Inspection·January 27, 2025

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the Facility failed to adhere to their Facility's Abuse Policy and Prevention Program for 1 of 3 residents (R1) in the sample of 3. Residents Affected - Few Findings include: The Facility's Abuse Policy and Prevention Program dated 10/2022 documents, Any incident or allegation involving abuse, neglect, exploitation, mistreatment or misappropriation of resident property will result in an investigation. It continues to document, Investigation Procedures: The appointed investigator will, at a minimum, attempt to interview the person who reported the incident, anyone likely to have direct knowledge of the incident and the resident, if interviewable. Any written statements that have been submitted will be reviewed, along with any pertinent medical records or other documents. It continues, Informing Local Law Enforcement- The Facility shall also contact local law enforcement authorities in the following situations: When there is a reasonable suspicion that a crime has been committed in the facility by a person other than a resident. It continues, If there is a reasonable suspicion that a crime has been committed that results in serious bodily harm, a report shall be made to local law enforcement and IDPH (Illinois Department of Public Health) immediately. If there is a reasonable suspicion that a crime has been committed that is not listed above and does not involve serious bodily injury, then a report to local law enforcement as soon as possible, but within 24 hours of when the suspicion was formed. The Facility's Illinois Department of Public Health Incident Report dated 1/11/2025 documents, Incident Category: Drug Diversion. It further documents the victim was R1, who is not capable of communication (due to impaired cognition). It continues to document V4, Licensed Practical Nurse (LPN) and V5, Registered Nurse (RN) as witnesses. The report continues, The Facility notified me (V2) that medications were missing from the cart for resident. The medication in question is Lorazepam. It is scheduled every 6 hours. His last administered dose was 0600 ( 6 AM) by the midnight nurse. This medication was provided by hospice and was delivered on December 20th. He was provided with 4 (medication) cards for a one month supply. On evenings the night of 1/10 (2025) the third card was zero'd out (marked as empty on the narcotics count book) and 2 doses were given from the new card. Interview with the nurse that worked an evening/night shift recalls that she completed 1 card and started using a new card and that there were 28 (pills) left in the card. The nurse that assumed care of the hall notified the other nurses working on another hall that the medication was not available and they assisted her in reaching out to the hospice team. They learned from hospice the amount and date of last delivery. The three nurses then searched the carts for this missing medication. When they were unable to located this medication they notified me of this issue. Video footage was reviewed and was inconclusive on who took the mediation. (Local) police department was notified and a report was made. Resident was assessed and no negative outcome was noted. The hospice doctor was notified of this occurrence, administrator notified. This report was completed by V2, Director of Nursing (DON). (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: 145655 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 145655 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Woodriver 393 Edwardsville Road Wood River, IL 62095 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)