Health inspection·December 8, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a last day worked listed as 11/05/25 documents: describe what happened: (facility name) was made aware by several residents that they were missing money from their personal funds. An investigation revealed that V6 had misused resident's credit cards and also misappropriated cash payments for personal use. This is considered a violation of (facilities name) resident's rights, and abuse and neglect policy and therefore your employment is terminated effective immediately. R1's final report - alleged financial misappropriation dated 11/11/25 documents: investigation summary: upon notification, the facility initiated a thorough internal investigation following facility policy and IDPH (Illinois Department of Public Health) reporting requirements. The alleged staff members (V6-business office manager and V1-administrator) were suspended pending completion of the investigation. Resident and staff interviews were conducted, and a review of relevant documentation, bank statements, and financial logs was initiated. Although, the (local) Police Dept investigation remains ongoing. Based on information available to date, we were able to substantiate that V6 had misused the residents credit card and misappropriated cash payments for personal use. Additional documentation and verification from external financial institutions are pending to determine the outcome with the criminal charges from (local police department).V1 (Administrator) was unable to be reached during this survey. 2.R2's admission record documents an admission date of 03/27/24 with diagnoses including: aphasia following cerebral infarction, human immunodeficiency virus disease type 2 diabetes mellitus with hyperglycemia, severe protein calorie malnutrition, brain stem stroke syndrome, biliary cirrhosis, muscle weakness, schizoaffective disorder bipolar type, end stage renal disease, bipolar disorder, and sepsis. R2's MDS dated [DATE] documents a BIMS score of 13 indicating cognitively intact. On 12/06/25 at 4:28 PM R2 stated, he had his debit card taken from his room. R2 stated, they made $2000.00 worth of transactions. R2 stated, he reported the missing money after he checked his bank account and seen transactions that he was not aware of and there was money missing. R2 stated, his bank has put the money back into his account pending the police investigation. R2 stated, if the police find someone guilty, he thinks the bank prosecutes and the bank reimburses him. On 12/06/25 at 4:42 PM V2 stated, they have conducted an investigation into R2's missing money and it has been turned into the police. V2 stated, they interviewed residents and staff and watched the cameras. There are two staff members suspended pending the investigation. V2 stated, they have watched the cameras and believe they have it narrowed it down to two possible employees (V8 (CNA) or V9 (agency Housekeeping)). V2 stated, the two employees are still suspended.R2's check card statement had transactions marked with locations written in for the in question transactions. A letter from R2's bank dated 10/27/25 documents: we are writing to you about recent transactions you alerted us to on your account. While we review the transactions, we applied the following to your account on 10/27/25 a provisional credit for $1935.72. This letter documents a case ID (identification) number from the fraud division. R2's care plan documents a focus area of abuse: R2 is at risk for abuse and neglect relating to CVA (cerebrovascular accident), aphagia, cirrhosis, diabetes mellitus, and bipolar/schizophrenia dated 08/23/24 with an intervention listed as: alleged misappropriation of funds, will initiate additional financial monitoring dated 11/05/25. The facility policy dated 2022 titled, abuse policy and prevention program documents: this facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse, neglect, exploitation, misappropriation of property, and mistreatment of residents. In order to do so, the facility has attempted to establish a resident sensitive and resident secure environment. The purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences of abuse, neglect, exploitation, misappropriation of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145668 If continuation sheet Page 2 of 3 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 12/08/2025 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)

F 0602 property, deprivation of goods and services by staff and mistreatment or residents. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145668 If continuation sheet Page 3 of 3