Inspection·May 5, 2025

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a mechanical lift was maintained in a safe working manner for 4 of 4 residents (R2, R5, R6, and R7) reviewed for equipment. Residents Affected - Some Findings Include: On 05/01/25 at 8:50 AM, V3, Certified Nursing Assistant (CNA) was walking down the 300 hallway pushing a mechanical lift and having a difficult time keeping it straight. While V3 was pushing the lift the right leg would swing out on its own without the use of the controls to move it. V3 would then use her foot to kick the leg back into position. On 05/01/25 at 9:07 AM, V4, CNA and V6, CNA Brought the mechanical lift down to R2's room. While wheeling the lift to R2's room the right leg would move/swing out without V4 using the controls. V4 would put the leg back in place with her foot as she was pushing the lift to the room. V4 and V6 placed R2 in the medical lift and used the controls to lift R2 to put her to bed. While R2 was up in the lift V4 was pushing the lift over the bed the leg swung open and V4 had to kick it back in place. V4 was struggling to get the mechanical lift to the correct position over R2's bed so she could lower R2 into the bed. V4 said the mechanical lift is hard to steer sometimes. On 05/01/25 at 1:35 PM, R5 Minimum Data Set (MDS) documented she was cognitively intact said they must use a mechanical lift to get her up out of bed. She said they need new ones because the old ones are hard to push at times. R5 said it scares her when they are getting her up and they have to push it (the lift) real hard to move it. She said it seems like it tilts. R5 said sometimes the CNAs must push it with their feet to get the wheels to turn and she said she is scared they will get her up in the air and the lift will quit on them. On 05/05/25 at 9:00 AM, R6 MDS documented she was cognitively intact said there are times she doesn't get up out of bed due to the mechanical lift battery is dead, they are having trouble with the lift's legs, there isn't enough slings for everyone, or there isn't enough staff in the building to get her up. She said she didn't get up for at least seven days because of all of that. R6 was asked about the word BAD being written on one of the lift legs and R6 said, kind of gives it away don't it. She said she did get up yesterday and when they put her back to bed, she asked them to leave the sling in her room so she would have it for today, but they came in and got it to use on someone else. R6 said when they are getting her up in the mechanical lift it feels like she isn't in it right and she has to grab the lift to keep her balance. On 05/01/25 at 8:53 AM, this surveyor questioned V3, CNA about the mechanical lift's leg swinging out the way it did. V3 said no, it shouldn't. V3 said it has been like that for a few weeks probably. (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 4 Event ID: 145438 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 145438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare of Collinsville 614 North Summit Collinsville, IL 62234 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)