Inspection·June 5, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm giving you another towel. I can clean myself up, but you can't. R4 stated later that night, the CNA through two dry towels at her but didn't get soap and water to use. R4 stated she likes to make sure she is cleaned up well because she doesn't want to get any more UTIs (urinary tract infections). R4 stated she knows when she has to use the toilet or bed pan but is never offered those especially at night and wishes she was. R4 stated she thinks this place is a psych (psychological) facility and it's horrible. Residents Affected - Few On 6/5/25 at 2:50 PM, V1, Regional Administrator, stated she expects all the residents to be treated with dignity and respect. Resident Council Meeting Minutes dated 3/26/25 documented concerns with CNAs (certified nursing assistants) not talking to residents right. Resident Council Meeting Minutes dated 3/26/25 documented that CNAs are telling residents what they will and won't do and when they will and won't get the up; the dietary weekend staff is very disrespectful to resident and when it's reported nothing happens. The facility's Resident Rights policy dated 2/2024 documented it is the facility's policy to identify and provide reasonable accommodation for resident needs and preferences except when it would endanger the health or safety of the resident or other residents. Residents have the right to retain and use personal possessions to promote a homelike environment and to support each resident in maintaining their independence. The facility will provide a safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 2 of 5 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 06/05/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to provide a safe, clean, comfortable, and homelike environment for 4 out of 4 residents, (R1, R3, R4, and R5); reviewed for resident rights in a sample of 5. Findings include: 1.R1's face sheet documented she was admitted to the facility on [DATE] with diagnosis of, in part, alcohol abuse, cognitive communication deficit, and cerebral aneurysm. R1's minimum data set (MDS) dated [DATE] documented R1 was moderately cognitively impaired. On 6/5/25 at 10:20 AM, R1's room had several dead cockroaches on the floor under her bed, a strong musty smell was present, dirty dishes and trash bin are covered in gnats. R1's floor had several dried-up liquid markings and missing floorboards containing dark residue. R1 stated she would like her room to be cleaned very much. 2.R2's face sheet documented he was admitted to the facility on [DATE] with diagnosis of, in part, Parkinson's disease, mild protein-calorie malnutrition, and type two diabetes mellitus. R2's MDS dated [DATE] documented R2 was cognitively intact. On 6/5/25 at 11:00 AM, R2's bathroom sink, and toilet had yellow-colored rings. R2 stated he doesn't understand why they can't clean his restroom up nicely. R2 stated it does not smell good at this facility ever and the paint is chipped throughout his room. R2's paint was chipped in multiple locations of his room. R2's air conditioning (A/C) unit was filled with dirt and dust as it blew air out. R2 stated the A/C unit isn't even sealed properly. 3.R4's face sheet documented she was admitted to the facility on [DATE] with diagnosis of, in part, hemiplegia and hemiparesis following cerebral infarction, major depressive disorder, and anxiety disorder. R4's MDS dated [DATE] documented she was cognitively intact. On 6/5/25 at 11:30 AM, R4 stated the floors here are too filthy for even my family to visit, they refuse to come. R4's A/C unit had trash inside the blowers including a tissue, a bottle cap, and random unidentifiable objects. 4.On 6/5/25 at 12:04 PM, R5's room had missing floorboards, a strong musty smell, and paper towels in A/C unit seals with a build up of dust where the air blows out. On 6/5/25 at 10:09 AM, the south hall community bathroom/shower room had black buildup on the wall where tiles were missing, several floor tiles had cracks with dark discoloration in them. On 6/5/25 at 10:28 AM, the bath/shower room on [NAME] hall has cracked tiles with dark discoloration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 3 of 5 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 06/05/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 6/5/25 at 10:57 AM, the central hall community bath/shower room had missing tiles behind the toilet, cracked missing tiles next to the shower with dark matter inside and part of the actual wall missing, a strong musty urine and stool smell is noted with humidity and damp floors. On 6/5/25 at 12:05 PM, pink and black discoloration on cracks of the bottom creases and corners seen shower on [NAME] community bath/shower room located across the hall from room [ROOM NUMBER]. On 6/5/25 at 10:15 AM, V3, housekeeping, stated the condition of the south hall bathroom has been that way since at least October of 2024, the central hall community bath/shower rooms also have these same issues included the one next door to this one. V3 stated that the missing tiles soak up all the dirt and bacteria but there is no way we can clean them up enough because they are broke. The bath/shower room next door was seen and had cracked tiles on floor and walls with the wall broken through to the wooden bases. V3 stated the wall tiles and foundation behind it are broke with discoloration seen. V3 stated it's concerning because these are high moisture areas the toilet overflows a lot due to one of the residents as well. V3 stated there is black buildup of some sort there. V3 stated R1's room has a cockroach problem also. On 6/5/25 at 10:28 AM, V3 (housekeeping) stated the missing floorboards are a concern just like the cracked tiles because they hold everything in and when liquids such as urine spill, it gets trapped it those places. V3 stated she would like to be able to clean it better, but we can't use bleach. V3 stated she doesn't know what they plan to do about it. On 6/5/25 at 11:15 AM, V4, housekeeping, stated she's noticed a lot of the dirt cracked tiles and floorboards for about 4 months now (since she started working here) and they harbor a lot of bacteria and it's worrisome. V4 stated there is a musty smell throughout the building and they need better cleaning products to be able to manage things properly. V4 stated the black/dark discolored sections in the bath/shower rooms could be mold. On 6/5/25 at 12:17 PM, V5, registered nurse (RN) stated the facility could be a bit more sanitary. On 6/5/25 at 12:17 PM, V6 certified nursing assistant (CNA) stated the cleanliness of the facility needs improvement, there are gnat build ups, but they have been getting better. On 6/5/25 at 2:50 PM, V1, Regional Administrator, stated she does not expect the facility to have a gnat buildup, cockroaches, and dirty buildups in the shower rooms, toilets, or sinks. V1 stated she expects the tiles and floorboards to be intact for sanitary and dignity reasons. V1 stated she expects all the A/C units are maintained in good working conditions without dirt, dust, or garbage within them. Resident Council Meeting Minutes dated 5/28/25 documented housekeeping needed to clean all rooms every day and maintenance not doing their job. R4 stated her floors are dirty. Resident Council Meeting Minutes dated 4/30/25 documented an issue of bad odor in the building and residents feel it never smells good. Resident Council Meeting Minutes dated 3/26/25 documented residents want 24-hour housekeeping to stop the smell. The facility's Pest Control policy dated 10/2017 documented the facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. The policy goes on to document that Garbage and trash are not permitted to accumulate and are removed from the facility daily; maintenance services assist, when appropriate and necessary, in providing pest control (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 4 of 5 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 06/05/2025 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 0584 services. Level of Harm - Minimal harm or potential for actual harm The facility's Resident Rights policy dated 2/2024 documented it is the facility's policy to identify and provide reasonable accommodation for resident needs and preferences except when it would endanger the health or safety of the resident or other residents. Residents have the right to retain and use personal possessions to promote a homelike environment and to support each resident in maintaining their independence. The facility will provide a safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145613 If continuation sheet Page 5 of 5