE REDACTED] documented Resident R3 was cognitively intact and ambulated via wheelchair.Resident R3's Care Plan initiated 9/29/25 documents Resident R3 has a history of inappropriate contact with peers and staff.On 10/15/25 at 2:10 PM, V7, Certified Nursing Assistant (CNA), stated on 10/5/25 around 5:30 or 6:00 PM, Resident R2 was sitting in her reclining wheelchair in the dining room with her legs in the air. Resident R3 was in his wheelchair sitting next to and facing toward Resident R2 moving his arm back and forth repeatedly. V7 walked closer and saw Resident R2's lower buttocks exposed with Resident R3's hand in her diaper. Resident R3 stated he was checking her diaper. V7 told V20, Licensed Practical Nurse (LPN), who notified V1, Administrator. On 10/16/25 at 2:54 PM, V20 stated when she arrived at work on 10/5/25 she was informed by V7 that Resident R3 was observed with his hands in Resident R2's incontinent brief. V20 notified V1 who stated she would take care of it. On 10/16/25 at 11:09 AM, V1 stated

she was notified about V7's allegation on 10/5/25, but did not report the allegation because nothing had happened. Local Police Report printed 10/16/25 documents on 10/6/25 at 10:56 AM, dispatch forwarded an anonymous caller regarding an alleged rape occurring today at (Facility). The caller stated multiple incidents were happening at the facility, but the administrators were not reporting them to the police.The Facility's Abuse Prevention and Prohibition Program Reviewed 6/1/25 documents Each resident has the right to be free from mistreatment, neglect, abuse, involuntary seclusion and misappropriation of property. The facility has zero-tolerance for abuse, neglect, mistreatment, and/or misappropriation of resident property. Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse, neglect, mistreatment. The facility is committed to protecting residents from abuse by anyone, including but not limited to facility staff, other residents, consultants, volunteers, staff from other agencies serving residents, family members, legal guardians, surrogates, sponsors, friends, and visitors. The Administrator is responsible for coordinating and implementing the facility abuse prevention policies, procedures, training programs, and systems. The Facility promptly and thoroughly investigates reports or resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Evercare at University

1095 University Drive Edwardsville, IL 62025

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 Level of Harm - Actual harm

protecting residents from abuse by anyone, including but not limited to facility staff, other residents, consultants, volunteers, staff from other agencies serving residents, family members, legal guardians, surrogates, sponsors, friends, and visitors. The Facility promptly and thoroughly investigates reports or resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts.

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

10/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Evercare at University

1095 University Drive Edwardsville, IL 62025

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 0689 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

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

and I really don't think she has the ability to consent. There is always potential for psychosocial harm with sexual abuse because that is a violation of personal space and overall safety.On 10/17/25 at 8:30 AM, V6 stated when she found Resident R3 in Resident R2's room, he was not in the bed with her but looked like he was going to get

in the bed his with her. Resident R3's pants were pulled down and he had shaving cream on his hands. Resident R2 was wearing a brief and gown, but her blanket was pulled back. V6 notified V2. On 10/16/25 at 3:14 PM, V1 stated on 10/6/25 V6 was rounding and saw Resident R3 in Resident R2's room. Someone said Resident R3 had shaving cream in there. When V1 went to Resident R2's room, Resident R2 was lying in bed on her left side curled up in a ball. She was not wearing a brief because she was in bed and sometimes they just put the incontinent pad underneath them.

Due to fact Resident R3 attempted, we contacted V26 who ordered him to go to the hospital. We wanted to find a (different) Facility for Resident R3, because usually if they do it once they are going to do it again. Allegations of abuse should be reported immediately and residents should be separated to make sure they are safe.

Local Police Report printed 10/16/25 documents on 10/6/25 at 10:56 AM, dispatch forwarded an anonymous caller regarding an alleged rape occurring today at (Facility). The caller stated multiple incidents were happening at the facility, but the administrators were not reporting them to the police. The caller stated

a resident staying at the facility was sexually assaulting another individual by the name of (Resident R2) but did not know the suspect's name. The caller stated the facility administrators were not doing anything about the incidents. V1 had been made aware of the alleged occurrence and stated than an incident had occurred. V1 showed surveillance video which showed Resident R3 moving his wheelchair down the hallway and entering Resident R2's room at 8:59 AM on 10/6/25. V7 was seen entering Resident R2's and calling for V18. At 9:04 AM on 10/6/25, Resident R3 was seen wheeling himself out of the room. V18 stated V7 entered the room to find Resident R3 out of his chair and lying in bed with Resident R2. V18 said Resident R3 had shaving cream on Resident R2's right butt check and heard him say, You stopped me before I started. V18 said Resident R2 was found lying on her left side, facing the facility wall, and had shaving cream on her right butt cheek. The Facility's Abuse Prevention and Prohibition Program Reviewed 6/1/25 documents Each resident has the right to be free from mistreatment, neglect, abuse, involuntary seclusion and misappropriation of property. The facility has zero-tolerance for abuse, neglect, mistreatment, and/or misappropriation of resident property. Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse, neglect, mistreatment. The facility is committed to protecting residents from abuse by anyone, including but not limited to facility staff, other residents, consultants, volunteers, staff from other agencies serving residents, family members, legal guardians, surrogates, sponsors, friends, and visitors.

Event ID:

Facility ID:

If continuation sheet