Health inspection·October 8, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to call emergency medical services, EMS, in a timely manner for 1 (R2) of 3 residents reviewed for delay in treatment in the sample of 10. This delay in treatment resulted in R2 experiencing a low oxygen level and later expiring at the the hospital from an unknown cause.Findings Include: R2's Face sheet documents an admission date of 7/30/2025. Diagnosis include Multiple Fractures of Ribs, Right Side, Wedge Compression Fracture of T11-T12 Vertebrae, Dysphagia, Severe Protein Calorie Malnutrition, Acute Thrombosis of Left Femoral Artery. R2's MDS dated [DATE] documents R2 is cognitively impaired.R2's care plan dated 7/31/2025 documents R2 is at risk for altered nutrition and hydration related to diagnosis of Pulmonary Embolism, Fracture of Thoracic Vertebra, Lumbar Fracture, Hyperlipidemia, Dementia.R2's progress notes dated 9/14/2025 at 3:12PM document Note Text: R2 sent to hospital due to possible aspiration and shortness of breath. Oxygen Saturation at 65%. R2 placed on Oxygen with rebreather mask until Emergency Medical Services, EMS, arrived. Blood Pressure cuff continued to read error, unable to obtain Blood Pressure. Emergency contact made aware of transfer.R2's progress notes dated 9/14/2025 at 5:30PM Telehealth Visit Chief Complaints: Emergency Department, ED, Transfer (R2 left building) Comments: R2 sent to ED at 3:12PM. Shortness of Breath, possible aspiration, Oxygen Saturation 65%, R2 placed on Oxygen. Lungs with audible crackles, unable to obtain vital signs. sent to hospital.No documentation of when change of condition began. No documentation of time EMS called. No SBAR, Situation, Background, Assessment, Recommendation, Assessment form completed. No documentation of notification of Physician during change of condition or before EMS being called.On 9/24/2025 at 12:10PM V2, Director of Nursing, DON, stated this happened on a Sunday. The nurse working said this was an acute change in condition. R2 had been fine all day and suddenly was having trouble breathing. R2 was immediately sent out. The nurse did not even call telehealth before calling Emergency Medical Services, EMS.On 9/24/2025 at 12:20PM V4, Certified Nursing Assistant, CNA, stated I was working the day (R2) was sent out to the hospital. When I came in the morning, I cleaned her up and fed her breakfast. (R2) ate all her breakfast and was not coughing or choking at all. She was on a pureed diet. I also fed her lunch. She took most of her lunch and drank all her drinks. I am not sure what time I checked on her next. I want to say 12:00PM-1:00PM. I noticed she was wheezing. I got (V5), Licensed Practical Nurse, LPN, and (V5) got (V3), Assistant Director of Nursing, ADON.On 9/30/2025 at 10:30AM V4, CNA, stated On 9/14/2025 I had started collecting the lunch trays after residents were finished with lunch. That is around the time I checked on (R2) and heard her breathing and rattling. It would've been 12:30PM to 1:00PM. When asked V4 if R2 was alert during the change in condition, V4 stated Her eyes were glazed over.On 9/24/2025 at 1:30PM V5, LPN, when asked about the change of condition on 9/14/2025 regarding R2, stated What about (R2)? (R2) had been fine all day. She ate fine. (V4), CNA, came and got me and told me (R2) was not the same. (R2) had shortness of breath and crackles that were audible. We got the oxygen tank, and I got (V3), Residents Affected - Few (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: 145668 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 145668 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Belleville 150 North 27th Street Belleville, IL 62226 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)