Inspection·February 21, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few him back and he's on the bathroom floor now. I then reported it to the nurse. (R43) messes with everyone and usually everyone ignores him. I think he went too far this time and (R43) got hurt. I think he fractured his hip. On 2/13/2025 at 10:46 AM, R43 stated, I hurt my hip when I slipped and fell and broke my hip. I hit (R44) but I apologized. I was mad and hit him in the bathroom and then he hit me back and I fell. R43's Final Report dated 1/23/2025 at 8:00 AM, Resident to Resident altercation was reported. (R44) was in the bathroom when resident (R43) barged in and was upset (R44) was taking too long. Residents made contact and resident (R44) came to report the incident to (V27), Psychosocial Director. Both residents were immediately separated and assessed. MD (Medical Doctor) and POA (Power of Attorney) more to follow pending final investigation. On final investigation it was found that (R44) was getting water from the bathroom sink and (R43) barged in and demanded (R44) to get out. Resident (R43) made contact with resident (R44). Resident (R44) made contact back and exited the bathroom. (R43) was moved off the Psychosocial hall and has had no further altercations since. R43's Involuntary Discharge papers undated documents, Patient punched another resident in his arm and started using racial slurs calling the other patient a 'N' word. Patient is rambling words and hard to redirect. Patient stated if he sees the other person again, he will hit him. R43's Hospital Records dated 1/23/2025 document, [AGE] year-old male, independent ambulatory without assistive devices, residents in nursing home. He was involved in altercation today at the nursing home when he and another resident were arguing over a cup of water. He fell and landed on his hip with subsequent pain and inability to bear weight. He presented to emergency department where he was found to have intertrochanteric fracture. The patient is admitted for further observation status post orthopedic surgery. X-ray document intertrochanteric fracture of right femur (Broken Hip), intertrochanteric fracture of femur. R44's January 2025 POS documents diagnoses of disorganized schizophrenia, cognitive communication deficit, paranoid schizophrenia, major depression, type 2 diabetes mellitus with hyperglycemia, and need for assistance with personal care. R44's MDS dated [DATE] documents R44 was cognitively intact for decision making of activities of daily living. R44's Care Plan: under Abuse documents, At risk for abuse and neglect r/t (related to) his dx (diagnosis of) Schizophrenia. 5/22/2023 Resident was accused of inappropriate behavior with a peer. 9/23- inappropriate behavior towards another resident. The Care plan does not address the 1/23/2025 abuse. R44's Nurse's Notes dated 1/23/2025 at 5:14 PM, documents nurse was notified by staff that resident was in an altercation with another resident, another resident tried to force this resident out of the bathroom, this resident asked if he could wait which lead to altercation, resident stated he was asked by the resident to get out the bathroom, resident stated he told him to wait till he was done, he stated the resident started using racial slurs and calling names and then it was lead to an altercation between the two, resident also stated that resident then tried walking back to the room once altercation was over, but then lost balance and fell, np (Nurse Practitioner) and psych np was notified, called POA (Power of attorney) and left VM (voicemail), no answer at this time, no injuries noted upon skin assessment, resident remains in stable condition, remains at normal baseline with no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 2 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 complications. Level of Harm - Actual harm R44's Initial Report dated 1/23/2025 at 8:00 AM, Resident to Resident altercation was reported. Resident (R44) was in the bathroom when resident (R43) barged in and was upset (R44) was taking too long. Residents made contact and resident (R44) came to report the incident to (V27) Psychosocial Director. Both residents were immediately separated and assessed. MD (Medical Doctor) and POA (Power of Attorney) notified more to follow pending final investigation. Residents Affected - Few R44's Final Report dated 1/23/2025 at 8:00 AM, documents Resident to Resident altercation was reported. (R44) was in the bathroom when resident (R43) barged in and was upset (R44) was taking too long. Residents made contact and resident (R44) came to report the incident to (V27), Psychosocial Director. Both residents were immediately separated and assessed. MD (Medical Doctor) and POA (Power of Attorney) more to follow pending final investigation. On final investigation it was found that (R44) was getting water from the bathroom sink and (R43) barged in and demanded (R44) to get out. Resident (R43) made contact with resident (R44). Resident (R44) made contact back and exited the bathroom. (R43) was moved off the Psychosocial hall and has had no further altercations since. On 2/6/2025 at 2:13 PM, R44 stated, I remember when I got into it with (R43). I was in the bathroom and then (R43) came in and he pushed me against the wall and hit me in the lip. (R43) was mad because I guess he thought I was taking too long. He is a bully, and he was yelling and screaming at me. He was going to hit me again, but I hit him back and then he fell on the floor. I did not think I hit him that hard and he hit me first. Then I went and told (V27, Psychosocial Director) what had happened. 2. R28's POS dated January 2025, document diagnoses of alcohol abuse, chronic obstructive pulmonary disease, difficulty in walking, muscle weakness, major depression disorder and hypertension. R28's MDS dated [DATE] documents R28 is cognitively intact for decision making of activities of daily living. R28's Care Plan date initiated of 6/2/2021 under Abuse documents, (R28) is risk for abuse and neglect r/t (related to) his history of ETOH (ethyl alcohol or ethanol abuse) and major depressive disorder. Mr. Ray is known to leave for LOA (Leave of Absence) and return to the facility under the influence of alcohol. He admits to drinking beer and liquor. He denies having a problem with alcohol and does not want to seek treatment at this time. He has been educated on the impact of his use on his medical diagnoses and need to withhold medications when he is under the influence. R28's Progress Notes dated 10/11/2024 at 11:53 AM, documents Note Text: After another resident's w/c (wheelchair) became locked with his, (R28) balled up his fist and struck said resident in the chest 2 times. R28's Initial Report documents on 10/11/2024 at 10:45 AM, It was reported that (R33) and (R28) were in the Psych/social office. (R33) was trying to back up, and his wheelchair bumped into (R28's) wheelchair, and their wheels locked together. It was reported that (R28) hit (R33) in the chest twice with a closed fist. (R33) hit (R28) back (staff reported he was slapping at him). Both residents were separated for their safety. Officer (V20), Local Police reported to the facility. Residents' physician and responsible parties notified. (R28) was sent to (Psych Hospital) for evaluation. (R33) was assessed with no apparent injuries noted. Final investigation to follow. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 3 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 R28's Final Report documents on 10/11/2024 at 10:45 AM, It was reported that (R33) and (R28) were in the Psych/social office. (R33) was trying to back up, and his wheelchair bumped into (R28's) wheelchair, and their wheels locked together. It was reported that (R28) hit (R33) in the chest twice with a closed fist. (R33) hit (R28) back (staff reported he was slapping at him). Both residents were separated for their safety. Officer V20, Local Police reported to the facility. Resident's physician and responsible parties notified. (R28) was sent to (Psych Hospital) for evaluation. (R33) was assessed with no apparent injuries noted. (same as initial report). The Undated Statement from, Psychosocial Director, V27, documents, On Friday, 10/11/2024 at approximately 10:45 AM, Resident (R33) was observed bumping into resident (R28's) chair. This worker then observed staff redirect (R28) to stop. This worker observed (R28) hitting (R33), the two were separated and redirected. Statement from V28, Activity Aide dated 10/11/2024, documents (R28) was in Psyche Social and the resident (R33) was trying to back his chair and he bumped his chair into and (R28) hit (R33) in his chest two times (R33) hit him back but not that hard. R33's POS for January 2025 documents diagnoses of unspecified mood (affective) disorder, need for assistance with personal care, weakness, alcohol abuse, unspecified dementia, unspecified severity without behavioral disturbances, and depression. R33's MDS dated [DATE] documents R33 has memory problems and is severely impaired for cognition of activities of daily living. R33's Care Plan with a date initiated of 7/20/2023 documents, ADL (Activities of Daily Living) with daily care need related to cognition decline, including incontinence of bowel and bladder. R33's Progress Notes dated 10/11/2024 at 12:50 PM, Note Text documents Pt (Patient) was struck in the chest with a closed fist by another resident. Pt presents No difficulty breathing, currently eating in dining area. Appetite good. Pleasant affect and easily approachable yet confused. Pt denies any pain. No obvious deformity of the chest. Lungs CTA (Clear to auscultation). Chest Excursion normal for Pt. no obvious bruising or discoloration, will continue to monitor for change. Skin intact over chest wall. R33's Progress Notes dated 10/11/2024 at 1:08 PM, documents Note Text: After resident's wheelchair became locked with his. (R28) balled up his fist and struck said resident in the chest two times. (Local Police) responded and took report. On 1/30/2025 at 2:49 PM, V29, Family of R33, stated the bottom line was that my brother was declining and becoming more forgetful. When he was involved in the incident we do not think (R33) intentional tried to hurt anyone and because of his confusion he was in the wrong place at the wrong time, accidentally bumped into someone and then was hit with a fist hand in his chest two times. (R33) did not know what was happening. It's quite sad. We moved him to a different facility hoping that if it happened again, the resident would be more understanding. 