Inspection·November 20, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to perform hand hygiene before and after glove changes and wear personal protective equipment during wound care for 3 of 3 (R1, R2 and R4) residents, reviewed for infection control in a sample of 8. Findings include:1.V5, Licensed Practical Nurse (LPN), performed hand hygiene and donned gloves but did not don an isolation gown for enhanced barrier precautions to perform wound care to R2. There was not any signage on R2's door or supplies for enhanced barrier precautions. V5 removed an old dressing from R2's left calf that was dated 11/17/2025. She then, without benefit of hand hygiene or glove change, cleansed R2's open area on his left calf with wound cleanser, covered with polymem max silver dressing, super absorbent dressing was placed, and area was wrapped with kerlix. She then removed her gloves and performed hand hygiene. She prepared the dressing supplies for R2's right leg. V5 applied gloves without benefit of hand hygiene, removed the dressing, which was dated 11/17/25 from R2's right calf and without benefit of hand hygiene or glove change, she cleansed the open area with wound cleanser. She then took triad cream and applied it to the polymem max silver dressing. With the same gloved hands applied the polymem max silver dressing that had triad cream on it, applied the super absorbent dressing and wrapped R2's right leg with kerlix. 2. V5, LPN, entered R4's room, donned gloves without benefit of hand hygiene and did not don a gown for enhanced barrier precaution. There was no signage on R4's door to notify staff that he was on enhanced barrier precautions nor was there supplies for enhanced barrier precautions. She opened the 4x4 gauze pads and sprayed wound cleanser on them, with the same gloved hands and she cleansed the area to the back of R4's left calf. She then, with the same gloved hands, opened a package of skin prep and applied it to the back of R4's left calf wound.3. V8, Registered Nurse, performed hand hygiene and donned a pair of gloves. She then opened a package of 4x4 sponges, took the Dakin's solution bottle and moistened the sponges and cleansed R1's wound on his outer ankle. V8, RN then removed her gloves and donned another pair of gloves without benefit of hand hygiene and opened the mupirocin ointment container and applied it to another 4x4 gauze sponge. She then doffed her gloves and without benefit of hand hygiene and donned another pair of gloves and she opened the calcium alginate package and cut a piece from it for R1's wound, then opened the bordered gauze dressing package, and removed it. With the same gloved hands, V8, RN applied the mupirocin ointment, and the calcium alginate to R1's wound bed and then covered the area with the bordered gauze dressing.On 11/19/2025 at 11:00 AM, R7 stated that the nurses do not wear an isolation gown when they come in to take care of her wounds. R7's Face sheet, documented that she was her own responsible party. R7's Physician's order sheet, dated 11/18/2025, documented, Enhanced Barrier Precaution initiated r/t wounds.On 11/18/2025 at 11:00 AM, R4 stated that the nurses don't wear the gowns when they come and fix his leg. R4's Minimum Data Set (MDS) dated [DATE] documented that his cognition was moderately impaired. R4 Physician's order sheet, dated 11/18/2025, documented, Enhanced Barrier Precaution initiated r/t wounds.On 11/17/2025 at 10:00 AM, Residents Affected - Some (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: 145981 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 145981 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare of Swansea 1405 North Second Street Swansea, 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)