Inspection·December 16, 2025

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the Facility failed to follow their abuse policy by reporting and investigating allegations of misappropriation for 1 of 3 residents (R3) reviewed for abuse in the sample of 8. Findings include:R3's Face Sheet documents R3 was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy and Alzheimer's disease.R3's Minimum Data Set (MDS) dated [DATE] documented R3 was severely cognitively impaired and dependent with transfer. R3's Physician Order dated 5/28/25 documents 5 mg (milligrams) oxycodone, given every four hours.On 12/11/25 at 2:59 PM, V1, Administrator, stated V6, R3's Family, reported R3 did not receive any of her medications on 11/21/25. V6 reported she watched the video footage from the video camera in R3's room, and R3's nurse never entered R3's room to give medications. On 12/11/25 at 3:20 PM, V1 stated the Facility did notify her of V6's allegation of missing medications on 11/21/25, and the nurse in question was V20, Licensed Practical Nurse (LPN). V1 stated she came in and watched the Facility's video footage that night and checked R3's Medication Administration Records (MARs) which documented the medications had been given. V1 felt the issue had been resolved and did not report or investigate the allegation.On 12/12/25 at 9:02 AM, V6 stated R3's nurse, whose identity was unknown, never entered R3's room during her shift, and R3 never received her medications. The nurse told V6 the oncoming nurse would give R3 her medications. The oncoming nurse, whose identity was also unknown, told V6 the medications were missing and had been documented as given. One of the Certified Nursing Assistants (CNAs), whose name was unknown, notified V1 of the situation. V1 stated she would be in the next day to talk to V6, but she never showed up or called.On 12/12/25 at 1:58 PM, V1 stated there is a camera at the nurse's station that is aimed down the hall and another camera a couple feet into the hall. The video footage showed V20 going from room to room and entering R3's room, but you cannot see which medications were administered. V1 stated she did not report or investigate this because she watched the video and found it was not substantiated. On 12/12/25 at 2:12 PM, V2, Director of Nursing (DON), stated if diversion is alleged, the Facility would notify her or V7, [NAME] President (VP) of Clinical Operations, and we would investigate it. We would check the counts, check the cards on the cart, and then we would check the signage on the MAR and on the narcotic book. If we found a discrepancy, we would investigate further. V2 stated she was not aware of this allegation and asked V1 if she had notified V7. V1 stated she did not notify V7.The Facility's Abuse Prevention and Prohibition Program Policy reviewed 12/2/25 documents, Each resident has the right to be free from misappropriation of property. The Administrator is responsible for coordinating and implementing the facility's abuse prevention policies, procedures, training programs, and systems. The Facility promptly and thoroughly investigates reports of resident abuse, mistreatment, neglect, injuries of an unknown source, or criminal acts. The Administrator will provide initial and follow-up written report of the results of all abuse investigations and consequent actions to the appropriate agencies. Residents Affected - Few 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 5 Event ID: 145555 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 145555 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare at Edwardsville 401 St Mary Drive Edwardsville, IL 62025 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)