3. R1's POS dated January 2025 documents diagnoses of Paranoid Schizophrenia, anxiety disorder, cannabis abuse, depression, cognitive communication deficit. R1's MDS dated [DATE] documents R1 was cognitively intact for decision making of activities of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 4 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 daily living. Level of Harm - Actual harm R1's Care Plan with target date of 1/26/2024 does not address abuse. Residents Affected - Few On 1/28/2025 at 4:24 PM, R1 stated, (R29) told me he wanted to f*** me in my butt until I bled. I told the staff because I don't know him and who would say something like that. They called the police and send him out, but he came right back, and he tried to approach me again, but I went and got the nurse. I don't even know him. I try and stay away from him. He is saying stuff like that to staff too. I heard him say the same thing to (V16, Licensed Practical Nurse, LPN). When he is around, I don't feel safe. I feel like he wants to fight me or hurt me. I try and keep my distance and when he approaches me, I try and get a nurse. I think he wants to hurt me. I think something is wrong with him and I just don't want him around me. He scares me. He said the same thing to a nurse, (V16). Something is not right with him. R1's Incident Report date of incident 1/21/2025, documents Verbal resident altercation was reported in the dining room. Resident (R29) spoke inappropriate comments to (R1). The incident was reported to the nurse. Nurse (V16) stayed with resident (R29) until EMS (Emergency Medical Services) and Police showed up. Resident (R29) is being sent out for a psych evaluation. MD and POA notified. More to follow pending final investigation. Upon final investigation it was noted that resident was having increased behaviors and speaking inappropriate to residents and staff even upon return. Residents was sent back from hospital and Resident was seen but Psych NP (Nurse Practitioner) and medications were changed for resident's increased behaviors. Resident was sent back out to the hospital for involuntary psych evaluation. Upon resident return he will be put on behavior monitoring for inappropriate comments, will be involved in group therapy sessions, and activities as needed. R29's POS January 2025 documents diagnoses of Schizoaffective, anxiety, depressive, and a history of substance abuse. R29's Care Plan date initiated of 10/26/2023 documents, (R29) has symptoms such as mood swings, impulsive behaviors, and attention seeking behavior related to a diagnosis of Bipolar Disorder/schizoaffective disorder, depression and ADD (Attention Deficit Disorder). He takes medication as orders. R29's Care Plan with a date initiated of 1/9/2025 under Abuse, the Goal documents, staff will monitor wellbeing of others. Resident will have zero episodes of abuse and neglect. The Care Plan does not document R29 making sexually inappropriate comments. R29's MDS dated [DATE] documents he is cognitively intact for decision making for activities of daily living. R29's Social Service Note dated 10/4/2025 at 11:14 AM, documents Note Text(*R29) is A&O x 3 (alert and orientated x 3). His BIMS (Brief Interview for Mental Status) is a 15 (cognitively intact for decision making). He has a diagnosis of Schizoaffective, anxiety, depressive, and a history of substance abuse. He is a current smoker and loves to chase the women. He was encouraged to be mindful of respecting others space, to proceed with caution. R29's Incident Report date of incident 1/21/2025, documents Verbal resident altercation was reported in the dining room. Resident (R29) spoke inappropriate comments to (R1). The incident was reported to the nurse. Nurse (V16) stayed with resident (R29) until EMS (Emergency Medical Services) and Police showed up. Resident (R29) is being sent out for a psych evaluation. MD and POA (Power of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 5 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 Attorney) notified. More to follow pending final investigation. Upon final investigation it was noted that resident was having increased behaviors and speaking inappropriately to residents and staff even upon return. Resident was sent back from hospital and Resident was seen but Psych NP and medications were changed for resident's increased behaviors. Resident was sent back out to the hospital for involuntary psych evaluation. Upon resident return he will be put on behavior monitoring for inappropriate comments, will be involved in group therapy sessions, and activities as needed. On 2/14/2024 at 11:33 PM, V16, Licensed Practical Nurse (LPN) stated R29 had made a comment to her as well as stating he wanting to f*** her in the butt until she bleeds, and they sent him out. 4. R23's POS for January 2025 documents diagnoses of other generalized epilepsy and epileptic syndrome. Nicotine dependence, alcohol abuse, and paranoid schizophrenia. R23's MDS dated [DATE] document R23 was moderately impaired for cognition for activities of daily living. R23's MDS documents R23 walks and is independent for most activities of daily living. R23's Care Plan date initiated of 10/1/2014. R23's Care Plan under ABUSE document: At risk for abuse and neglect r/t Seizure disorder, Major depression, Schizophrenia, CVA, Lupus, Alcohol abuse, Seizure disorder. He is noted to be verbally aggressive and difficult to redirect at times. He is noted to have history of peer-to-peer altercations. R23's Initial Incident Report dated 12/20/2024 documents, Resident to Resident altercation. Resident (R23) and Resident (R24) made contact in the smoke line to go outside. Resident (R24) pushed staff member and then went to swing on the staff member and resident (R23) intervened. Residents were immediately separated. Both residents were sent out for evaluation due to behavior, MD (Medical Doctor) and POA (Power of Attorney) notified. More to follow in final investigation. Final Report, dated 12/20/2024, documents Resident to Resident altercation. Resident (R23) and Resident (R24) made contact in the smoke line to go outside. Resident (R24) pushed staff member and then went to swing on the staff member and resident (R23) intervened. Residents were immediately separated. Both residents were sent out for evaluation due to behavior, MD and POA notified. Both residents came back from the hospital and were free of any injury. Resident care plan was updated to reflect these found behaviors. Residents have had no further altercations. On 1/31/2025 at 1:04 PM, V32 Dietary Aide stated, Yes, I remember that day (R23) hit (R24). I was helping during smoke break and all of the residents were crowded together ready to go outside and smoke. There was an ambulance trying to get through and (R24) shoved one of the residents and I told him you can't shove people and because you shoved someone you cannot smoke now, and he got mad. I reached down the cart and he swung at me and hit me pretty hard. And as I was coming up, he tried to swing at me again and (R23) grabbed him and protected me. I think I would have got hurt really bad if (R23) had not been there. (R23) did not start it, he was just protecting me. On 1/31/2025 at 1:32 PM, R23 stated he did hit (R24) but he was only protecting (V32) because (R24) was going to hurt (V32). R24's POS for January 2025 documents diagnoses of Schizophrenia, chronic obstructive pulmonary disease, unspecified speech disturbances, other specified hypoparathyroidism, cognitive communication deficit, muscle weakness, difficulty in walking, paranoid schizophrenia, and anxiety disorder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 6 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 R24's MDS dated [DATE], documents R24 was cognitively intact for decision making of activities of daily living. Level of Harm - Actual harm Residents Affected - Few R24's Progress Notes dated 12/20/2024 at 5:37 PM, documents Residents were lining up to go out for smoke break (R24) became agitated he pushed an aid and another resident. The resident he pushed then began to hit him and a physical fight ensued. workers managed to break them up and separated them into rooms. (R24) had a nosebleed but upon assessment vital signs were table and WNL (within normal limits), redness to nose and upper back area found upon assessment but otherwise no injuries and no complaints. The Abuse Policy dated 10/2022 documents, The facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation, of property, deprivation of goods and services by staff or mistreatment. The facility therefore prohibits abuse, neglect, exploitation, misappropriate 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. 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, deprivation of goods and services by staff and mistreatment of residents. Abuse means any physical or mental injury or sexual assault inflicted upon a resident other than by accidental means. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 7 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0610 Respond appropriately to all alleged violations. 