Health inspection·December 29, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 interviews and record review the facility failed to provide hot water for bathing for 4 out of 4 residents (R4, R6, R7 and R8); reviewed for Resident Rights in a sample of 8.Findings include:1.R4's Facesheet documented he was admitted to the facility on [DATE] with diagnoses of, in part, fracture of lumbosacral spine and pelvis, type two diabetes, and sleep disorder.R4's Minimum Data Set (MDS) dated [DATE] documented he was cognitively intact. On 12/29/25 at 9:23 AM, R4 stated early this month there was no hot water for 4-5 days, and he had to take a cold shower or wait until it was fixed.2.R6's Facesheet documented she was admitted to the facility on [DATE] with diagnoses of, in part, cerebral infarction, type two diabetes mellitus and chronic obstructive pulmonary disease.R6's MDS dated [DATE] documented she was cognitively intact.On 12/29/25 at 1:03 PM, R6 stated she had to go two weeks without hot water and had to get wet wipe baths, no other alternative was given. R6 stated she will take showers sometimes and bed baths other times it just depends on what is available.3.R7's Facesheet documented she was admitted to the facility on [DATE] with diagnoses of, in part, multiple sclerosis, asthma, and acute respiratory failure with hypoxia.R7's MDS dated [DATE] documented she was cognitively intact.On 12/29/25 at 12:57 PM, R7 stated it was nearly two weeks they had no hot water this month. R7 stated during that time she either refused, was given wet wipe baths or would have to take a cold shower.4.R8's Facesheet documented he was admitted to the facility on [DATE] with diagnoses of, in part, type two diabetes mellitus, protein calorie malnutrition and insomnia.R8's MDS dated [DATE] documented he was cognitively intact.R8's Shower Sheet dated 12/4/25 at 3:20 PM, documented, Went to talk to residents to set up a time for showers and both said there was no hot water so I check and ran the water for about 10 minutes and was still cold so they said they will wait for hot water.On 12/29/25 at 12:50 PM, R8 stated they didn't have hot water about 3-4 weeks ago for about 4-5 days. R8 stated during that time he would have to take cold showers or just refuse them and wasn't offered any alternative to that.On 12/24/25 at 8:34 AM, V1 (Administrator) stated they had work on their water at the beginning of December and they did turn the hot water off for a short amount of time, not for days, and it was turned on when the workers left, so it was off and on. We had two new water tanks placed.On 12/24/25 at 11:46 AM, V8 (Maintenance Director) stated the problem earlier this month with the water was that it wasn't getting hot enough, but it wasn't cold. V8 stated the men's shower room was affected and wouldn't get hot after a few showers and would only get warm. V8 stated he went to check the tanks and one of them was completely out of order, so they had that one and the other one replaced. On 12/24/25 at 10:20 AM, V7 (Housekeeping) stated they didn't have hot water for a short time this month but couldn't remember for how long or dates. On 12/24/25 at 12:26 PM, V10 Certified Nursing Assistant (CNA) stated they didn't have hot water and had to use wipes or take cold showers, aides called in to help when repaired this month.On 12/24/25 at 12:27 PM, V11 (CNA) stated they didn't have hot water earlier Page 1 of 4 145427 145427 12/29/2025 Nexus at Alton 3523 Wickenhauser Alton, IL 62002

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some this month, they had to do a wet wipe bath or cold showers until it was repaired.On 12/29/25 at 2:19 PM, V19 (Regional Maintenance Director) stated he was notified that the facility was having intermittent problems with hot water and found that one of the two hot water tanks was not working. V19 stated under normal operating conditions, the facility was not able to keep up with the hot water and would out of it. V19 stated he was notified on a Thursday and to his knowledge it started that day, had it access on Friday and repaired the following Monday. V19 stated his recommendations were to limit the amount of hot water usage and spread out the timing of showers to maintain the hot water but he was not sure what the facility actually did with the information he provided that weekend. An E-mail dated 12/24/25 at 10:57 AM, documented V19 stated, On December 5, 2025, at 7 am I received a call from V8 that the facility was having problems keeping a sufficient supply of hot water. Upon arrival, I found the on-demand water heaters were not functioning properly. They were putting out hot water but there was not enough for the demand. I scheduled profession services to come out and replace the products. Because of supply issues, they were not able to receive and install the product until Monday December 8, 2025. The product was installed first am Monday morning and there was sufficient hot water for the entire building. Please see attached invoice for reference.The facility's Invoice documented on 12/8/25, two new tankless water heaters were installed. On 12/29/25 at 2:14 PM, V1 (Administrator) stated she expects the residents to have access to hot water at all times.The facility's Resident Rights policy dated 9/2024, documented the facility will provide a safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. 145427 Page 2 of 4 145427 12/29/2025 Nexus at Alton 3523 Wickenhauser Alton, IL 62002

