Inspection·July 2, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the Facility failed to prevent verbal abuse for 1 of 5 residents (R9) by (R6) for two residents (R9, R6) reviewed for abuse in the sample of 9. Findings include: R9's Face Sheet documents R9 was admitted to the facility on [DATE] with diagnoses including hemiplegia and hemiparesis following cerebral infarction, need for assistance with personal care, and vascular dementia. R9's Minimum Data Set (MDS) dated [DATE] documented R9 was cognitively intact and required substantial assistance with bed mobility and transfer. R9's Care Plan dated 11/14/18 documents R9 is at risk for abuse and neglect related to communication deficit, weakness to right side and requirement for assistance with care tasks. R6's Face Sheet documents R6 was admitted to the facility on [DATE] with diagnoses including depression and paranoid schizophrenia. R6's MDS dated [DATE] documented R6 was moderately cognitively impaired and ambulated with supervision. R6's Care Plan dated 10/1/14 documents R6 has a history of peer to peer altercations and is verbally aggressive and hard to redirect at times. R6's Progress Note by V20, Registered Nurse (RN), on 3/24/25 documents R6 was getting an item off the food tray cart and another resident told him he cannot do that without staff permission. R6 made explicit comments and aggressive behaviors walking toward the other resident. V20 attempted to de-escalate and redirect R6, but R6 approached the other resident with his fist balled up to side. V20 stepped in between the resident and R6 and closed the door to provide a barrier. R6 then began speaking toward V20 in an explicit and aggressive tone. R6 was encouraged to go to his room and calm down. On 7/1/25 at 2:20 PM, V20 stated R6 was taking an item off the food cart and R9 told him he should not do that. R6 then became aggressive toward R9 and walked toward him with his hand in a fist. V20 stepped between the two residents and closed the door to R9's room. There was no physical contact, but R6 made verbally abusive comments toward R9. (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 07/02/2025 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)