Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
Level of Harm - Actual harm
Residents Affected - Few
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to ensure residents resided in a safe
environment, free from actual and potential abuse. This failure resulted in R3 who has a diagnosis of
Schizophrenia, Bipolar Disorder and Depression, experience physical abuse from a staff member, injury to
left eye and feeling fear, anger, and ashamed. Findings include:R3's Care Plan, dated 7/31/2025,
documents that R3 is at risk for abuse and/or neglect related to Self-Isolation, psychotropic medications,
hallucination/delusions, history of compulsive behavior, history of verbal and physical aggression and DX:
Schizophrenia, Bipolar Disorder and Depression. It also documents If resident becomes difficult during
care, make sure resident is safe and walk away. Allow resident time to calm down, then reapproach. Keep
resident safe from harm at all times. 10/5/25 CNA (Certified Nurse's Assistant) was sent home for
allegation, investigation started, abuse coordinator made aware, BPD ([NAME] Police Department) called
out to report incident. Resident sent to hospital for eval and treatment, psychosocial follow-up to continue
upon return.R3's Minimum Data Set, dated [DATE], documents that R3 is cognitively intact. It also
documents that R3 has not had any behaviors affecting others. No hallucinations, delusions, verbal, or
physical behaviors towards others.R3's Long-Term Care Facility & IID - Serious Injury Incident and
Communicable Disease Report, dated 10/5/2025 at 8:07 PM, documents that on 10/5/2025 at 7:06 PM
Resident (R3) accused an agency C.N.A. (V14) of abuse. investigation to follow MD/POA/(local) Police
Notified C.N.A. suspended pending investigation.R3's Progress Note, dated 10/5/2025 at 7:22 PM,
documents that Nurses Notes, Note Text: this nurse was notified by nursing assistant that resident throwing
water and slipped and fell resident has a hematoma darkness under left eye. resident state she had a fight
with nursing asst. on hall. administrator is notified as well as family. sending resident to [NAME] memorial
for eval. resident v/s (vital signs) 135/95. P (pulse)-45. R (respirations) -21 98% room airR3's Progress
Notes, dated 10/6/2025 at 4:44 AM, documents that Psychotropic Notes, Late Entry: Note Text: Follow-Up
Evaluation Note, Chief Complaint: Follow-up History of Present Illness: 79 yo (year old) F (female) with
Bipolar Disorder and Schizophrenia Disorder. Updated obtained from patient and staff. Patient was
cooperative with the during today's visit. Patient reported to psych provider that she was involved in a
physical altercation with a CNA. (R3) stated, in her words, that we were fighting like cats and dogs. She
reported that she threw water on the CNA, who then struck her in the eye, after which the altercation
escalated. (R3) did not provide specific times for the incident. Patients continue to deny anxiety, depression,
sleep disturbances, appetite changes, suicidal or homicidal ideations, or auditory or visual hallucinations.
Patient is non-compliant with current medication regimen. Patient is currently being treated for insomnia,
depression, and anxiety. Patient has a documented diagnosis with Insomnia, anxiety disorder unspecified,
and paranoid schizophrenia. Patient has a documented diagnosis of Insomnia, Schizophrenia unspecified,
bipolar disorder unspecified, MDD recurrent unspecified, and
(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
10/16/2025
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)
F 0600
Level of Harm - Actual harm
Residents Affected - Few
Alzheimer's disease unspecified.On 10/6/2025 at 1:36 PM, observed R3's face. Observed scratches to R3's
forehead. R3's left eye was swollen with scratches and abrasions, with dried blood, ranging from the inner
top eye lid to the middle of the eyelid. R3 had various shades of purple and blue discolorations to the left
eye covering the upper and lower lids of the eye. R3's sclera was red, and the surrounding tissue had
purple and blue discolorations.On 10/6/2025 at 1:36 PM R3 stated that stated she was beaten by a staff
member. R3 stated that she saw that a chair was in the hallway, took it in her room. R3 stated that V14
started to enter her room, R3 told V14 not to and pulled the privacy curtain in the room. R3 stated that she
told V14 to not to come in her (R3) room but V14 came in anyway. R3 stated that she informed V14 to get
out. R3 stated that they were fighting over the chair. R3 stated that V14 kept pulling the chair away from R3.
R3 stated that she then she threw water on V14. R3 stated that V14 then punched R3 in the face causing
R3 to fall to the floor on her back and roll onto her left side. R3 stated that she then began to swing at V14
as she was falling to the floor and continued once on the floor. R3 stated that she doesn't know if she hit
V14, but she was trying to. R3 stated that she didn't hit her head on the floor. R3 stated that V5, CNA, came
to the room to see what was going on. R3 stated that the CNA told them she fell but she didn't. R3 stated
that V14 hit her in the eye. R3 stated that her eye hurts, she is having pain, and her vision is blurry. R3
stated that she is old and can get a little rough, but she didn't deserve to be hit. R3 stated that it scares her
because she can't defend herself. R3 stated that she is embarrassed. R3 stated that she (R3) was beat up.