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 ensure all alleged violations were thoroughly investigated for 4 of 13 residents (R1, R5, R12, R29) reviewed for abuse investigations in the sample of 51. Residents Affected - Some Findings include: 1. R12's Physician Order Sheet (POS) dated January 2025 document diagnoses of schizoaffective disorder, bipolar type, insomnia due to other mental disorder, mild intellectual disabilities, and bipolar disorder. R12's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) score of 15 indicating cognitively intact for decision making for activities of daily living. R12's Care Plan with a date initiated of 1/10/2025 documents Abuse: (R12) is at risk for abuse and neglect related to DM (diabetes mellitus), type 2, schizoaffective disorder, bipolar disorder, asthma and mild intellectual disability. On 1/29/2025 at 3:14 PM, R12 was unable to recall the incident between her and R5. R12's Initial Report dated 12/7/2024 at 11:03 AM, documents, Resident to resident altercation occurred with resident (R5) and (R12). Residents were separated immediately. Resident (R5) was moved to west hall. Resident (R12) was placed on 15-minute visuals. Residents were both assessed head to toe with no injury, MD (medical doctor) and POA have been notified, more to follow pending final investigation. The initial report does not document anything related to any resident being inappropriately touched or why R5 was moved to a new room. R12's Progress Notes dated 12/7/2024 at 12:36 PM, documents Resident agitation continues, she walked out of the front doors stating that she was mad and wanted to be left alone. She stated that she was mad and wanted to be left alone. She stated that she doesn't like that staff 'follow her around.' Resident is currently on 15 minutes checks ADON was able to get (R12) back inside the building. Writer attempted to help calm her down. (R12) walked past writer, said 'and I'm going back outside' and proceeded to exit through the side door. Writer and ADON followed her outside and back into the front doors. (R12) continues) to express her frustration with not being able to do what she wants to do as well as being 'followed'. R12's Final Report dated 12/7/2024 at 11:03 AM, documents, Resident to resident altercation occurred with resident (R5) and (R12). Residents were separated immediately. Resident (R5) was moved to west hall. Resident (R12) was placed on 15-minute visuals. Residents were both assessed head to toe with no injury, MD and POA have been notified more to follow pending final investigation. Upon final investigation this allegation has been unfound. Resident (R5) interview stated (R12) kept standing in his doorway and he asked her to leave and then she would come back. Resident (R5) said every time she came back, he told her to leave, and she would. Resident (R12) was interviewed and said no one touched her she has no issues and feels safe in the facility. Resident (R12) was moved to women's hall closest to the nurses' station to ensure her wandering the building is minimal. Resident (R12) has been care planned and behavior tracking for wandering in resident's room. No further issues have occurred. R12's Investigation did not have any statement from R12 asking her what happened. She was asked three questions: Has anyone ever touched you inappropriately? No. Do you feel safe in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 8 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0610 Level of Harm - Minimal harm or potential for actual harm facility? Yes. Do you like your new room? Yes. The investigation did not include interviews with any other females to see if R5 has a pattern of sexual inappropriate behavior towards others. R12's Nurse Notes dated 12/7/2024 at 8:57 AM, Note Text: Patient noted yelling and displaying sadness walking through dining area. Residents Affected - Some On 2/4/2024 at 6:24 PM, V4, Former DON (Director of Nursing) stated (R12) is really young and she is a little confused and staff reported to me that they found (R12) in (R5's) Room and when I talked with her (R12) told me that (R5) was touching her and when I reported it to (V1, Administrator) she told me to get a statement and then she said she did not want that statement and she tried to downplay the incident and make it look differently than what really happened. I tried to tell her we could not do that, but she was going to do things her way and I do not think it was right. We do not ask a resident if they wander into someone else's room if they were touched inappropriately and we do not do an investigation unless there was an allegation of abuse or move a resident to another room. R5's POS for January 2025 documents diagnoses of Bipolar disorder, current episode depressed, mild depression, type 2 diabetes mellitus without complications, schizophrenia, unspecified psychosis not due to a substance or known physiological conditions. R5's MDS dated [DATE] documents R5 was cognitively intact for decision making of activities of daily living. He has not impairment on the upper of lower extremity and uses a walker. R5's Care Plan under ABUSE documents: (R5) is at risk for abuse and Staff will monitor well-being of 10.29.2023 enhance monitoring initiated. Neglect r/t (related to) depression, weakness, bipolar others. Resident will have zero episodes of abuse and neglect throughout next review. The Interventions documented 12/7/24, enhanced monitoring 15-minute checks. The Initiation date of this was 12/8/24. There is no documentation as to why R5 was placed on 15-minute checks. R5's Nurses Notes dated 12/7/2024 at 3:00 PM, Resident to resident has been reported to Admin (Administrator). (R5) will be moved to (different room). R12's Final Report dated 12/7/2024 at 11:03 AM documents, Resident to resident altercation occurred with resident (R5) and (R12). Residents were separated immediately. Resident (R5) was moved to west hall. Resident (R12) was placed on 15-minute visuals. Residents were both assessed head to toe with no injury, MD (Medical Doctor) and POA (Power of Attorney) have been notified more to follow pending final investigation. Upon final investigation this allegation has been unfound. Resident (R5) interview stated (R12) kept standing in his doorway and he asked her to leave and then she would come back. Resident (R5) said every time she came back, he told her to leave, and she would. R5's undated statement documents, (R5) stated (R12) kept coming into his room and he told her to leave stay out of his room she kept standing in the doorway. (R5) did not contact (R12). No other statements were provided by the facility asking other staff members and or residents from the incident on 12/7/2024 or if they had seen or heard anything related to this allegation. The investigation was incomplete. No other female staff was interviewed. 2.R1's POS dated January 2025 documents a diagnosis of Paranoid Schizophrenia, anxiety disorder, cannabis abuse, depression, cognitive communication deficit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 9 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0610 R1's MDS dated [DATE] documents R1 was cognitively intact for decision making of activities of daily living. Level of Harm - Minimal harm or potential for actual harm R1's Care Plan does not address abuse. Residents Affected - Some On 1/28/2025 at 4:24 PM, R1 stated, (R29) told me he wanted to f*** me in my butt until I bled. I told the staff because I don't know him and who would say something like that. They called the police and send him out, but he came right back, and he tried to approach me again, but I went and got the nurse. I don't even know him. I try and stay away from him. He is saying stuff like that to staff too. I heard him say the same thing to (V16). When he is around, I don't feel safe. I feel like he wants to fight me or hurt me. I try and keep my distance and when he approaches me, I try and get a nurse. I think he wants to hurt me. I think something is wrong with him and I just don't want him around me. He scares me. He said the same thing to a nurse (V16, Licensed Practical Nurse (LPN). Something is not right with him. R1's Incident Report date of incident 1/21/2025, Verbal resident altercation was reported in the dining room. Resident (R29) spoke inappropriate comments to (R1). The incident was reported to the nurse. Nurse (V16) stayed with resident (R29) until EMS (Emergency Medical Services) and Police showed up. Resident (R29) is being sent out for a psych evaluation. MD and POA notified. More to follow pending final investigation. Upon final investigation it was noted that resident was having increased behaviors and speaking inappropriate to residents and staff even upon return. Residents was sent back from hospital and Resident was seen but Psych NP and medications were changed for resident's increased behaviors. Resident was sent back out to the hospital for involuntary psych evaluation. Upon resident return he will be put on behavior monitoring for inappropriate comments, will be involved in group therapy sessions, and activities as needed. R1's incident report does not take down R1's statement and or what actually transpired. On 2/4/2025 at 6:15 PM, V4, Former DON stated, (R1) was verbally abused by (R29). I took the statements and gave them to (V1, Administrator) and she told me I had to rewrite the statements and redo them because she was not going to get a tag and it needed to have less information on it, be reworded. I was shocked because that is never how we did it. We took down the statements that were given. I do not believe the police were contacted either. R1's investigation report documents three residents were interviewed, two male residents asked if 'inappropriate things said to you by (R29)' and the only female resident that was documented as being asked was (R1). No other female interview was in the file asking them if (R29) had ever approached or asked them inappropriate comments. R29's POS January 2025 