Inspection·May 21, 2025

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident's right to privacy when privacy curtains were not present in their rooms for 4 of 4 residents (R1, R2, R4, and R12) observed in a sample of 23 residents observed for privacy curtains. Residents Affected - Some Findings include: 1.R1's undated face sheet documented diagnoses of Cerebral infarction, asthma, diabetes, gait abnormalities, left hip pain, encephalopathy, sleep apnea, hyperlipidemia, restless leg syndrome, cerebral palsy, and chronic pulmonary embolism. R1's minimum data set (MDS) dated [DATE] documented that she is alert and cognitively oriented. R1 requires substantial assistance for personal hygiene and is dependent for upper and lower body dressing. R1 is always incontinent of bowel and bladder. R1's care plan dated 4/17/2025 documented problems including, assistance with activities of daily living (ADLs), brace on her right lower leg and self-care transferring deficit. Interventions include provide with one or two staff assistance with ADL, provide peri care following incontinence episodes, and staff to help as needed with dressing, toileting, hygiene, and bathing. On 5/19/2025 at 10:25 am, R1 was observed to have one privacy curtain between her bed and the wall that was not pulled during care. It was hanging between the wall and her bed and a few of the hooks were not attached at the top and hanging loosely. There were two knocks on the door and V6 (CNA) called out patient care. One staff member entered anyway and needed the gait belt. V8 (CNA) also knocked and opened the door to see if she was needed. On 5/19/2025 at 3:45 pm, R1 stated that she is missing the privacy curtain on the right side of her bed, between her and the window and she would like to have that. R1 stated that sometimes someone will walk by the window outside and if she is changing it feels rather personal and she feels exposed. 2.R2's undated face sheet documented diagnoses of paraplegia, diabetes, asthma, schizophrenia, hypertension, hyperlipidemia, anxiety disorder, depression, dementia, Injury at unspecified level of cervical spinal cord. R2's MDS dated [DATE] documented she was admitted to the facility on [DATE]. She is cognitively alert and oriented. She requires moderate assistance for lower body dressing and substantial assistance for personal hygiene. R2 is frequently incontinent of bowel and bladder. (continued on next page) 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 Page 1 of 3 Event ID: 145290 Printed: 05/15/2026 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 145290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nexus Pavilion at Belleville 727 North 17th Street Belleville, IL 62226 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)