Health inspection·April 9, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation and interview, the facility failed to maintain clean, sanitary shower rooms for 4 of 4 residents (R1, R2, R3 and R5) reviewed for environment in a sample of 5. Residents Affected - Some Findings include: On 4/8/2025 at 11:05 am, R1 stated he has seen mold in the 100-hall shower room. These showers have a sign with the words bath room on them. R1 stated this is the only place he has also noticed the smell of mold. On 4/8/2025 at 11:10 am a black, slimy appearing substance was noted in the corner junctions of the shower in the 200-hall shower room. On 4/8/25 at 11:10 am, R2 noticed a little bit in the facility and her bathroom. The bathroom has a sign marked out of order. A scattered blackish substance noted on the floor in R2's bathroom. On 4/8/2025 at 11:15 AM, V5, Certified nursing assistant, (CNA) stated that she has noticed mold in the bathroom and the shower room on the 100-hall. On 4/8/25 at 11:15 AM, V6, CNA, stated she has noticed mold in the shower room on the 100-hall and the shower room also smells like mold. On 4/8/2025 at 11:20 am, V7, Medical records/transport stated that she has heard there is mold in the 100-hall area. On 4/8/2025 11:25am 100-hall shower room observed. The room smells very musty with a large amount of a black/orange substance noted diffusely on the shower walls. In an inset in the room that was a previous towel storage area there is a large amount of a black substance on the corner floor. On 4/8/25 at 11:30 AM, V8, laundry-aide, stated that she notices mold in the resident's rooms on the 100-hall when she brings their clothes in and out of their rooms. On 4/8/25 at 11:30 AM, V9, Housekeeper, stated she has noticed mold in the shower rooms, the individual resident rooms, and the bathrooms. On 4/8/2025, V4, Regional Maintenance Director, stated he had not noticed mold in the facility. V4 accompanied surveyor to the 100-hall shower room, and he stated this is surface mold. Also, V4 looked at the recessed area in the room and stated it also was mold. V4 accompanied the surveyor to the Page 1 of 3 145981 145981 04/09/2025 Evercare of Swansea 1405 North Second Street Swansea, IL 62226

F 0584 200-hall shower room and stated it was mold in the corners of the shower stall. Level of Harm - Minimal harm or potential for actual harm On 4/8/25 at 1:00 pm R3's shower head in R3's bathroom is noted to have a large amount of a fuzzy black substance on the surface of the shower head. Residents Affected - Some On 4/8/25 at 2:25 pm, 200-hall med room was observed. A very musty odor smelled. On the floor on the front of the sink is an area with a yellowed paper is stuck to the floor. On top of this is a moderate amount of a black substance that can be smudged with a gloved hand. There is also a hole in the wall with a splotchy black substance noted on the right edge of the hole. Black splotches are also noted in the peripheral walls of the stainless-steel sink. On 4/8/25 at 2:35 PM, V2, Director of Nurses, (DON) stated she has not actually seen mold. V2 stated that R5 had reported to her a few weeks ago that she noticed the smell of mold in her room. V2 went to R5's room and stated she did smell a faint mold odor, but she did not visualize any mold. On 4/8/25 at 2:35pm, R5's room did have a slight musty smell. R5's room is adjacent to the 100-hall shower room. On 4/8/2025 at 3:45 pm, V2 stated that there is currently no housekeeping supervisor. V2 stated she is acting as the supervisor as she has been overseeing the housekeepers. V2 accompanied the survey team to the med room on the 200-hall and when asked if that was mold on the floor, wall and sink she stated that it was. V2 also acknowledged the extreme musty odor. On 4/8/25 at 4:40 pm, V2 stated that any resident who takes a shower uses one of the two shower rooms in the facility and do not shower in their rooms. At this time, the facility provided a document V1 signed and dated it that has listed the residents who take bed baths (BB) and do not shower. The document shows there are 37 residents who use the resident shower rooms. Undated Facility policy titled Mold & Mildew Policy & Guidelines Policy Statement documented mold and mildew growth can occur in areas of humid or often damp areas like shower stalls, kitchens, and restrooms. Surface mildew and mold can be mitigated by ensuring these areas are routinely deep cleaned. If areas of mildew or mold are found, these areas must be immediately cleaned with proper mold and mildew cleaners, ensuring all areas are free of mildew or mold. Policy Implementation: In the event areas of surface mold or mildew are found, immediate notify Administrator of concerns and the areas must be immediately cleaned and sanitized with appropriate cleaners effective at removal of mold and mildew and growth before use of areas. Proper PPE required for safely handling the cleaning chemicals must be adhered to during use. Areas should be cleaned and then re-inspected regularly to ensure no other growth of areas of concerns. A Center for Disease Control, (CDC) document dated September 26, 2024, documented the possible health effects of mold. Exposure to damp and moldy environments may cause a variety of health effects, or none. For some people, mold can cause a stuffy nose, sore throat, coughing or wheezing, burning eyes, or skin rash. People with asthma or who are allergic to mold may have severe reactions. Immune-compromised people and people with chronic lung disease may get infections in their lungs from mold. For people who are sensitive to molds exposure to molds can lead to symptoms such as stuffy nose, wheezing, and red or itchy eyes, or skin. Severe reactions, such as fever or shortness of breath, may occur 145981 Page 2 of 3 145981 04/09/2025 Evercare of Swansea 1405 North Second Street Swansea, IL 62226

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some among workers exposed to large amounts of molds in occupational settings, such as farmers working around moldy hay. In 2004 the Institute of Medicine (IOM) found there was sufficient evidence to link indoor exposure to mold with upper respiratory tract symptoms, cough, and wheeze in otherwise healthy people; with asthma symptoms in people with asthma; and with hypersensitivity pneumonitis in individuals susceptible to that immune-mediated condition. 145981 Page 3 of 3