documents a diagnosis of Schizoaffective, anxiety, depressive, and a history of substance abuse. R29's MDS dated [DATE] documents he is cognitively intact for decision making for activities of daily living. R29's Social Service Note dated 10/4/2025 at 11:14 AM, & Note Text *R29) is A&O x 3 (alert and orientated x 3). His BIMS (Brief Interview for Mental Status) is a 15 (cognitively intact for decision making). He has a diagnosis of Schizoaffective, anxiety, depressive, and a history of substance abuse. He is a current smoker and loves to chase the women. He was encouraged to be mindful of respecting others space, to proceed with caution. R29's Incident Report date of incident 1/21/2025, Verbal resident altercation was reported in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 10 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dining room. Resident (R29) spoke inappropriate comments to (R1). The incident was reported to the nurse. Nurse (V16) stayed with resident (R29) until EMS (Emergency Medical Services) and Police showed up. Resident (R29) is being sent out for a psych evaluation. MD and POA notified. More to follow pending final investigation. Upon final investigation it was noted that resident was having increased behaviors and speaking inappropriately to residents and staff even upon return. Resident was sent back from hospital and Resident was seen but Psych NP and medications were changed for resident's increased behaviors. Resident was sent back out to the hospital for involuntary psych evaluation. Upon resident return he will be put on behavior monitoring for inappropriate comments, will be involved in group therapy sessions, and activities as needed. On 2/14/2024 at 11:33 PM, V16, Licensed Practical Nurse (LPN) stated (R29) had made a comment to her as well as wanting to F*** her in the butt until she bleeds, and they sent him out and the police did come out for her for that. On 2/5/2025 at 11:05 AM, V39, Local Police Records Department stated there was no report with the numbers provided and/or no report for (R29) and (R1) for 1/21/2025. The undated Abuse Policy documents, The investigator will attempt to interview the person who reported the incident, anyone likely to have direct knowledge of the incident and resident. Any written statements that have been submitted will be reviewed, along with any pertinent medical records or other documents. Residents to whom the accused has regularly provided care, and employees with whom the accused has regularly worked, will be interviewed. The original allegation (note day, time, location, the specific allegation, the alleged perpetrator, witness to the occurrence, circumstances surrounding the occurrence and any noted injuries. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 11 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide follow-up urology care per standards of practice for 1 of 3 residents (R28) reviewed for quality of life in the sample of 51. This failure resulted in a delay of R28's scrotal surgery, ongoing unnecessary pain which affects R28's quality of life. Residents Affected - Few Findings include: R28's Physician's Order Sheets for February 2025 document diagnoses of alcohol abuse, uncomplicated, chronic obstructive pulmonary disease, Chronic obstructive pulmonary disease, Type 2 diabetes without complications, Need for assistance with personal care, Hyperlipidemia, Benign prostatic hyperplasia with lower urinary tract symptoms, Hypertension, pain in unspecified knee, unsteadiness on feet, difficulty in walking muscle weakness, inflammatory disorder of scrotum. R28's Minimum Data Set (MDS) dated [DATE] documents R28 is cognitively intact for decision making of activities of daily living. R28's Care Plan under skin document, (R28) is at risk for skin complications related to surgical removal of lipoma to right upper back, resolved 2/15/2022. The Care Plan does not address any issues with his scrotum. On 2/14/2024 at 1:03 PM R28's scrotum hung down lower than the other side and appeared abnormal with swelling present in that area. On 2/14/2024 at 1:18 PM, R28 stated he had surgery on his scrotum a few years ago and they messed it up during surgery. R28 stated his testicles were together but now they are separate, and one is up, and one hangs down. R28 stated he has to be careful when he sits down because he can sit on the one that hangs down and it causes him pain and the area becomes tender. R28 stated the facility does give him pain medication for it. R28 stated he needs to get surgery to fix his scrotum really bad but has not been able to get an appointment and this has been going on for a few years now. R28's Progress Note dated 12/21/23 at 10:35 AM, documents Referral TO UROLOGY DX (diagnosis) encysted hydrocele (type of scrotal swelling that occurs when fluid collects in the thin sheath that surrounds the testicle) with history of repair last July 2023, recurrent hydrocele, Chronic, needs evaluation and treatment with urologist surgeon arrange with referral coordinator. (This surgery needed to be repeated). R28's Progress Note dated 1/10/24 at 7:38 AM, documents Arrange for clearance. Discussed with resident regarding this matter. orders were entered: The following: future surgery hydrocele repair; (R28) Surgery appointment scheduled on 2/14/2024 @ (at)1155a @ (Hospital) Instructions in PCC (Point click care) must arrive 2 hours prior to surgery. Nurse to contact Nurse practitioner Cardio for clearance for second time repair for his hydrocele surgery on [DATE]. R28's Progress Notes dated 1/24/24 at 10:43 AM, documents NP (Nurse Practitioner) cleared him to his surgery. R28's Progress Notes dated 1/25/24 at 12:06 PM, documents Spoke with Urologist due to high AIC 9.2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 12 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0684 %, deferred his surgery at this time re-evaluate in 2 months. Level of Harm - Actual harm R28's Progress Notes dated 1/24/2024 at 6:29 AM, documents Note Text: Surgery was canceled. Residents Affected - Few R28's 2025 medical record was reviewed and did not have any documentation regarding an upcoming appointment scheduled for his surgical procedure. On 2/14/2025 at 2:03 PM, V46, Social Service Director stated, I am new to this job. I have not completed my training and I am just learning. I am not sure why (R28) has not had an appointment for his surgery. I know at one time we were having issues with his insurance, and it was scheduled but then it was canceled. I am not sure why he has not had an appointment. I will look into it. We have a census of 118 residents. On 2/14/2025 at 2:03 PM, V23, Licensed Practical Nurse stated, (R28) has some issues with his scrotum and occasionally he will complain about it hurting in that area. On 2/14/2025 at 3:13 PM, V2, Director of Nursing stated, If a resident needed a follow up appointment, I would expect it to be scheduled and if there was a certain issue that it could not be scheduled I would expect staff to follow up and make sure it gets scheduled if it was indicated. On 2/14/2025 at 4:45 PM, V46, Social Service Director, stated she was not sure what happened, but she just scheduled him an appointment for an evaluation to see what he needs or should be done. On 2/21/2025 at 12:22 PM, V40, Medical Doctor of Urology stated, I did a procedure on (R28) back in July of 2023. Originally, (R28) was supposed to have it repeated because of some complications but there some issues with his blood work so it had to be delayed. We thought he would be rescheduled. I was the one who did the surgery, and we were working with the insurance company because I was the one who did the surgery. (R28) he was not in my network but then because of the delay, he must have slipped through the cracks because now too much time has elapsed, and the insurance provider will not let me bill because he is not in my network and too much time has passed. I would have thought he would have already had this procedure. We had it all fixed back in 2023 to repeat the procedure but now (R28) will need to find a new provider that is in his network. It is a shame because that is a lot of time has passed. The delay of course will affect his quality of life, some pain, maybe some inflammation. It is hard for me to say exactly because I have not put eyes on him since 2023. It can cause discomfort, pain, swelling. Nothing life threatening but it does affect his quality of life and is fixable. The Appointment and Transportation Policy dated 9/2024 documents, When a resident has an appointment outside of the facility, the staff will make the transportation arrangements, unless the responsible party chooses to make the arrangements themselves. Staff nurse or designee will call the place of the appointment to verify the date, time, and location. The staff nurse will notify the attending physician and any appropriate ancillary physicians (i.e. nephrologists) of the resident's appointment. If the resident will be missing any type of procedure or timed medication, the appropriate physician will be notified, and order received. (i.e. missed dialysis, missed IV meds, etc.) Staff nurse or designee will then call the family to see if they will be providing transportation and accompanying the resident. If the family is not making transportation arrangements, the staff nurse or designee will call the transportation company (Medicare, ambulance, etc.) to set up the date and time of pick up. The pickup time should be at least one hour prior to the appointment. If the family will not be accompanying the resident, the staff nurse or designee will inform the DON (Director of Nursing) to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 13 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0684 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete determine if an escort is needed for the resident. Prior to the appointment, the staff nurse or designee will gather the necessary paperwork to send with the resident to the appointment. This includes a face sheet and continuity of care document, and other requested documents. On the day of the appointment, the staff nurse will ensure that the received personal care resident and dressed appropriately for the weather. All paperwork should be given to the family or driver for the appointment. If the resident is unable to keep the appointment, it is the staff nurse responsibility to cancel the appointment and reschedule it at the earliest time. If the primary physician had arranged the appointment, the staff nurse should alert them to the schedule change. The responsible party will also be notified of any appointment that is canceled and changed. Event ID: Facility ID: 145613 If continuation sheet Page 14 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat pressure ulcers per physician's orders for 1 of 4 residents (R35) reviewed for pressure ulcers in the sample of 51. Residents Affected - Few Findings include: 1. R35's undated Face Sheet documents R35's medical diagnoses include Encephalopathy, Chronic Obstructive Pulmonary Disease, Benign Prostatic Hyperplasia, Parkinsonism, Paranoid Schizophrenia, and Need for assistance with personal care. R35's Care Plan, dated 1/22/25, documents R35 is at risk for skin complications related to needing assistance with activities of daily living. R35 refuses to lay down at times and is non-compliant with footwear. Interventions include skin assessment weekly. R35's Minimum Data Set (MDS), dated [DATE], documents R35 has memory problems and is rarely/never understood, needs partial/moderate assistance with toileting hygiene, and is always incontinent of bowel and bladder. R35's Braden Skin assessment dated [DATE] documents R35 is at moderate risk for pressure ulcers. R35's active physician orders dated 12/2/24 documents sacrum stage 3 pressure area: cleanse with wound cleanser, apply silver sulfadiazine cream, hydrogel, collagen particles, and calcium alginate, and cover with bordered gauze daily and as needed every day shift. R35's physician order dated 12/2/24 at 11:51 AM documents Left Heel Stage 2 pressure area: cleanse with wound cleanser, apply silver sulfadiazine cream, hydrogel, collagen particles, and calcium alginate, cover with bordered gauze every day shift. R35's February Treatment Administration Report (TAR) documents R35 did not receive wound treatment to his Stage 2 pressure wound to the left heel or to his stage 3 pressure wound to the sacrum on 2/8/25, 2/10/25, and 2/11/25. R35's Wound Assessment Report dated 1/24/25 documents sacrum pressure wound stage 3 is stable and measures 1.50 cm (Length) x 1.10 cm (width) with scant serosanguineous drainage. Left heel unstageable pressure wound worsening and measures 1.00 cm (length) x 1.60 cm (width) with scant serosanguineous drainage. On 2/13/25 at 9:22 AM, R35 was given incontinent care by V35, Certified Nursing Assistant and V41, Certified Nursing Assistant. No dressing was noted to R35 sacrum pressure wound. On 2/13/25 at 10:45 AM V2, Director of Nursing (DON) stated it is expected to be documented on the resident's TAR once a wound treatment is completed. V2 stated if a date is left blank on the TAR, then it is assumed the treatment was not completed. The Facility's Skin Management: Pressure Injury Treatment/General Wound Treatment Policy, dated 4/2004, documents General Treatment Guidelines: 1. Review the physician's order in the EHR (electronic health record) and place all necessary supplies in the treatment cart. 3. Cleanse hands before and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 15 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete after procedure. 4. Apply gloves before performing wound assessment. 5. Remove and discard dressing and gloves. Perform hand hygiene and apply new gloves. when treating an individual with multiple pressure injuries, treat the most contaminated site last. 6. Perform the treatment as ordered using proper techniques of infection prevention and control. 8. Document routine and PRN (as needed) treatments in the treatment administration record of the EHR. Document all significant observations in the nursing progress note. 10. The staff nurse will notify the Wound Nurse upon identification of skin impairment. If the Wound Nurse is not available, the staff nurse should document the open area on a Skin Screen Form and alert the Health Care Provider for treatment orders. 12. If a wound shows no signs of healing after three weeks, a reevaluation of the treatment plan including determining whether to continue or modify the current interventions is done. If the decision is made to retain the current regimen, documentation of the rationale for continuing the current plan will occur. Event ID: Facility ID: 145613 If continuation sheet Page 16 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the Facility failed to implement progressive interventions to prevent falls, failed to implement safe mechanical lift transfer techniques, and ensure equipment is in good repair to prevent injury for 4 of 7 residents (R6, R7, R25, R30) reviewed for supervision to prevent falls/accidents in the sample of 51. Findings include: 1.R6's Physician Order Sheet (POS) for January 2025 documents a diagnosis of hemiplegia, unspecified affecting right dominant side, hemiplegia, unspecified affecting left dominant side, type 2 diabetes mellitus without complications, difficulty in walking, abnormal posture, need for assistance with personal care, weakness, other abnormalities of gait and mobility, repeated falls, unspecified dementia, unspecified severity with other behavioral disturbances, and schizoaffective disorder. R6's Minimum Data Set, (MDS), dated [DATE] documents R6 has moderate cognitive impairment. R6 needs substantial/ maximal, helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort for rolling left to right, sit to standing, lying sitting to setting on side of bed, chair bed to chair transfer, toilet transfer, and tub, shower transfers. R6's Care Plan with a date initiated of 8/3/2012 documents, Fall, (R6) is at high risk for falls r/t (related to her) DX (diagnosis of MMR (Mild Mental Retardation) Dementia, past CVA, h/o (history of) frequent falls and non-compliance. She uses a w/c (wheelchair) for mobility with assist for transfers, able to ambulate with assist from staff short distances. (R6) can be very stubborn with allowing staff to assist her at times. She makes attempts to transfer and ambulate on her own and refuse to sit in wheelchair. Resident is an extensive assist for one staff member for ADL's (activities of daily living). Resident requires cueing for task 9/10/2022. Resident fell in room while trying to find clothes to change- ambulating without assistance. R6's Nurse's Notes dated 9/16/2024 at 7:03 AM, Note Text: Patient slid from the bed to the floor while she was attempting to transfer herself, patient did not use her call button, patient stated she wanted to get on her chair, patient was assessed head to toe, no injuries were noted, patient denied any pain or discomfort, patient was assisted with staff back in the chair with a gait belt, patient pain, fall and skin assessment was done. Patient MD (Medical Doctor) was made aware, patient family was made aware; DON (Director of Nursing) was made aware. Nurse continues to monitor patient through the shift. Intervention, patient educated on using the call button for any assistance, verbalizes understanding, staff educated on making sure they do 2 hour rounds and frequent checks with patient dt hx (related to history) of falls. R6's Incident Report dated 9/23/2024 Resident observed on floor lying next to bed. Resident stated, I tried to transfer myself into bed. Resident assessed for pain and injuries, none observed. Resident educated on assistance into bed and use of call-light. Resident verbalized understanding. Resident denies pain. NP (Nurse Practitioner) notified, and DON (Director of Nursing). Neuros started per facility protocol. Resident stated, I was trying to get into bed Intervention: educated use of call light. R6's Nurse Notes dated 10/14/2024 at 9:56 PM, Note Text: (R6) had witnessed fall going from her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 17 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chair into her bed and slipped off the bed and landed her bottom on the floor. No injuries present. Will continue to monitor. R6's Nurse's Note, Late Entry dated 10/14/2024 at 7:59 PM, Late Entry: Note Text: Resident was transferring herself from her wheelchair into her bed when she slipped off her wheelchair and landed on her bottom onto the floor, on skin assessment no bruising or open areas were found. Patient was assessed by the nurse, no injuries were noted. Patient denies any pain or discomfort. Patient did not use her call button. Patient MD was made aware, family was made aware, patient was assisted up x2 assist with gait belt after assessment. Neurological assessment was done. Patient will continue on pain assessment, skin assessment, and fall risk assessment. Patient educated on using call button when she needs assistance, verbalizes understanding. R6's Progress Notes dated 1/3/2025 at 7:05 AM, Note Text: Resident found on community bathroom floor. Resident sitting on bottom next to toilet, states that floor was wet, and she slipped when attempting to pull her pants down. ROM WNL (Range of Motion Within normal limits). No c/o (complaint of) pain or discomfort. Resident A/O (alert and orientated) and states that she did not hit her head. Resident is her own responsible party. No injuries noted. NP Nurse Practitioner) and DON (Director of Nursing) made aware. Will follow up. R6's Care Plan was not revised with new interventions to address R6's falls in September and October 2024 and after she fell on 1/3/25. 