Inspection·April 10, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, the facility failed to provide incontinence care to 2 of 3 residents (R1, R4) reviewed for incontinent care in the sample of 6. Residents Affected - Few Findings include: 1.R4's Face sheet documents an admission date of 9/23/2015 with diagnoses of Cerebral Palsy, Intellectual Disabilities, Neuralgia and Neuritis Contracture of Left and Right Knee, Schizoaffective Disorder, Bipolar type, Contracture Right Elbow. R4's Minimum Data Set, MDS, updated 3/27/2025 documents R4 has no cognitive impairments and is dependent for mobility and transfers. MDS dated [DATE] documents R4 is always incontinent of bladder and bowel. R4's Care Plan updated 3/3/2025 documents Activities of Daily Living, ADL: R4 is alert with a diagnosis of Cerebral Palsy, Mental Retardation, Schizoaffective disorder, and Depression. R4 requires extensive to total assistance of one with his daily care tasks He has functional incontinence of both bowel and bladder and is noted to demand to wear multiple depends at one time. Interventions include keep clean and dry after each incontinent episode. On 4/8/2025 at 9:19 AM, R4 stated he has to wait a long time after pushing his call light for staff to come change him and clean him up. R4 stated he has to wait at least 40 minutes after pushing his light for staff to come into his room. R4 stated he often sits in a wet (incontinence brief) and bedding for long periods of time, especially at night and this does not make him feel good at all. On 4/9/2025 at 6:00AM V13, Certified Nursing Assistant, CNA, and V14, CNA, entered R4's room. V14 took R4's incontinence brief off. R4's incontinence brief was heavily wet with urine. V14 discarded R4's brief. V14 then put new brief on R4 without performing incontinent care or peri care. Then V14 proceeded to dress R4. 2.R1's Face sheet documents an admission date of 3/31/2025 with diagnoses of Cerebral Infarction, Hemiplegia Unspecified affecting left nondominant side, Osteoarthritis, Schizoaffective Disorder. R1's MDS dated [DATE] is in progress due to being new admit. R1's Baseline Care Plan dated 4/2/2025 documents FALL: R1 is at risk for falls Functional Deficits, Poor Balance, Use of Psychotropic Medication. Interventions include educated R4 to call for assistance when needing help to go to the bathroom. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 145613 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 04/10/2025 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)