Inspection·December 8, 2025

F 0744 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to care for a dementia resident in a safe manner for 1 of 2 resident (R2) reviewed for abuse in the sample of 10. This failure resulted in R2 sustaining a left humerus fracture. Findings include:Based on interview and record review, the facility failed to care for a dementia resident in a safe manner for 1 of 2 resident (R2) reviewed for abuse in the sample of 10. This failure resulted in R2 sustaining a left humerus fracture. Findings include:R2's admission Record, print date of 12/1/25, documents R2 was admitted on [DATE] with diagnoses of Osteoarthritis and Dementia. R2's Minimum Data Set, dated [DATE], documents R2 is severely cognitively impaired, is dependent on staff for toileting, lower body dressing, chair to bed transfer, is incontinent of bowel and bladder, and has no behaviors. R2's Care Plan, Date Initiated: 05/27/2025, documents, Resident has some memory loss and impaired decision making ability. Dx (diagnosis) dementia. Resident can be resistive to cares, verbally abusive to staff d/t (due to) confusion/dementia. Interventions: dated 5/27/25 revision on 11/4/25. Staff to approach at later time if being combative as able. Inform resident what task you are helping with prior to performing. Staff may need to provide care in pairs if resident is overly stimulated. Refer to psych (psychiatry) as needed. R2's Nursing Note, dated 11/22/2025 2:54 PM, documents, Made aware by CNA (Certified Nurse Aide) staff that he heard a POP while turning and repositioning resident from wheelchair to bed. This nurse assessed resident. Resident noted to be lying in bed on back, holding left arm. resident alert and oriented per usual, verbal, c/o (complaint of) pain to L (left) elbow. No bruising noted to arm; resident stated that the CNA hurt her arm . Limited ROM (range of motion) noted to L arm. Resident noted to have acute pain to L mid-humerus and elbow area. Mild deformity observed to L mid humerus area. Resident rates the pain a 10/10, worsening when area is touched or lifted. Denies numbness or tingling. Distal pulse present, cap (capillary) refill <3 seconds and skin warm. Sensation noted to finger, and able to slowly wiggle fingers, but not able to form a fist at time of incident. Call placed to MD (Medical Doctor) to make aware of incident. New order received to send resident to ER (Emergency Room) for eval/treat (evaluation and treatment). Call placed to 911 for transport. Resident transported to (Regional Hospital). On 11/27/25 at 12:18 PM, V1, Administrator, stated, (R2) did break her arm last Sunday. She was combative with care. I did do an investigation on it and sent in the final report last night. (V4) did not mean to hurt (R2). He has since received training. On 11/27/25 at 1:12 PM, V3, Certified Nurse Aide (CNA), stated, (R2) can become combative. You have to just walk away and left her calm down and then you go back to her. You never make any resident do something they don't want to do. On 11/27/25 at 2:20 PM, V4, CNA, stated, I transferred (R2) to bed using the full mechanical lift by myself. She transferred just fine. I had her on her left side doing peri care. She was being combative. She began to lean over to the edge of the bed. I was trying to get her back into the middle of the bed. She was fighting me. As I was trying to get her back in bed, I heard a pop from her arm. She Residents Affected - Few (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: 146075 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 146075 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Evercare of Granite City 3500 Century Drive Granite City, IL 62040 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)