Health inspection·June 8, 2025

F 0602 diagnosis of osteoarthritis and cholecystitis. Level of Harm - Minimal harm or potential for actual harm On 6/8/2025 at 12:03 PM V1, Administrator, stated R3 has general abdominal pain related to his cholecystitis that they were not able operate on. He also reports heel pain at times. Residents Affected - Few R3's Undated Care plan, documents alteration in comfort advanced disease process, chronic physical or psychological disability circulatory, Musculoskeletal, neurological, skin/tissue impairment. R3's POS, dated 4/7/2025 and 5/2025 documents a physician's order started 4/7/2025 hydrocodone-acetaminophen 5-325 mg give 1 tablet by mouth every 6 hours as need for pain. R3's MDS dated [DATE] documents resident is alert and has occasional pain. R3's Controlled Drug Received Record/Disposition Form, received from the pharmacy on 4/16/2025 documents V4 signed off she administered hydrocodone 5-325 mg to R3 on 4/22/2025, 4/26/2025 2 doses, 4/27/2025, 4/28/2025, 5/1/2025 2 doses, 5/2/2025, 5/3/2025, 5/5/2025, 5/6/2025 3 doses, 5/9/2025, 5/10/2025 3 doses, 5/11/2025 and 5/12/2025 3 doses that equals 21 pills administered. R3's MAR dated 4/2025 documents V4 signed off hydrocodone 5-325 mg was administered to R3 only on 4/22/2025 and 4/27/2025 which equals 2 doses administered, not 5 doses like the narcotic count sheet documents she administered to R3. R3's Controlled Drug Received Record/Disposition Form, received from the pharmacy on 5/12/2025 documents V4 signed off she administered hydrocodone 5-325 mg to R3 on 5/19/2025, 5/20/2025 2 doses that equals 2 pills administered. R3's MAR dated 5/2025 documents V4 signed off hydrocodone 5-325 mg was administered to R3 only on 5/3/2025, 5/5/2025, 5/13/2025 and 5/15/2025 which equals 4 pills administered, not 16 pills like the narcotic count sheet documents she administered to R3. On 6/3/2025 at 5:00 PM V1, Administrator stated she was first alerted by V2, Director of Nursing, DON about suspicious documentation on R2's hydrocodone 5-325 mg narcotic count sheet on 5/21/2025. V1 stated she, V2 and V3, Assistant Director of Nursing, ADON went over all narcotic count sheets at that time and noted that V4, LPN was assigned to R2 and R3 on a regular basis and was signing off on the narcotic count sheets both hydrocodone 5-325 mg tablets were being administered to both residents PRN (as needed) as soon as the medications were available. V1 stated neither R2 nor R3 have a history of taking hydrocodone on a regular basis and they are both prescribed PRN. V1 stated both R2 and R3 aren't interviewable and she believes that is why V4 targeted their hydrocodone because they couldn't speak for themselves. V1 stated V4 didn't sign the hydrocodone off on either R2's or R3's MAR, just on the narcotic sheets. V1 stated she called V4 into the facility to be interviewed. V1 stated V2 and V3 and the police were called. V1 stated V4 confessed to the police that she took R2's and R3's hydrocodone 5-325 mg tablets and had taken 66 pills total. V1 stated V4 was hired as an LPN to the facility and worked night shift 6:00 PM to 6:00 AM and worked full time since her hire date of 4/2/2025. The first time V4 signed off hydrocodone on R2's narcotic count sheet was 4/17/2025 and it was brought to her attention on 5/21/2025. V4 told her that she got the hydrocodone medication from the medication cart, signed it off on the resident's narcotic count sheet then went to the resident's room and placed the pill in her pocket to take it later. V1 stated there was no video evidence of V4 taking the narcotic pain medication by mouth or putting it in her pocket because she allegedly did that in resident rooms, where there are no surveillance cameras. V1 stated the facility has done (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145785 If continuation sheet Page 2 of 4 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 06/08/2025 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)

