Health inspection·July 7, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure resident's rooms are maintained at comfortable temperature for 2 out of 3 residents (R1 and R2) reviewed for homelike and comfortable environment in a sample of 4. Findings Include: 1. R2's Face Sheet, print date of 07/07/25, documented he has diagnoses of but not limited to Chronic obstructive pulmonary disease, obstructive sleep apnea, and Ischemic Cardiomyopathy. R2's Minimum Data Set (MDS), dated [DATE], documented he is cognitively intact with a Brief Interview for Mental Status (BIMS) of 15 out of 15 and he is dependent on staff or requires substantial/maximal assistance with his activities of daily living (ADLs). On 07/02/25 at 1:40 PM, R2 was lying in bed with just a sheet on the lower half of his body. He did not have on any clothing on the upper half of his body. He had a small osculating fan sitting on his over the bed table blowing directly on him. The room was warm and stuffy. R2's room did not have any air conditioning vents in it and there was no individual air unit of any kind in his room. On 07/02/25 at 1:40 PM, R2 said they have been having problems with the air in the facility for the last four or five days. He said it has been getting hot in his room and the only air vents are out in the hallway, and he doesn't have any in his room. R2 said they have been checking the temperatures in the hallway, but they haven't checked the temperature in his room. R2 said he has heart problems and doesn't tolerate the heat very well. He said when the Certified Nursing Assistants (CNAs) come in and do patient care and they shut the door it gets even hotter. He said the CNAs are sweating and he even starts to sweat. He said sometimes it feels like it is over 100 degrees in there. On 07/02/25 at 2:50 PM, R2 stated they came in and offer to move him to another room after this surveyor had left the room. He said they had never offered before that. He said they also came in and temped his room and they had never done that before either. R2 said they didn't tell him what the temperature was after they took it. This surveyor took a calibrated thermometer into R2's room and asked if I could test and see how hot it was in his room, and he agreed. This surveyor laid the thermometer on the over the bed table with nothing touching it. This surveyor stayed in the room and talked with R2 and after five minutes of lying on the table the thermometer read 79 degrees. This surveyor continued to speak with R2 and after another five minutes the thermometer was checked again and it still read at 79 degrees. This surveyor was just standing in the room with R2 and had sweat on my forehead. R2 said the room even gets hotter than it was now especially between 10:00 AM and 11:00 AM (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: 145410 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 145410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare of Breese 1155 North First Street Breese, IL 62230 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)