Evercare At Stearns
Evercare at Stearns in GRANITE CITY, IL — inspection on November 20, 2025.
Found 3 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
of using agency staff and past experiences she put this in place to prevent diversion. V2 stated that R3 passed away on a Wednesday or Thursday. V2 stated that when she went to destroy the medication, she noted that the Controlled Drug Record was altered with R3's name marked out and R5's name handwritten on the record. V2 stated that she checked the medication and noted that the medication and noted that the original box was altered in the same way. V2 stated that she then checked with her staff and was informed by V6, LPN , that when R5 was admitted he was experiencing pain. It was noted that the morphine was in the cart and V5, Hospice RN, changed the name on the record and the box. V2 stated that she notified hospice of what she was made aware. V2 stated that her staff did administer R3's medication to R5. V2 stated that this is medication tampering and is not allowed in her facility. On [DATE] at 3:07 PM V5 stated that she came to the facility because R5 was being admitted to hospice. V5 stated that R5 was in a lot of pain and family was requesting pain relief. V5 stated that she was informed by V6 that R3's Morphine was in the cart. V5 stated that she initialed that R3 had 29.5 mls of Morphine. V5 stated that she did not alter the record or the container and did not administer the medication. V5 stated that V6 altered the document and the bottle. V5 stated that she did place orders for R5's medication but did not order the morphine because she was informed by V6 that that the facility would use R3's medication.On [DATE] at 10:22 AM V9, LPN, stated that she administered R5's 0.5ml from the morphine bottle labeled in the cart and documented on the Controlled Drug Record labeled with R5's name. V9 stated that the signature on R3's Controlled Medication Record dated 9/21 at 10 am, 2pm and 4pm were her signature. V9 stated that the medication was administered to R5. V9 stated that she did not pay attention to the marked-out name she only looked at R5's name. V9 stated that they don't use other residents' medication and if she would have noticed it, she would have said something.The facility's Abuse Prevention policy, dated 1/25, documents POLICY: The facility is committed to protecting the residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents, consultants, volunteer and staff from other agencies providing services to our residents, family members, legal guardians, surrogates, sponsors, friends, visitors, or any other individual.
Definitions g) Misappropriation of Resident Property: The deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/20/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Evercare at Stearns
3900 Stearns Avenue Granite City, IL 62040
SUMMARY STATEMENT OF DEFICIENCIES
Transfer and discharge includes movement of a resident to a bed outside of the certified facility whether that bed is in the same physical plant or not.
Transfer and discharge does not refer to movement of a resident to a bed within the same certified facility.
The facility must permit each resident to remain in the facility and not transfer or discharge the resident from the facility unless specific criteria, as outlined below, are met. It continues Procedure: 2.
Documentation will be entered into the resident's medical record regarding the transfer/discharge reason(s) and the appropriate transfer/discharge information will be communicated to the receiving healthcare center, provider, resident and/or Resident Representative. a.
Documentation includes: 1.
The basis for the transfers/discharges for reasons listed (a) through (g) above.
- The specific need(s) that cannot be met, the attempts to meet the needs, and the service available at the
receiving facility to meet the need(s) for (a) above. 3.
The resident's physician will provide documentation for a transfer due to (a) and (b) above. 4. A physician will provide documentation for a transfer/discharge due to (c) and (d). 8.
Before a facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the nursing facility must provide written information to the resident and the resident representative or legal representative that specifies the duration of the bed-hold policy and the facility's policies regarding bed-hold policies. 13.
Involuntary discharge will be effected after the minimum notice requirements prescribed by applicable state law and regulation, or thirty (30) days notice if no state law or regulation is applicable (unless the health or safety of others in the facility is jeopardized), subject to any legal rights of appeal or challenge prescribed by law.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/20/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Evercare at Stearns
3900 Stearns Avenue Granite City, IL 62040
SUMMARY STATEMENT OF DEFICIENCIES
V5 stated that she came to the facility because R5 was being admitted to hospice. V5 stated that R5 was in a lot of pain and family was requesting pain relief. V5 stated that she was informed by V6 that R3's Morphine was in the cart. V5 stated that she initialed that R3 had 29.5 mls of Morphine. V5 stated that she did not alter the record or the container and did not administer the medication. V5 stated that V6 altered the document and the bottle. V5 stated that she did place orders for R5's medication but did not order the morphine because she was informed that that they would use R3's medication.On [DATE] at Approximately 10:00 AM V2 provided Midnight Census report, dated [DATE], that documents 99 occupied resident beds in the facility.On [DATE] at 2:12 PM V10, Pharmacist, stated that the medications are labeled, with a specific resident's name and sent from the pharmacy with that label. V10 stated that once the medication leaves the pharmacy the label remains the same and is not to be changed in the facility. If the medication is expired or the person dies the medication is to be destroyed. V10 stated that each medication is specific to a particular resident and not to be shared or used for another.The facility's Medication Storage policy, dated 1/15, documents that POLICY: All drugs, treatments, and biologicals must be stored securely and following the manufacturer's labeled recommendations, or per facility policy.The facility's Medication Administration General Guidelines, dated 1/15, documents that POLICY: Medications are administered as prescribed, in accordance with good nursing principles and practices.
Procedure; 18.
Prior to administration, the medication and dosage schedule on the resident's MAR I TAR is compared with the medication label.
Information on the medication should be checked against the MAR / TAR at least three times during the med preparation and administration process. If the label and MAR I TAR are different and the container is not flagged indicating a change in directions or if there is any other reason to question the dosage or directions, the physician's orders are checked for the correct dosage schedule prior to administering. If the medication is discontinued, outdated, or unusable, remove the medication for proper disposal.
Facility ID: