Deficiencies per Year
4
3
2
1
0
High
Moderate
Census Over Time
Inspection Report
Annual Inspection
Census: 76
Deficiencies: 2
May 5, 2025
Visit Reason
The inspection was conducted as an annual licensure survey to assess compliance with state regulations including disaster preparedness and physician assessments.
Findings
The facility failed to conduct required bi-monthly disaster/fire drills including night drills, failed to document resident participation and assistance during drills, and did not complete physician assessment certifications for residents with significant changes in condition, particularly those admitted to hospice care.
Severity Breakdown
Type 2 Violation: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to conduct disaster/fire drills on a bi-monthly basis including two night drills, and failure to document resident participation and assistance during drills. | Type 2 Violation |
| Failure to complete physician assessment certification for residents identified with significant change of condition. | Type 2 Violation |
Report Facts
Residents: 76
Fire drills conducted: 2
Residents on hospice: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E8 | Maintenance Director | Stated facility had not been documenting resident participation in drills and could not provide night shift drills |
| E2 | Director of Wellness | Reported six residents on hospice without physician assessment certification after significant change of condition |
Inspection Report
Annual Inspection
Census: 76
Deficiencies: 2
May 5, 2025
Visit Reason
The inspection was conducted as an annual licensure survey to assess compliance with state regulations including disaster preparedness and physician assessments.
Findings
The facility failed to conduct required bi-monthly disaster/fire drills including two night drills, failed to document resident participation and assistance during drills, and did not complete physician assessment certifications for residents with significant changes in condition, particularly those admitted to hospice.
Severity Breakdown
Type 2 Violation: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to conduct disaster/fire drills on a bi-monthly basis including two night drills, and failure to document resident participation and assistance during drills. | Type 2 Violation |
| Failure to ensure physician assessment certification was completed for residents identified with significant change of condition. | Type 2 Violation |
Report Facts
Residents present: 76
Fire drills conducted: 2
Residents on hospice: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E8 | Maintenance Director | Stated facility had not been documenting resident participation in drills and could not provide evidence of night shift drills. |
| E2 | Director of Wellness | Admitted no physician assessment certification was done for residents with significant change of condition admitted to hospice. |
Inspection Report
Complaint Investigation
Deficiencies: 1
Mar 18, 2025
Visit Reason
The inspection was conducted as a complaint investigation (#2542162/IL187954) regarding the facility's failure to report a serious incident involving a resident's fall resulting in a fractured wrist.
Findings
The facility failed to report a resident's fall on 11/21/24 that resulted in an emergency room visit for a fractured right wrist to the Illinois Department of Public Health, as required by regulation.
Complaint Details
Complaint Investigation #2542162/IL187954 regarding failure to report a serious incident involving a resident's fall with fracture. The complaint was substantiated based on interview and record review.
Severity Breakdown
Violation Type 3: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report a fall resulting in an emergency room visit for a fractured right wrist to the Illinois Department of Public Health. | Violation Type 3 |
Report Facts
Incident date: Nov 21, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 | Confirmed that the resident's fall with fracture on 11/21/24 was not reported to IDPH |
Inspection Report
Complaint Investigation
Deficiencies: 1
Mar 18, 2025
Visit Reason
The inspection was conducted as a complaint investigation (#2542162/IL187954) regarding the facility's failure to report a serious incident involving a resident's fall resulting in a fractured wrist.
Findings
The facility failed to report a resident's fall on 11/21/24 that resulted in an emergency room visit for a fractured right wrist to the Illinois Department of Public Health, violating Section 295.2050 Incident and Accident Reporting regulations.
Complaint Details
Complaint Investigation #2542162/IL187954 regarding failure to report a serious incident involving a resident's fall with fracture; substantiation confirmed by interview with E1 on 3/17/25.
Severity Breakdown
Violation Type 3: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report a fall resulting in an emergency room visit for a fractured right wrist to the Illinois Department of Public Health. | Violation Type 3 |
Report Facts
Incident date: Nov 21, 2024
Report confirmation date: Mar 17, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| E1 | Executive Director (ED) | Confirmed failure to report incident; no longer employed as of 3/24/25 |
| Regional Director of Nursing | Will provide re-education on communication and incident reporting to interim ED, Director of Nursing, and Assistant Director of Nursing |
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