Inspection·November 21, 2025

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide appropriate services to 1 of 1 (R6) resident investigated for dementia care in a sample of 9. Findings include:R6's EMR (Electronic Medical Record) undated documents that the resident was admitted to the facility on [DATE].R6's EMR dated 8/5/25 documents diagnose of unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety; and Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side.R6's MDS (Minimum Data Set) dated 11/11/25 documents a BIMS (Brief Interview for Mental Status) score of 3 out of 15. The MDS documents that the resident requires substantial/maximal assistance for roll left and right. The MDS documents that the resident is dependent for sit to lying, lying to sitting on side of bed, sit to stand, chair/bed to chair transfer, and toilet transfer.R6's Nurses Notes dated 10/18/25 at 6:45 PM documents Resident was involved in abuse allegation. Head to toe assessment completed. Resident does not have any new open areas and is resting at this time. All V/S (vital signs) WNL (within normal limits). No s/s (signs/symptoms) of pain noted. MD (Medical Director), POA (Power of Attorney) and Administrator and DON (Director of Nursing) notified of allegation. Agency LPN (Licensed Practical Nurse) sent home, and investigation initiated.R6's Facility's Abuse Investigation dated 10/18/25 documents On 10/18/25 I received a call from (V28), C.N.A. (Certified Nurses Aid) and (V18), C.N.A. alleging verbal and physical inappropriate interaction by an agency LPN (V27). Physician and family notified. [NAME] Police notified. Risk completed including skin and body assessment. No injury identified. (R6) is a [AGE] year-old male resident who admitted to (facility) on 8/4/25. His diagnosis include hemiplegia and hemiparesis, L2 wedge compression fracture, moderate calorie malnutrition, aphasia, dysphagia, cerebral infarction, schizophrenia, malignant neoplasm of prostate, unspecified dementia, cognitive communication deficit. His BIMS score is 3. He is dependent for most ADL's (Activity of Daily Living). He ambulates with an unsteady gait and his primary mode of locomotion is by wheelchair. He is combative with staff and easily agitated. On 10/18/25 I received a call from (V28), and C.N.A. and (V18), C.N.A. alleging verbal and physical inappropriate interaction by an agency LPN (V27). Physician and family notified. [NAME] Police notified. Risk completed including skin and body assessment. No injury noted. (V18), (V20) reported that they witnessed Agency LPN (V27) being verbally inappropriate with resident (R6). (V20) approached (V27) and removed her from the situation while (V28) contacted management for assistance. The group kept (V27) out of resident area until the administrator called and had her sent home. (V27), LPN denied the allegation. A full investigation was completed and based on witness statements it was determined that the allegation supported inappropriate behavior. Alert residents were interviewed, and no other concerns were voiced. (V27) was suspended pending the investigation and had been blocked from being able to pick up shifts with the agency. The agency was contacted and informed of the allegation and outcome. (R6) does not appear to recall the incident.On 11/19/25 at 3:32 PM, V16, CNA stated 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 11/21/2025 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)