Inspection·May 2, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure progressive fall interventions were in place and staff were aware of these interventions for 1 of 4 residents (R5) reviewed for falls in the sample of 7. Findings include: R5's Face Sheet documents R5 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, cerebral infarction, hypotension, dementia and abnormalities of gait and mobility. R5's Minimum Data Set, dated [DATE] documented R5 was severely cognitively impaired, used wheelchair and required partial assistance with walking. R5's Care Plan documents R5 is at risk for falls. R5's Fall Risk assessment dated [DATE] documented R5 was at high risk for falls. R5's Fall Investigation dated 10/9/24 documents R5 tripped while ambulating and fell. There was no injury. R5's Care Plan Update on 10/9/24 documents staff were educated to ensure R5 is wearing grippy socks at all times when out of bed. R5's Fall Investigation dated 4/13/25 documents R5 was found on the floor in the dining room with a small laceration and large bump on her forehead and skin tears on her right forearm. R5 was sent to the emergency room (ER) for evaluation. R5's ER Note dated 4/13/25 documents R5 sustained a hematoma to the forehead. R5's 4/13/25 Fall Investigation documents a (Non-Slip Mat) will be added to R5's wheelchair. On 5/1/25 at 1:11 PM, R5 was sitting in the dining room in her wheelchair with dark purple bruising under both eyes and yellowish green bruising on her forehead. She was wearing regular socks that did not have grips on the bottom. V9, Certified Nursing Assistant (CNA), stated she was not told to put gripper socks on R5. When asked if R5 has a (Non-Slip Mat), V9 stated, What's that? On 5/2/25 at 7:58 AM, V11, CNA, stated she did not know if R5 is supposed to have a (Non-Slip Mat) (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: 145785 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 145785 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nexus at Mascoutah 901 North Tenth Street Mascoutah, IL 62258 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)