R3 stated that they tried to send her to the hospital, but she refused. R3 stated they were trying to make it
seem as though she was crazy, and she wasn't. R3 stated that she knows what happened. R3 stated that
the police came. On 10/6/2025 at 1:55 PM V5, CNA, stated that around 7:30 PM she was sitting with
another resident in the room next to R3's room. V5 stated that the rooms share a wall. V5 stated that she
heard what sounded like a fight and people throwing furniture. V5 stated that she could hear R3 screaming
but couldn't tell what was said. V5 stated she got up and went to R3's room right away. V5 stated that when
she got there, she saw R3 lying on the floor and V14 standing over R3. V5 stated that R3 told her V14 hit
R3 in the eye. V5 stated that she reported it to the nurse working at that time. V5 stated that after she
reported it she went back into the room next door. On 10/6/25 at 2:15 PM, V6, Licensed Practical Nurse,
(LPN) stated she wasn't at the facility when the incident happened, but she saw R3's injuries and didn't
think she would have gotten those from a fall. V6 stated that R3 will have episodes of psychosis but periods
of being alert and oriented completely and she has been that way today so far for her. V6 stated that the
CNA working was with an agency group, and she was not familiar with her. V6 stated that she was told that
R3 slipped and fell. V6 stated that she was informed by V5 that it sounded like grown men fighting in the
room. V6 stated she has concerns about this CNA being able to work in the facility or any facility. V6 stated
R3 has her typical behaviors and when she asks to be left alone, you leave her alone and she won't be
bothered; she should have known to not bother her and left the room instead.On 10/6/25 at 2:57 PM, V18,
LPN, stated that she was the nurse for R3's hall last night and has a good rapport with R3. V18 stated that
R3 wanted to go outside for a bit so she took her out for about 40 minutes and R3 was in good spirits
during that time. V18 stated that when she took R3 back inside, R3 headed to her room and V18 went to
get her laptop. V18 stated hardly any time passed and she was being told by the other nurse that R3 was
on the floor. V18 stated that she went to R3's room and R3 told her that the CNA hit her, and they were
fighting. V18 stated she saw R3's eye and tried to calm her down, then assessed her and started notifying
the proper people. V18 stated she went to the CNA and asked her to complete a statement of what
happened, V14 was so calm and just sitting in the hallway.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145290
If continuation sheet
Page 2 of 3
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
10/16/2025
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)
F 0600
Level of Harm - Actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
V18 stated she (V18) was shocked and confused. V18 stated that R3's story never changed no matter how
many times V18 asked her and R3 seemed alert and oriented at the time. V18 stated that all the CNA told
her was that she didn't touch R3, she just moved the chair, that she didn't do anything to her. V18 stated
that R3 showed V18 a rubber bracelet R3 said was ripped off during the fight and it was ripped. V18 stated
the police showed up. On 10/6/2025 at 2:49 PM V14 stated that R3 was upset that V14 had a chair in the
hallway. V14 stated that R3 was yelling at V14. V14 stated that R3 informed V14 that R3 used to be a nurse
and that ‘Bitch you're not sitting down. Whore you're going to work.' V14 stated that she was sitting outside
R3's room. V14 stated that she got up and answered a light. V14 stated that when she returned the chair
was gone. V14 stated that she went into R3's room to get the chair. V14 stated that she grabbed a hold of
the chair and started to remove the chair from the room. V14 stated that R3 was trying to get to V14. V14
stated that R3 threw water at her. V14 stated that she continued to pull the chair out of the room. V14 stated
that R3 fell. V14 stated that she was not sure how R3 fell, she may have slipped in the water on the floor.
V14 stated that R3 fell in slow motion. V14 stated that she didn't hit R3. If anything, she hit herself. V14
stated that she doesn't know how R3 got the black eye. V14 stated that R3 was agitated all day calling her
bitches and whores. On 10/6/25 at 3:25 PM, V4, [NAME] President of Clinical Operations, stated that she
showed up last night after being notified of the incident right away. V4 stated that R3 might have fallen on
the chair to get the injury to her eye but hasn't finished up the investigation yet. V4 stated that R3 has been
cycling lately and she came this weekend to see her room destroyed at one point. V4 stated she thinks the
CNA might have argued when she shouldn't have with R3 but V4 still hasn't completed the investigation. V4
stated so far, she understands that the CNA went into R3's room to get the chair and R3 threw water at her.
V4 stated when the CNA pulled the chair, R3 went after it and might have slipped on the water trying to
grab the chair. V4 stated R3 told her the CNA punched her.On 10/8/2025 at 1:22 PM V10, LPN, stated that
she was called to the room. V10 stated that R3 was lying on the floor. V10 stated that R3 stated that V14 hit
her. V14 stated that R3 complained of pain to her left eye. V14 stated that R3 was alert. V14 stated that she
works at the facility from time to time and V14 knew who she was and their last interaction. V14 stated that
R3 has behaviors but R3 was alert and oriented. The facility's Abuse policy, dated 9/2017, documents that
This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of
property or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of
property, and mistreatment of residents. In order to do so, the facility has attempted to establish a resident
sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing
all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of
property and mistreatment of residents.
Event ID:
Facility ID:
145290
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
FAQ · About this visit
Common questions about this visit
What happened during the October 16, 2025 survey of Nexus Pavilion at Belleville?
This was a inspection survey of Nexus Pavilion at Belleville on October 16, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Nexus Pavilion at Belleville on October 16, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.