Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews and record reviews the facility failed to maintain the resident hallways and resident
common seating area carpet, in a clean, sanitary, odor free condition. This failure affects all 76 residents
that reside in the facility.Findings include: Resident Council Minutes dated [DATE] and [DATE] old business
([DATE]) and new business, documents residents' grievance of unclean carpet. Resident Council minute
grievance notes documented a resolution to spot clean the carpets.On [DATE] at 10:20 am, V6 (R5's Family
Member) stated the carpet throughout the facility is 'filthy and smells like urine.' V6 also stated Them spot
cleaning the halls is not enough. On [DATE] at 10:35 am, V3, Maintenance Director/Housekeeping/Laundry
Supervisor toured the facility with this surveyor. V3 stated I figured it was probably the carpet when I heard
state was in the building for environmental issues. I ‘ve been here four years. I have tried different ways over
the years to tackle the problem. Resident council group continues to complain because it is still a big issue.
Last Spring, I had a commercial, carpet cleaning extraction machine. It was old and died. I don't have a
commercial extractor available. I have to use a residential carpet cleaner. Basically, it is used for spot
cleaning. The carpets need deep cleaned. The residential carpet extractor is the same as the one you can
rent for your home. On [DATE] at 10:40 am, V3 Maintenance Director/Housekeeper/ Laundry Supervisor
began the tour of the facility. V4 Maintenance Assistant brought a small, residential, upright carpet cleaning
extractor to the resident hallway, T- junction of the hallway. V4 stated the residential appliance is what the
facility uses to clean the facility carpet. V4 confirmed the facility does not use a commercial extractor
/cleaner in the facility. V4 then stated the strength of the cleaner is the same as what is used when cleaning
carpets at home. R7's Minimum Data Set (MDS) dated [DATE] documents R7's Brief Interview of Mental
Status (BIMS) score of 15 out of a possible 15, indicating no cognitive impairment. On [DATE] at 10:50 am,
R7 stated he is blind in one eye and can barely see out of the other. He can't tell if the carpet is soiled. R7
stated I know something stinks in all the hallways. It may well be the carpet.On [DATE] at 11:00 am through
11:25 am, V3 Maintenance Director and this surveyor continued the tour of all common areas and resident
lounges. All resident hallways and common areas, East Long Hall, East Short Hall, [NAME] Long Hall,
[NAME] Short Hall, Center Hallway, in front of both East and [NAME] Dining rooms and around the nurses'
stations all had light green, or light green with beige bordered carpet. All hallways had a faint urine odor.
There were copious wide-spread black and brown stains Some of the stains measured approximately six to
eight-foot size patches The stains extended the full length of 100 foot on East and [NAME] Long hallways.
The stains also dominated the full forty-foot length of the East, West, and Center hallways of the facility.
More of the carpet was stained than not, throughout the facility. There was also a foul feces-like odor on the
[NAME] long hallway. Also on the [NAME] long hallway, there was an approximately five-foot section of
black mold-like substance present that extended approximately six inches out from
(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 3
Event ID:
145016
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
145016
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Goldwater Care Bloomington
700 East Walnut
Bloomington, IL 61701
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 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
the baseboard. V3 stated the facility had a toilet overflow awhile back and had to have a plumber out to fix
it. That caused this black stain. V3 also stated the facility has had a couple other toilets back up too. V3
stated I can't smell since I had Covid. I can't confirm the odor. Bottom line is the carpet is old and needs to
be replaced. In my opinion, a tile surface would be much better and easier to keep clean. On [DATE] at
11:30 am, V8 Certified Nursing Assistant (CNA) stated No, the carpets are not clean comfortable or
homelike. They haven't been, since I started working here three years ago. They are dirty and need
cleaned. There are odors from the carpet. That is expected when you see all the stains. On [DATE] at 11:35
am, V9 CNA stated I don't smell anything, probably because I am busy and used to it. The condition of the
carpet is not even close to being clean. I see housekeeping spot clean at times. That does not seem to
make any difference. It needs to be replaced. The worst areas of the carpet are the areas at the nurse's
station, (V9, points to the East Hall carpet around the nurse's station to confirm) where a couple of the
residents eat. That is why the carpet is soiled with black stains. On [DATE], V10 Agency, Licensed Practical
Nurse stated I work in a lot of facilities. I have worked here several times. What stands out to me is the
horrible odors from the dirty carpet. I can give all the medication in the world to the residents, but the
atmosphere is not conducive to healing. Absolutely, not clean, comfortable, or homelike. It is a shame. This
is a very nice home. R2's MDS dated [DATE] documents R2's BIMS score as 15 out of a possible 15,
indicating no cognitive impairment. On [DATE] at 11:50 am, R2 stated I have no problem with the care in
the facility, they keep me clean and dry. They keep my room neat and tidy. The hallways are atrocious. The
carpets are filthy, and they stink. The smell is not in my room, thank God. I am usually in my room or dining
room. I don't have any issues with either of those places, where I spend my time in. R4's MDS dated [DATE]
documents R4's BIMS score as 15 out of a possible 15, indicating no cognitive impairment. On [DATE] at
12:00pm, R4 stated I had my toilet overflow several weeks ago. Then, as you would expect, there was a
strong odor of (feces). I think the carpet outside my room had some seepage, from that situation. I just kept
my door closed a couple days. That smell is gone. The normal odor of urine is bad in some areas. I am sure
that comes from the carpet. You can look and you will see, the carpet has never been cleaned. It has gotten
worse over the past few months. The stains all connect. It is hard to tell the actual color of the carpet now. It
is bad. R3's MDS dated [DATE] documents R3's BIMS score as 15 out of a possible 15, indicating no
cognitive impairment. On [DATE] at 12:10 pm, R3 stated Occasionally there can be bad odors of urine. It
was real bad in the hot weather. Some odor is expected in a nursing home. The carpet, they need to take a
scrub brush to. The carpets are terrible. It is filthy, as I am sure you have already noticed.R1 MDS dated
[DATE] documents R1's BIMS score as 15 out of a possible 15, indicating no cognitive impairment. On
[DATE] at 12:20pm, R1 stated The carpet in the hall looks bad. The carpet is full of stains. I have not noticed
any odors out there. My floor is fine. I am glad there isn't carpet in here. On [DATE] at 12:25 pm, V7 (R6's
Family Member) stated I am in the facility four to five hours almost every day. I have not noticed any
lingering odors from the carpet. I have certainly noticed the condition of the carpet. It is old and full of
stains. It does not matter what hall you're on. The carpet is definitely dirty. I have seen them vacuum
regularly, that is all. If this were my home, I would recognize it is time to change the carpet. I would have
been replacing it a long time ago. On [DATE] at 12:30 pm, V5 Activity Director confirmed the resident
council meeting minutes for [DATE] and [DATE] document the carpets in the facility are dirty and the
resolution was to spot clean the carpets. V15 stated The residents had been complaining much longer than
two months that the carpet is real dirty. They have not complained about an odor, that I recall. The
resolution is always the same, to spot clean the carpet. That is
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145016
If continuation sheet
Page 2 of 3
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
145016
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/11/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Goldwater Care Bloomington
700 East Walnut
Bloomington, IL 61701
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 0921
Level of Harm - Minimal harm
or potential for actual harm
not working, obviously. We have invited (V11, Regional Director of Operations) Corporate to attend council
group and hear, firsthand from the residents. I believe she is coming next month.The facility CMS Matrix
802 dated [DATE] documents 76 residents reside in the facility.
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145016
If continuation sheet
Page 3 of 3
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F921 - Other Environmental Conditions
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
FAQ · About this visit
Common questions about this visit
What happened during the September 11, 2025 survey of GOLDWATER CARE BLOOMINGTON?
This was a inspection survey of GOLDWATER CARE BLOOMINGTON on September 11, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at GOLDWATER CARE BLOOMINGTON on September 11, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.