Inspection·July 16, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to promote resident's dignity by answering call lights and addressing resident's needs for 4 of 4 residents (R1, R2, R3, R6) reviewed for Resident Rights in the sample of 6.Findings include: 1.R6's Face sheet documented he was admitted to the facility on [DATE] with diagnosis of, in part, dementia, hypothyroidism, and zoster ocular disease.R6's Minimum Data Set (MDS) dated [DATE] documented he was cognitively intact and required supervision or touching assistance from staff for toileting hygiene and toileting transfers as well as needing partial/moderate assistance with lower body dressing. R6's Care Plan dated 10/18/22 documented he is at risk for falls with an intervention added on 9/26/24 to keep nurse call light within easy reach and instruct resident to use call light for assistance. R6's Care Plan dated 10/18/22 documented a plan for ADLs (activities of daily living) with an intervention added 9/26/24 to assist to toilet as needed and assist with hygiene after voiding/bowel movements to prevent skin breakdown. On 7/15/2025 at 5:13 AM, R6's room call light is lighted up and on above his door. On 7/15/2025 at 5:14 AM, at the nurse's station the call light is beeping and is audible and flashing in red. The computer documents R6's call light was turned on and has been on for 32 minutes. The computer documents the room number and the amount of time the call lights have been on.On 7/15/2025 at 5:30 AM, at the nurse's station the lights are flashing, and the computer is beeping. On the computer R6's room was identified and documented the light had been activated for 44 minutes. On 7/15/2025 at 5:42 AM, R6's call light is still on and beeping at the nurse's station and lighting up. On 7/15/2025 at 5:43 AM, the computer at the nurse' station document the call light for R6's room was on for 50 minutes.On 7/15/2025 at 5:48 AM, on the V8 (Licensed Practical Nurse/LPN) stated, I am working the 200 and 300 halls. Usually during the night shift, we have two halls that we are responsible for, and we have a CNA working on each hall. We can always use more help. It's hard if a staff goes on break because sometimes, I can't even take a break because of the load we have. The computer tells us what call lights have been turned on and how long the response is before they are answered. I see Room (R6's) call light has been going off for 50 minutes now and has not been answered.On 7/15/2025 at 5:50 AM, V8 (LPN) opened R6's door and asked him what he needed. R6 was in the bathroom sitting on the toilet and could be observed from the hallway. On 7/15/225 at 5:51 AM, V8 stated R6 needed a pull up/adult diaper.On 7/15/2025 at 5:58 AM, R6 stated he had been on the toilet for almost an hour waiting for staff to answer his call light and bring him a (adult pull up diaper) as he was out. I think they need more staff to answer the call lights at night.2.R2's Face sheet documented he was admitted to the facility on [DATE] with diagnosis of, in part, displaced fracture of upper end of left humerus, morbid obesity, acute pain, overactive bladder, and type two diabetes mellitus.R2's MDS dated [DATE] documented he was cognitively intact and was dependent on staff for toileting hygiene and required substantial/maximal assistance from staff for toileting transfers.R2's Care Plan dated 4/26/25 documented a plan for (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 2 Event ID: 145620 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 145620 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evervella of Swansea 100 Rosewood Village Drive Swansea, IL 62220 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)