Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0697
Provide safe, appropriate pain management for a resident who requires such services.
Level of Harm - Actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to provide ordered pain medication timely, for
one of three residents (R2) reviewed for pain control, in a sample of three. This failure resulted in R2
experiencing intermittent excruciating pain from 12/12/24 until 12/16/24.
Residents Affected - Few
FINDINGS INCLUDE:
The (undated) facility policy, Pain Management, directs staff to, The facility must ensure that pain
management is provided to residents who require such services, consistent with professional standards of
practice, the comprehensive person-centered care plan and the resident's goals and preferences. Pain
Management and Treatment: Pharmacological interventions will follow a systematic approach for selecting
medications and doses to treat pain. Opioids will be prescribed and dosed in accordance with professional
standards of practice and manufacturers' guidelines to optimize their effectiveness and minimize their
adverse consequences.
R2 was admitted to the facility on [DATE] at 1:00 P.M. from a local hospital after a Total Right Knee
Replacement on 12/9/2024. At the time of discharge, V10/Orthopedic Surgeon prescribed
Acetaminophen/Hydrocodone 325 MG(Milligrams) /5 MG one tablet every 6 hours as needed for pain.
R2's Nursing admission Progress Note documents, 12/13/24 2:25 P.M. (R2) arrived at the facility at 1:30
P.M. (R2) diagnosis (includes) total (right) knee arthroplasty. (R2) is alert and oriented. (R2) has pain rated
as a 9 out of 10. (R2) is a general diet. (R2) has an ice machine for RLE (Right Lower Extremity). (R2)
oriented to room and call light. Therapy to evaluate and treat.
R2's Nursing Progress Notes document on 12/13/24 at 10:02 P.M., (R2) given standing order of Tylenol 325
MG two tablets for pain. (R2) stated pain was a 9:10. (R2) reassessed at 2200 (10:00 P.M.) and stated pills
were not effective. Current (medication) orders on order.
No further assessment of R2's pain was documented until 12/16/24 at 10:30 A.M., when R2's pain was
documented as a 10:10.
On 12/14/24 at 8:58 P.M., R2's Nursing Progress Notes document, Call placed to (V11/Medical Doctor) to
call (R2's) pain medication into Pharmacy due to the fact (R2) wasn't sent to the facility with hard
prescriptions to receive from Pharmacy. (V2/Director of Nurses) notified of medication absence.
On 12/15/24 at 9:05 P.M., R2's Nursing Progress Notes document, Call placed again to Pharmacy to check
the status of pain medication and they informed this nurse that they had not received call from (V11/MD) for
the medication. This nurse notified (V2/DON) and fax sent to (V11's) office in regard
(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:
145027
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
145027
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allure of the Quad Cities
833 Sixteenth Avenue
Moline, IL 61265
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 0697
to situation.
Level of Harm - Actual harm
On 12/16/24 at 9:43 A.M., R2 was up in a wheelchair in her room, at the bedside, crying and moaning,
clutching her right knee. R2 stated her right knee hurts, and the pain is excruciating R2 rated the pain as a
10:10. R2 stated she was admitted to the facility on [DATE] at 1:00 PM and was supposed to receive Norco
as needed for pain, but facility staff have told her they don't have her Norco. R2 stated she has only
received Tylenol for the pain one time, and it doesn't help at all. R2 stated she has been in pain since she
arrived at facility, and no one is doing anything about it. R2 also states she is supposed to have the ice
machine on her knee to help with pain, but staff never fill up the machine with ice. Ice machine observed
and only contains water. R2 states she unable to sleep due to pain and is unable to eat, also. R2 requesting
help with getting pain medication addressed immediately.
Residents Affected - Few
On 12/16/24 at 9:51 A.M., V3/Registered Nurse states resident told her she was in excruciating pain and as
soon as she finished her medication pass, she was going to call the doctor and pharmacy.
On 12/16/24 at 4:00 P.M., V8/Licensed Practical Nurse stated, (R2) was my patient this past weekend. I
worked second shift both Saturday and Sunday night. R2 was having pain and I noticed she still didn't have
her (narcotic) pain meds (medications). I called (V2/Director of Nurses) and she instructed me to call
(V11/Physician) and let him know. When I came in the next night, (R2) still didn't have her pain medications,
so I called the Pharmacy and asked them if (V11/Physician) had called in the script and they said he hadn't.
I called (V2/DON) again that night and she told me to fax the information to (V11's) office, which I did.
On 12/17/24 at 9:45 A.M., V7/Nurse Practitioner stated, I work in the facility Monday through Friday. I
usually arrive around 7:00 A.M., I didn't work last Friday (12/14/24) and didn't see (R2) for the first time,
until yesterday morning. When I assessed her, (R2) told me she had been having excruciating pain since
admission and (facility) staff kept telling her they didn't have her pain medication in. Also, she didn't receive
the polar ice to her knee. Polar ice provides continuous ice therapy for a patient that has undergone knee
replacement surgery. It helps significantly with pain and swelling and allows a patient to move around to
take care of themselves and participate in therapy.
On 12/17/24 at 10:10 A.M., V2/Director of Nurses stated, (V8/Licensed Practical Nurse) called me on
(12/14/24 and 12/15/24) to let me know that R2 had not received her pain medication, as it wasn't in the
facility. (V8) said that (R2) was admitted and she didn't have a (hard) prescription for the narcotics, so
Pharmacy couldn't fill it. I told her to call (R2's) doctor and to tell him to call the Pharmacy and he could
send an E-Prescription (electronic prescription) to the pharmacy, and they could immediately take the pain
medication from our facility convenience box. I thought that's what (V8/LPN) did. When she called me back
on (12/15/24) and said that (R2) still didn't have her pain medication, I told her to call the doctor back and to
send a fax to his office.
On 12/17/24 at 10:15 A.M., V9/Pharmacist verified he was the Pharmacist for the facility. V9 stated when a
resident is admitted to the facility with a narcotic medication, the facility faxes over the order and the order
gets processed. V9 states once the pharmacy receives a copy of the prescription, they will release a code
to the nurse, who then can withdraw the medication from the facility convenience box, which is located in
the medication room. At this time, V9/Pharmacist confirmed the pharmacy did not receive a prescription for
R2's pain medication until 12/16/24 at approximately 10:30 A.M.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145027
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
145027
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/17/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allure of the Quad Cities
833 Sixteenth Avenue
Moline, IL 61265
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 0697
Level of Harm - Actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
On 12/17/24 at 10:35 A.M., R2 was in bed, watching television. The polar ice machine to R2's right knee
was on and functioning. R2 was calm and relaxed. At that time R2 stated she had been receiving her
(narcotic) pain medication every six hours and staff were applying the polar ice machine to her right knee
as ordered by the physician. R2 stated she felt so much better and was able to concentrate on therapy and
getting stronger so she could return home.
Event ID:
Facility ID:
145027
If continuation sheet
Page 3 of 3
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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.
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
FAQ · About this visit
Common questions about this visit
What happened during the December 17, 2024 survey of Allure Of The Quad Cities?
This was a inspection survey of Allure Of The Quad Cities on December 17, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Allure Of The Quad Cities on December 17, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide safe, appropriate pain management for a resident who requires such services."
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.