Health inspection·April 7, 2025

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Interview, Observation, and Record Review, the facility failed to maintain a pest free environment for 4 of 5 residents (R1, R2, R3, R4) reviewed for pest control in the sample of 5. Residents Affected - Some The Findings Include: 1. R1's admission Record, dated 4/3/25, documents R1 was admitted to the facility on [DATE] with diagnosis of Asthma, Type 1 Diabetes Mellitus (DM), Obesity, and Schizoaffective Disorder. R1's Minimum Data Set (MDS), dated [DATE], documents R1 is cognitively intact. On 4/3/25 at 9:35 AM, R1 stated I see bugs in my room at least once a week, and they are usually coming from around the wall and then sometimes in my bed. R1 pulled her sheets back and one bug was seen in her bed. 2. R2's admission Record, dated 4/3/25, documents R2 was originally admitted to the facility on [DATE] with diagnosis of Hypertension (HTN), Schizoaffective Disorder, Bipolar Disorder, Generalized Anxiety Disorder, Insomnia, Major Depressive Disorder, Hyperlipidemia, and Neurofibromatosis. R2's MDS, dated [DATE], documents R2 has a moderate cognitive impairment. On 4/3/25 at 9:30 AM, R2 stated I have found some bugs on my bed lately. I am not sure what they do for them besides stripping my bed and give me clean linen. R2 pulled her sheets back and there were two live bed bugs seen crawling around her sheets. R2 grabbed the bugs and squished them, then removed her sheets herself and stated, I will go and put some clean ones on. 3. R3's admission Record, dated 4/3/25, documents R3 was admitted to the facility on [DATE] with diagnosis of Spinal Stenosis Lumbar, Schizophrenia, Nicotine Dependence, Incontinence, and Dementia. R3's MDS, dated [DATE], documents R3 has a severe cognitive impairment and requires partial/moderate assistance for Activities of Daily Living (ADLs). R3 is always incontinent of both bowel and bladder. On 4/3/25 at 9:55 AM, R3 was seen sitting in a geriatric-chair next to his bed. R3 was not interviewable. V3, Certified Nursing Assistant (CNA), was seen in R3's room assisting R3 and stated I have seen bed bugs in the resident beds when I am changing their linen. I usually report it to maintenance for them to spray. I will remove the resident's linen and will look in the curtain and take it down if I see any. For a while, I was seeing them all the time, but not too much lately. V3 pulled the Page 1 of 3 145290 145290 04/07/2025 Nexus Pavilion at Belleville 727 North 17th Street Belleville, IL 62226

F 0925 Level of Harm - Minimal harm or potential for actual harm sheets and blanket back from R3's bed and several bed bugs were seen. R3's sheets appeared to be very soiled and dirty. 4. R4's admission Record, dated 4/3/25, documents R4 was originally admitted to the facility on [DATE] with diagnosis of Schizophrenia, Drug Induced Dystonia, Dementia, and Major Depressive Disorder. Residents Affected - Some R4's MDS, dated [DATE], documents R4 has a moderate cognitive impairment. On 4/3/25 at 10:50 AM, V1, Administrator, stated We just found bed bugs in (R4's) room yesterday (4/2/25). They were on his bed and on the curtain. We stripped the bed and took down the curtain and sprayed the room. On 4/3/25 at 10:55 AM, R5, R4's roommate, stated (R4) had bugs all over his bed and I saw them in the curtain and everywhere. They came in and stripped his bed and took the curtain down and sprayed the room. They were out of control in this room. I have had them in my bed before too. R5's MDS, dated [DATE], documents R5 is cognitively intact. On 4/3/25 at 12:52 PM, V4, Licensed Practical Nurse (LPN), stated We see bed bugs off and on in the resident rooms. Recently there was a resident who was sitting in the dining room and had a bug crawl on her, and we went and checked her bed and did not find any more. On 4/3/25 at 12:56 PM, V5, CNA, stated I was feeding (R3) recently in his room, and I had a bed bug crawl on me, and I shook it off. We also had a resident who was smoking outside recently and had a bed bug crawl on his hand, and he grabbed it and used his cigarette to kill it. On 4/3/25 at 1:45 PM, V6, (Facility's Pest Control Company) Account Executive, stated We came into the facility in January and treated the entire building for bed bugs. Then in February, we got a call that there were more found, so we came in with a dog and found four more rooms and treated those rooms too. If they are still finding them, we will keep treating. Bed bugs are hard to keep out of homes because residents keep bringing them in, and once they get in the mattresses, they are hard to find. This facility replaced a lot of mattresses that had holes and rips in them. On 4/3/25 at 2:40 PM, V6 stated I went into the rooms where you saw bed bugs today and I did not see any more bugs on any of them except for one. I believe the facility sprayed the beds after you mentioned it to them. I did find some baby bed bugs on (R4's) bed. He does not have any sheets on his bed, but I lifted the flaps on the sides of his mattress and found the baby bugs. We will need to try and figure out where they are coming from. Was there a new resident in that room recently? Was there new furniture brought in? On 4/3/25 at 2:45 PM, V1 stated We will be throwing out (R4's) mattress and giving him another one. V1's emails from (Facility's Pest Control Company), dated 2/20/25, documents in part As you know, we had the bed bug detection dog inspect the facility the other day. The inspection identified bed bug activity in four rooms, which (company worker) has already treated accordingly. Additionally, the dog detected activity in the dining area, which was not originally included in the treatment plan. The Facility's Resident Council Meeting Minutes, dated 2/20/25, documents Old Business: Hall Sweep for Bugs. 145290 Page 2 of 3 145290 04/07/2025 Nexus Pavilion at Belleville 727 North 17th Street Belleville, IL 62226

F 0925 The Facility's Resident Council Meeting Minutes, dated 3/26/25, documents Old Business: Bugs. Level of Harm - Minimal harm or potential for actual harm The Facility's Pest Control Policy, dated 8/2024, documents This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. Residents Affected - Some 145290 Page 3 of 3