2.R7's POS for January 2025 documents a diagnosis of weakness; need for assistance with personal care; syncope and collapse; contracture of left and right knee, schizoaffective disorder; post traumatic seizure; history of falling, post traumatic seizures; hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting right dominant side; personal history of traumatic brain injury; vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety. R7's MDS dated [DATE] documents R7 was cognitively intact for decision making of activities of daily living. R7 has impairment on both the upper and lower extremities on one side, uses a wheelchair, R7 needs substantial/ maximal, helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort for rolling left to right, sit to standing, lying sitting to setting on side of bed, chair bed to chair transfer, and toilet transfers. R7's Care Plan: Falls with a target date of 4/20/2024 for Goals documents, (R7) is at high risk for falls r/t (related to) unsteadiness, h/o (history of) falls, weakness, ROM (Range of Motion) deficit to LUE (Lower upper extremity) and LLE (Lower left extremity), noncompliance with safety guidelines. He uses a w/c (wheelchair) for mobility with assistance for transfers. R7's Nurse's Notes dated 9/23/2024 at 10:11 PM, Note Text: Resident observed on floor lying next to bed. Resident stated, I tried to transfer myself into bed Resident assessed for pain and injuries, none observed. Resident educated on assistance into bed and use of call-light. Resident verbalized understanding. Resident denies pain. NP notified and DON. Neuros started per facility protocol. R7's Incident Report dated 9/23/2024 Resident observed on floor lying next to bed. Resident stated, I tried to transfer myself into bed Resident assessed for pain and injuries, none observed. Resident educated on assistance into bed and use of call-light. Resident verbalized understanding. Resident denies pain. NP notified and DON. Neuros started per facility protocol. Resident stated, I was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 18 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0689 trying to get into bed Intervention: educated use of call light. BIMS high, appropriate intervention. Level of Harm - Minimal harm or potential for actual harm R7's Nurse's Notes dated 10/10/2024 at 3:12 PM, Note Text: The resident had a fall trying to transfer himself from the wheelchair to the bed. No call light was present for assistance. Educated resident on the use of call light for assistance with transfers. Bowel sounds are present. No injuries or bruising noted. Resident denies pain. The resident is currently lying in bed watching TV. Non labored breathing. Call light within reach. Residents Affected - Some R7's Incident Report dated 10/10/2024 documents, The resident had a fall trying to transfer himself from the wheelchair to the bed. No call light was present for assistance. Educated resident on the use of call light for assistance with transfers. Bowel sounds are present. No injuries or bruising noted. Resident denies pain. The resident is A & 0 x 3. The resident stated I was trying to transfer myself from my wheelchair to bed. I don't have time to wait. Immediate Action: Patient was educated on using call light to voice concerns. This is the same intervention documented on 9/23/2024. R7's Nurse's Notes dated 12/10/2024 at 6:20 PM, Hall CNA reported to this writer that resident was on the floor. Upon entry resident noted on floor on the side of his bed sitting on bottom. ROM (Range of motion) WNL (within normal limits). Resident states that he could not find his call light, so he attempted to get up by himself. Resident states that he did not hit his head, no complaints of pain, will follow up. R7's Incident Report dated 12/10/2024 at 9:21 AM, documents, Hall CNA (certified nursing assistant) reported to this writer that resident was on the floor. Upon entry resident noted on floor on the side of his bed sitting on bottom. ROM WNL. Resident states that he could not find his call light, so he attempted to get up by himself. Resident states that he did not hit his head, no complaints of pain. Will follow up. I was trying to get my call light. No interventions were documented for this fall. 3.R25's POS dated January 2025 documents a diagnosis of cerebral ischemia, moderate protein calorie malnutrition, need for assistance with personal care, unsteadiness on feet; other abnormalities of gait and mobility, other lack of coordination, weakness, muscle wasting and atrophy, related falls, cognitive communication deficit, age related physical debility; schizophrenia, altered mental status. R25's MDS dated [DATE] documents BIMS 6/15 severely impaired for cognition for activities of daily living. Uses a walker, no impairments on upper and or lower extremity. R25's Care Plan for Falls with a target date of 3/13/2024 documents, (R25) is at risk for falls, cognitive deficits, poor balance, repeated falls, and weakness. R25's Progress Notes dated 2/1/2025 3:53 PM, Text: Right lateral upper forearm is noted to have a scab. Area is noted to be a scab at this time with no drainage noted. Area is not open at this time. Area measured 1.6 in x 1 in x UTD. Upon investigation with the administrator, (V1), it was determined that the resident's right arm of his wheelchair is cracked, and peeling causing rough edges over the cushion of the arm of the chair. Upon discussion with therapy, we discussed a proper intervention to be to apply a foam pad covering on cushion of arm of w/c (wheelchair) Foam pad is secured to wheelchair with tape. Assessing patient as well as residents use of arm of wheelchair and it was noted to be okay with no concerns noted at this time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 19 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 2/20/2025 at 12:15 PM, V1 stated we believe R25's wheelchair was cover was cracking and it started to peel, and he scrapped his arm on the wheelchair, and we ended up putting a pool noodle over that area. I don't know if any staff are responsible for checking wheelchairs daily and or staff, but I would expect if any staff saw any equipment breaking down to notify me. I do not believe any one is responsible for checking wheelchairs, but I have been ordering new wheelchairs and replacing a lot of wheelchairs. I would have to look at my policy. The Maintenance Equipment Policy dated 1/2025 documents, The policy of (Facility) shall provide that Medical Equipment be maintained for optimum performance. The Fall Prevention and Management Policy dated 8/2024 documents, This facility is committed to maximizing each resident's physical, mental and psychosocial well-being. While preventing all falls is not possible, the facility will identify and evaluate those residents at risk for falls, plan for preventive strategies, and facilitate as safe as an environment as possible. All resident falls shall be reviewed, and the resident's existing plan of care shall be evaluated and modified as needed. 4. R30's admission Record, dated 1/30/25, documents R30 was originally admitted to the facility on [DATE] with diagnosis of Hemiplegia/Hemiparesis, Respiratory failure, Obesity, Type 2 Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Cellulitis of Right Lower Leg, Left Above Knee Amputation (LAKA), Chronic Ulcer of Right Calf, Chronic Kidney Disease (CKD)-stage 3, Acute Kidney Failure (AKF), Cardiomyopathy, Congestive Heart Failure (CHF), Lymphedema, Peripheral Vascular Disease (PVD), Automatic Implantable Cardioverter Defibrillator (AICD), COVID, Atrial Fibrillation, Arteriosclerotic Heart Disease (ASHD), Major Depressive Disorder, Myocardial Infarction, Occlusion coronary artery, Hypertension (HTN). R30's Care Plan, dated 11/27/24, documents R30 is at risk for falls and requires assistance from staff with Activities of Daily Living (ADLs). R30 is an extensive assistance x two using full body mechanical lift device for transfer, bed mobility and toileting. R30 utilizes wheelchair for primary mode transportation. Interventions: Motorized wheelchair use, encourage R30 to go at slower speeds, 7/6/24 - staff educated to make sure full body mechanical lift device straps are secured, continue to encourage R30 to wear socks and shoes, encouragement provided to use her call light to allow staff to assist her with transfers, R30 to make sure properly situated in motorized wheelchair prior to motion, staff to assist as needed. R30's Minimum Data Set (MDS), dated [DATE], documents R30 is cognitively intact and is dependent on staff for ADLs and transfers. On 1/30/25 at 9:45 AM, V25, Certified Nurse's Assistant, CNA, and V26, CNA, brought in the full body mechanical lift device in to transfer R30 from her electric wheelchair to her bed. The lift device sling was already underneath R30. V25 and V26 attached the sling to the lift device and when starting to lift R30, both noticed that R30 was leaning to the left side. R30 was lowered back to her wheelchair and V25 stated Whoever put this sling under her did it backwards, the feet side is where her head is, and it is the wrong size. Both readjusted the sling and lifted R30 off her wheelchair anyway and moved R30 to her bed, then lowered to the bed, and the sling removed. V25 stated This sling looks like it is a Medium size because the edges are green, and R30 should probably have a larger one. R30's Nursing Note, dated 7/6/24 at 9:00 PM, documents Resident fell out of w/c (wheelchair) outside on smoke break said she caught her (full body mechanical) lift bad under her wheel of her w/c and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 20 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0689 Level of Harm - Minimal harm or potential for actual harm slid out c/o (complaint of) minor pain in left hip states I did not hit my head stat x-ray 2 views left hip ordered, resident refused to go to hospital for assessment, this nurse assessed resident and skin intact 0 abnormalities in ROM (range of motion), is LAKA (left above the knee amputation), v/s (vital signs) stable T (temperature) 97.7, P (pulse) 84, R (respirations) 20, B/P (blood pressure) 107/60, PERRLA (pupils equal, round, and responsive to light and accommodation) present. Residents Affected - Some R30's Fall Risk Evaluation, dated 1/24/25, documents R30 is a High Fall Risk. The Facility's Mechanical Lift - Hoyer Policy, dated 10/2024, documents To assist the lift and transfer of a resident from one surface to another using a (full body mechanical) lift when appropriate. 