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to provide hot water for bathing for 4 out of 4 residents (R4, R6, R7 and R8); reviewed for Physical Environment in a sample of 8.Findings include:1.R4's Facesheet documented he was admitted to the facility on [DATE] with diagnoses of, in part, fracture of lumbosacral spine and pelvis, type two diabetes, and sleep disorder.R4's Minimum Data Set (MDS) dated [DATE] documented he was cognitively intact. On 12/29/25 at 9:23 AM, R4 stated early this month there was no hot water for 4-5 days, and he had to take a cold shower or wait until it was fixed.2.R6's Facesheet documented she was admitted to the facility on [DATE] with diagnoses of, in part, cerebral infarction, type two diabetes mellitus and chronic obstructive pulmonary disease.R6's MDS dated [DATE] documented she was cognitively intact.On 12/29/25 at 1:03 PM, R6 stated she had to go two weeks without hot water and had to get wet wipe baths, no other alternative was given. R6 stated she will take showers sometimes and bed baths other times it just depends on what is available.3.R7's Facesheet documented she was admitted to the facility on [DATE] with diagnoses of, in part, multiple sclerosis, asthma, and acute respiratory failure with hypoxia.R7's MDS dated [DATE] documented she was cognitively intact.On 12/29/25 at 12:57 PM, R7 stated it was nearly two weeks they had no hot water this month. R7 stated during that time she either refused, was given wet wipe baths or would have to take a cold shower.4.R8's Facesheet documented he was admitted to the facility on [DATE] with diagnoses of, in part, type two diabetes mellitus, protein calorie malnutrition and insomnia.R8's MDS dated [DATE] documented he was cognitively intact.R8's Shower Sheet dated 12/4/25 at 3:20 PM, documented, Went to talk to residents to set up a time for showers and both said there was no hot water so I check and ran the water for about 10 minutes and was still cold so they said they will wait for hot water.On 12/29/25 at 12:50 PM, R8 stated they didn't have hot water about 3-4 weeks ago for about 4-5 days. R8 stated during that time he would have to take cold showers or just refuse them and wasn't offered any alternative to that.On 12/24/25 at 8:34 AM, V1 (Administrator) stated they had work on their water at the beginning of December and they did turn the hot water off for a short amount of time, not for days, and it was turned on when the workers left, so it was off and on. We had two new water tanks placed.On 12/24/25 at 11:46 AM, V8 (Maintenance Director) stated the problem earlier this month with the water was that it wasn't getting hot enough, but it wasn't cold. V8 stated the men's shower room was affected and wouldn't get hot after a few showers and would only get warm. V8 stated he went to check the tanks and one of them was completely out of order, so they had that one and the other one replaced. On 12/24/25 at 10:20 AM, V7 (Housekeeping) stated they didn't have hot water for a short time this month but couldn't remember for how long or dates. On 12/24/25 at 12:26 PM, V10 Certified Nursing Assistant (CNA) stated they didn't have hot water and had to use wipes or take cold showers, aides called in to help when repaired this month.On 12/24/25 at 12:27 PM, V11 (CNA) stated they didn't have hot water earlier this month, they had to do a wet wipe bath or cold showers until it was repaired.On 12/29/25 at 2:19 PM, V19 (Regional Maintenance Director) stated he was notified that the facility was having intermittent problems with hot water and found that one of the two hot water tanks was not working. V19 stated under normal operating conditions, the facility was not able to keep up with the hot water and would out of it. V19 stated he was notified on a Thursday and to his knowledge it started that day, had it access on Friday and repaired the following Monday. V19 stated his recommendations were to limit the amount of hot water usage and spread out the timing of showers to maintain the hot water but he was not sure what the facility actually did with the information he provided that weekend. An E-mail dated 12/24/25 at 10:57 AM, documented V19 stated, On December 5, 2025, at 7 am I received a call from V8 that the Residents Affected - Some 145427 Page 3 of 4 145427 12/29/2025 Nexus at Alton 3523 Wickenhauser Alton, IL 62002

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility was having problems keeping a sufficient supply of hot water. Upon arrival, I found the on-demand water heaters were not functioning properly. They were putting out hot water but there was not enough for the demand. I scheduled profession services to come out and replace the products. Because of supply issues, they were not able to receive and install the product until Monday December 8, 2025. The product was installed first am Monday morning and there was sufficient hot water for the entire building. Please see attached invoice for reference.The facility's Invoice documented on 12/8/25, two new tankless water heaters were installed. On 12/29/25 at 2:14 PM, V1 (Administrator) stated she expects the residents to have access to hot water at all times.The facility's Resident Rights policy dated 9/2024, documented the facility will provide a safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. 145427 Page 4 of 4