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few several audits of the narcotics since this has been brought to her attention and no further issues with narcotics were discovered. V1 stated V4 was terminated the same day the investigation was initiated on 5/21/2025 so she no longer has access to the resident's narcotic pain medication at the facility. On 6/3/2025 at 5:20 PM V3, Assistant Director of Nurses (ADON) stated V5, Registered Nurse, RN, stated she was aware of suspicious documentation on R2's and R3's hydrocodone 5-325 mg PRN narcotic count sheets on 5/21/2025 and she worked with V1 and V2 to get the investigation started. V3 stated she and V2 interviewed V4 at the facility and she initially stated it was a mistake and that she read the resident's hydrocodone physician order wrong, she thought it was scheduled, not PRN then she changed her story to it was just a mistake then she spoke 1:1 to the local police officer at the facility and she confessed to stealing R2's and R3's hydrocodone 5-325 mg pills and it was 66 pills she stole in total. V3 stated V4 told her she was in pain and the hydrocodone helped her get through the day. V4 told her she walked into the resident's room as if she was going to administer the hydrocodone medication then she put it in her pocket. V3 didn't know if V4 took the hydrocodone pain medication while working or not. V3 stated she worked with V4 on night shift a few times and never noted her to be under the influence or off in any way. On 6/3/2025 at 5:45 PM V2, Director of Nurses (DON) stated she and V3 were notified by V5 of suspicious documentation on (R2's) narcotic count sheet on 5/21/2025. V2 stated her and V3 did a complete audit on all resident's narcotic count sheet and noted suspicious documentation on R3's narcotic count sheet as well. Neither R2 nor R3 took the hydrocodone PRN medication often but according to the narcotic count sheet something had occurred because V4 documented both residents were taking the narcotic pain medication multiple times a shift when V4 worked. V2 stated it was odd and she knew something was really wrong when she checked R2's and R3's MARs, V4 didn't document on the resident's MAR that the medication was administered. V2 stated no resident's narcotic count sheets count was off at anytime. V2 stated it was only because V5 brought it to her attention that the facility caught onto what V4 was doing which was stealing R2's and R3's hydrocodone PRN narcotic pain medication. V2 stated she and V3 interviewed V4 the same day and she initially denied taking any residents hydrocodone narcotic pain medication, then the police got here, and she spoke to the police officer 1:1 and admitted to stealing 66 pills of R2's and R3's hydrocodone 5-325 mg PRN pills. On 6/3/2025 at 6:05 PM V5, RN stated she works days from 6:00 AM to 6:00 PM. V5 stated was the nurse to initially find the suspicious documentation on R2's narcotic count sheet on 5/21/2025. V5 stated as soon as V2 got to the facility she gave her R2's narcotic count sheet and said something is suspicious here and V2 told her she'd look into it. V5 stated she knew something wasn't right because R2 rarely takes Tylenol and never requests a narcotic pain medication from her and when she saw R2's hydrocodone 5-325 mg PRN pill count went from 20 pills for the longest time down to 6 pills she knew there was an issue. V5 stated V4 probably took the narcotic pain medication from R2 and R3 because neither one of these residents are interviewable and they couldn't speak up and tell on her for taking their medications. On 6/3/2025 at 7:05 PM V4, LPN stated she started working at the facility as an LPN on 4/2/2025 and she has chronic bilateral hip pain which she used to get pain injections for, but she no longer has health insurance so when she started working at the facility, she was tempted to take R2's and R3's hydrocodone 5-325 mg PRN narcotic pain medication because she was hurting really bad. V4 stated she documented the hydrocodone was administered on the narcotic count sheet but not on the resident's MAR and that's how she got caught. On 5/21/2025 she was sleeping and V2 called her to come in and speak to about a concern. V4 stated when she got to the facility, she spoke to V2 and V3 about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145785 If continuation sheet Page 3 of 4 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 06/08/2025 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)

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few documentation on R2's and R3's hydrocodone narcotic count sheets and initially V4 stated she denied taking the resident's hydrocodone pills but then she spoke to the police officer at the facility, and she finally admitted to it. V4 stated she took approximately 11 to 14 hydrocodone 5-325 mg PRN pills from R2 and R3 hydrocodone 5-325 mg PRN pills from R3. V4 stated she didn't take anywhere close to 66 hydrocodone 5-325 mg pills from the residents. V4 stated she knew what she did was wrong, but she was in such pain she felt she didn't have another choice. V4 stated she didn't take the resident's hydrocodone pills at the facility she entered the resident's room as if she was going to administer the medication then she put the pill in her pocket and took it so she could sleep when she got home from work. Employee Disciplinary Form dated 5/21/2025 documents V4, LPN start date at the facility was 4/2/2025 and last day worked 5/19/2025. Employee action/discipline: discharge and felony/theft. Describe what happened: two residents were found to have narcotics signed out on the narc sheets but not on the MAR. Residents were given urine drug screens which were negative for any opioids despite documentation on the narc sheets that she gave the residents Norco the morning of 5/20/2025 at approximately 5:30 AM and 6:00 AM. Video was reviewed and did not show V4 entering one of the resident rooms at all during that timeframe. V4 was given a urine drug screen that was positive for opioids. V4 admitted to Administrator and local police officer to taking the medication. Report filed with local police department. Report made to IDPH as well. On 6/3/2025 at 9:00 PM V7, Local Detective, stated V4 admitted to stealing hydrocodone from the facility in April and May 2025 and stated V4 is being charged with theft. The Facility Abuse Policy, reviewed 9/2017 documents this facility affirms the right of our residents to be free from misappropriation of property. This facility therefore prohibits misappropriation of property. 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 misappropriation of property. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145785 If continuation sheet Page 4 of 4