1. Identify resident and explain procedure. 2. Check the sling for rips, tears, or abnormal wear prior to use; if noted, take out of circulation immediately, and notify DON or designee. 3. Place sling evenly under resident. 4. Position mechanical lift so the frame can be conversed, over the resident. Attach the fabric to the frame. Note manufacturer's instructions for specifics of how sling should be attached to frame. 8. In the event the (full body mechanical lift) cannot perform a complete transfer, staff are advised to immediately initiate a safe transfer by lowering resident to a secured position (i.e., chair, bed, floor). The Battery-Powered Patient Lift Manufacturer's User Manual, dated 2002, documents Page 11: 2.2.5 Using the Sling: Be sure to check the sling attachments each time the sling is removed and replaced to ensure it is properly attached before the patient is removed from a stationary object (bed, chair, or commode). If the patient is in a wheelchair, secure the wheel locks in place to prevent the chair from moving forward or backward. When connecting slings equipped with color-coded straps to the patient lift, the shortest of the straps MUST be at the back of the patient for support. Using the long section will leave little or no support for the patient's back. The loops of the sling are color coded and can be used to place the patient in various positions. The colors make it easy to connect both sides of the sling equally. Make sure there is sufficient head support when lifting a patient. Page 12: 2.2.6 Lifting the Patient: When elevating a few inches off the surface of the stationary object (wheelchair, commode, or bed) and before moving the patient, check again to make sure the sling is properly connected to the hooks of the hanger bar. If any attachments are not properly in place, lower the patient back onto the stationary object (wheelchair, commode, or bed) and correct the attachments. Page 18: 4.2 Full-Body, Divided-Leg, and Toileting Slings: Size Medium -Width 41.5, Length 54.7, Weight Capacity 450. Large - Width 45.5, Length 60.5, Weight Capacity 450, X-Large - Width 45.5, Length 65.3, Weight Capacity 450. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 21 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. On 2/3/2025 at 12:00 PM, R4's room had 2 white-oblong shaped pills and a 30 milliliter (ml) disposable medication cup with 20 ml of a white powdery substance in it sitting on her nightstand. R4 was not in the room at this time. R4's Physician's order sheet, dated 2/2025, documented diagnoses of Encephalopathy, other Specified Sepsis, COPD. There was no order to leave medication at the bedside. R4's MDS, dated [DATE], documented that her cognition was intact. R4's Care Plan, dated 3/2/2022, documented, Administer medication as ordered. 4. On 2/3/2025 at 12:05 pm, in R36's room there was a Ventolin inhaler on her overbed table. The Ventolin inhaler did not have R36's name on it nor was it labeled or dated. R36 was not in her room at this time. R36's Physician's order sheet, dated 2/2025, documented diagnoses of Hemiplegia and Hemiparesis following CVA of right dominate side, Unspecified asthma, and HIV. It also documented and order on 9/5/2024 of Albuterol HFA 108 (90) base MCG/ACT Aerosol 1 puff every 4 hours as needed Shortness of breath. There was no order documenting that R36 could self-administer her medications. V2, Director of Nurses, documented an order on 2/3/2025 at 12:26 pm, May keep Albuterol Inhaler at bedside per patients request. R36's MDS, dated [DATE], documented that her cognition was intact. R36's Care Plan, dated 10/2/2024, documented, Administer medications/treatments as ordered. 5.On 2/3/2025 at 12:07 pm, in R37's room, there was Nystop powder on overbed table with R39's name on the container. R37's Physicians order sheet, dated 2/2025 documented diagnoses of Primary Generalized osteoarthritis, Unspecified Dementia, Unspecified without behavioral disturbance psychotic disturbance, mood disturbance and anxiety and Bipolar disorder. R37's Physicians order sheet did not document an order for Nystop powder. R37's, MDS, dated [DATE], documented that her cognition was intact. R37's Care Plan, dated 4/2/2024, documented, Administer medications as prescribed the physician. 6. On 2/3/2025 at 12:08 PM, in R38's room, in a small medicine cup, there was 1- green-peach colored capsule, 1-large white round pill and 1-smaller white round pill that was on her overbed table. R38 was not in her room at that time. R38's Physician order sheet, dated 2/2025, documented diagnoses of Schizophrenia, Depression, and a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 22 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0761 Personal History of Traumatic Brain Injury. Level of Harm - Minimal harm or potential for actual harm R38's MDS, dated [DATE], documented that her cognition was intact. R38's Care Plan, dated 1/11/2024, documented, Administer medications as prescribed the physician. Residents Affected - Some On 2/3/2025 at 12:50 PM, V33, Licensed Practical Nurse (LPN), stated that R38 is an independent resident and had asked her to leave her morning medicine on her table in her room so she could take them after breakfast. V33 then stated, Is that not allowed? State Agency Nurse then asked V33 if R38 had an order to leave her medications at the bedside and she stated, No. V33 then stated that those meds were the only medication that she had left at the bedside today. On 2/3/2025 at 12:20 PM, V1, Administrator, was shown the above medications that were left at residents' bedside. She then collected all medication and stated that the nurses should not leave medications at the bedside. The facility's policy, Medication Administration, dated 4/2024, documented, Guideline: 1. An order is required for administration of all medication. 2. Medications are administered by licensed personnel only. It continues, 6. check medication administration for the right medication, dose, route, patient/resident, and time. It continues, 14 Prepare or pour each dose of medication using an appropriate measuring device. It continues, 19. Identify resident using two resident identifiers. It continues, 21. Remain with the resident to ensure that the resident swallows the medication. The facility's policy, Storage of Medications, dated 3/2024, documented, Storage of Medications: 1. Medication and biologicals must be stored safely, securely, and properly, following the manufacturer's recommendations or those of the supplier. The medication supply should only be accessible to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medication. Based on observation, interview, and record review the facility failed to properly store medications for 6 of 6 residents (R4, R11, R34, R36, R37, R38) observed for proper medication storage in the sample of 51. The Findings Include: 1. R11's admission Record, dated 2/3/25, documents R11 was admitted to the facility on [DATE] and discharged on 1/29/25 with diagnosis of Compartment Syndrome of right lower extremity, Type 2 Diabetes Mellitus (DM), Accidental discharge from firearms, Deep Vein Thrombosis, Malignant neoplasm of colon, Vascular implants and grafts, Hypertension (HTN), and Peripheral Vascular Disease (PVD). R11's Care Plan, dated 1/22/25, documents R11 is at risk for bleeding/bruising related to anticoagulation medication use. He takes Lovenox as ordered. He has a history embolism. R11's Minimum Data Set (MDS), dated [DATE], documents R11 was cognitively intact. R11's Physician Order, dated 12/31/24, documents Enoxaparin Sodium (Lovenox) Injection Solution Prefilled Syringe 120 MG/0.8ML Inject 0.8 ml subcutaneously every 12 hours for Prophylaxis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 23 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0761 Level of Harm - Minimal harm or potential for actual harm R11's Medication Administrator Record (MAR), dated January 2025, documents the morning dose was the last dose of Enoxaparin injection was given on 1/29/24. On 1/30/25 at 8:45 AM, a small Enoxaparin syringe with needle exposed and not covered was seen sitting on a side table next to R11's bed. Residents Affected - Some On 1/30/25 at 8:50 AM, V23, Licensed Practical Nurse (LPN), stated that R11 was discharged the evening before. V23 stated R11 gets Lovenox in the morning and the evening and that this syringe must have been from last evening before R11 left. V23 confirmed that it was a Lovenox syringe and took the syringe and put it in a sharps box. 2. R34's admission Record, dated 2/3/25, documents R34 was originally admitted on [DATE] with diagnosis of Metabolic Encephalopathy, Type 2 DM, Cirrhosis of liver, Morbid obesity, Cardiogenic shock, Nicotine dependence, Myocardial Infarction, Congestive Heart Failure (CHF), and Chronic Kidney disease. R34's Care Plan, dated 1/10/25, documents R34 is at risk for constipation related to medication side effects. Interventions: Give medication as ordered, monitor for signs and symptoms of GI distress. R34's MDS, dated [DATE], documents R34 is cognitively intact. On 1/30/25 at 9:00 AM, V15, Registered Nurse (RN), stated When I give residents their medications, I make sure they take all of their meds (medications) before I leave the room. I do have some that say they want to take them later and want me to leave them for them, but I will make sure they take them in front of me. I don't leave the meds in a cup for the residents. On 1/30/25 at 9:05 AM, R34 was seen sitting on the side of his bed with a medicine cup with two tablets in it sitting on his bedside table in front of him. R34 stated the nurse gave him some Tums and he has not taken them yet. On 1/30/25 at 9:10 AM, when asked about R34 having two pills in a medicine cup on his table, V15 stated Yes, I gave those to him earlier. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 24 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Interview, Observation, and Record Review, the facility failed to maintain a clean and sanitary environment during wound care, and to wear Personal Protective Equipment (PPE) for residents who are on Enhanced Barrier Precautions (EBP) for 3 of 3 residents (R3, R5, R37) reviewed for wound care in the sample of 19. Residents Affected - Few The findings include: 1. R3's admission Record, dated 5/12/25, documents R3 was admitted to the facility on [DATE] with diagnosis of Cerebral Infarction, Paraplegia, Flaccid Neuropathic Bladder, Moderate Protein-Calorie Malnutrition, and Osteomyelitis. R3's Care Plan, dated 3/5/25, documents R3 requires assist with daily care. Interventions: Monitor skin integrity during routine care and report abnormal findings. It continues R3 requires Enhanced Barrier Precautions (EBP) related to wound and indwelling medical device (urinary catheter). Interventions: Enhanced Barrier Precautions as per facility protocol, staff to wear gown and gloves when performing ADL's (activities of daily living): Dressing, bathing/showering, transferring, providing hygiene, changing linen, changing briefs or assisting with toileting. R3's Minimum Data Set, (MDS), dated [DATE], documents R3 has a moderate cognitive impairment and requires substantial/maximum assistance from staff for toileting and bathing. R3 is at risk for pressure ulcers and has one unhealed pressure ulcer. R3 has a pressure reducing device for bed and gets pressure ulcer care. On 5/12/25 at 8:32 AM, V3, Wound Care Nurse, was observed gathering supplies on top of her wound care cart outside R3's door to do wound care, then carried them into R3's room and placed them on R3's cluttered bedside table, pushing aside some items, without wiping it down or applying a clean barrier cloth to the table. R3 has signs on his door Please see the Nurse before entering the room and a Enhanced Barrier Precautions along with PPE (personal protective equipment) hanging on the door. R3's Care Plan documents R3 is on Enhanced Barrier Precautions. V3 did not don any PPE while performing wound care on R3. The old dressing was removed, dated 5/11/25 and placed on top of the clean supplies. After cleaning the wound, the 4X4 gauze pads used for cleaning the wound, and V3's soiled gloves were also placed on top of the clean supplies, then thrown away and the clean dressings were placed on R3. 2. R5's admission Record, dated 5/12/25, documents R5 was admitted to the facility on [DATE] with diagnosis of Cerebellar Stroke Syndrome, Hemiplegia, Type 2 Diabetes Mellitus (DM), Malignant Neoplasm of Skin, Schizophrenia, and Epilepsy. R5's Care Plan, dated 4/23/25, documents R5 is at risk for skin complications. Interventions: Skin assessment weekly, notify MD (Medical Doctor) of abnormal findings, assist and encourage resident to turn and reposition every one to two hours and PRN (as needed). It continues 5/5/25 R5 has Impaired skin integrity related to prolonged pressure and tissue breakdown as evidenced by full-thickness skin loss with exposed subcutaneous tissue. Intervention: Monitor wounds for signs of infection. It continues 5/8/25 R5 has Impaired skin integrity related to wound on left lateral knee. Intervention: Continue treatment as ordered for the wound on the left lateral knee. R5's MDS, dated [DATE], documents R5 has a moderate cognitive impairment and requires (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 25 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few partial/moderate assistance from staff for ADLs. R5 is continent of both bowel and bladder. R5 is at risk for pressure ulcers. On 5/12/25 at 8:25 AM, V3 gathered supplies to provide wound care for R5. V3 gathered supplies from her cart by lying them on top of unclean wound cart, then walked in and placed the supplies on the unclean sink counter with R5 sitting in his wheelchair at the sink after returning from a shower. There was no dressing seen on R5 as it was removed in shower. V3 provided wound care with no PPE worn for EBP, and no maintaining of a clean field during wound care. 3. R37's admission Record, dated 5/13/25, documents R37 was admitted to the facility on [DATE] with diagnosis of Morbid Obesity, Dementia, Schizophrenia, Delusional Disorder, Bipolar Disorder, major Depressive Disorder, Degenerative Disease of Nervous System, Epilepsy, Idiopathic and Peripheral Autonomic Neuropathy. R37's Care Plan, dated 5/1/25, documents R37 is at risk for skin complications. Interventions: Assess and document of progress of areas weekly, educate resident on the risks of infection and poor healing r/t non-compliance, educate resident on MD orders for wound care, observe and assess regularly, Skin assessment weekly. 5/1/25 R37 was seen by wound NP (Nurse Practitioner), continue Betadine to plantar right foot and right heel. It continues 4/23/25, R37 returned from hospital after foot surgery with interventions: Monitor the right heel and plantar foot wound sites during dressing changes for signs of infection or delayed healing and report changes to the WNP (Wound NP). R37's MDS, dated [DATE], documents R37 is cognitively intact and is dependent on staff for toileting and dressing, and requires substantial/maximum assistance for bathing. R37 is occasionally incontinent of both bowel and bladder. R5 is at risk for developing pressure ulcers. On 3/12/25 at 11:20 AM, R37 was sitting in her wheelchair by her bed, when V3 entered to do wound care on R37. V3 gathered supplies on top of her unclean wound cart, then took the supplies to a table by R37's bedside and placed the clean supplies on the soiled table without wiping it off or putting barrier cloth down. V3 removed R37's old dressing on top of the clean supplies on the table, V3 then placed her soiled gloves, and the 4X4s used to clean the wound also on top of the clean supplies. V3 then walked the soiled items to the trash can by the door, then continued with wound care and put the clean dressings that were on the table onto R37's wound. There was no PPE worn while on EBP during wound care and V3 did not have a clean and sanitary place to put the clean wound care supplies. On 5/12/25 at 11:45 AM, V3 stated Anyone who has a wound and is getting wound care should be on EBP, and staff should be wearing PPE especially while performing care. On 5/13/25 at 11:05 AM, V8, Certified Nursing Assistant (CNA), stated If a resident is on EBP, I make sure to use PPE any time I am doing resident care. On 5/13/25 at 11:10 AM, V21, Registered Nurse (RN), stated Any time a resident is receiving wound care or dressing changes, they should automatically be on EBP. If the resident is on EBP, I gown up, use gloves and goggles, if necessary, do hand hygiene, and dispose of the dirty PPE and dressings. On 5/13/25 at 11:14 AM, V22, Licensed Practical Nurse (LPN), stated All residents receiving wound care or dressing changes are considered to be on EBP. I would wear appropriate PPE when doing the wound care or any other resident care. I would maintain a clean field so I can have a place for the clean items, then have a dirty field for the soiled items. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 26 of 27 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 145613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Cahokia 3354 Jerome Lane Cahokia, IL 62206 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 5/13/25 at 11:50 AM, V2, DON, stated I would expect all staff to wear appropriate PPE while doing any resident care, especially wound care, if a resident is on EBP. I would expect the nurses who are doing the wound care to provide a clean and sanitary environment and maintain a clean and a dirty area. The Facility's Enhanced Barrier Precautions (EBP) Policy, dated 10/16/23, documents Our facility employs the use of Enhanced Barrier Precautions (EBP) to reduce transmission of MDROs (Multi-Drug-Resistant Organism) to staff hands and clothing that employees targeted gown and glove use during high-contact resident care activities. EBP are indicated (when contact precautions do not otherwise apply) for residents with any of the following: Open wounds that require a dressing regardless of MRDO status, or an indwelling medical device regardless of MDRO status, or colonization with a targeted MDRO/XDRO (Extensively Drug-Resistant Organism). Process: Staff utilize gown and gloves for high-contact resident care activities when residents require EBP; high contact activities may include: Dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator, and Wound Care: any skin opening requiring a dressing. The Facility's Infection Control Program Content Policy, dated 10/2024, documents The Infection Control Program establishes guidelines to follow in the prevention and control of contagious, infectious, or communicable diseases. The objectives of the program are to: Provide a Safe and Sanitary Environment. Prevent or control the spread of communicable diseases. Establish guidelines that adhere to standards of care and CDC (Centers for Disease Control) guidelines. Administration and the Infection Control Designee assure that infection control guidelines and procedures are implemented and followed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 27 of 27