Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to report an injury of unknown origin to Illinois Department of
Public Health (IDPH) for a resident with bruises to her inner thigh area for 1 of 3 residents (R1) reviewed for
injury of unknown origin in the sample of 6.
The findings include:
The Nurses Note dated [DATE] at 12:01 AM for R1 showed, the aides took the resident to the bathroom
and had noticed scattered bruising to her inner thighs (yellow, green, and purple bruises). The certified
nursing assistant (CNA) stated they were not sure how long they have been there due to resident being a
standby assist and taking herself to the bathroom. Resident also refuses cares at times. When I asked the
resident stated, it's from these and pointed to her depends. No pain or discomfort noted to the area of
bruising.
The facility did not report the bruises to R1's inner thighs to Illinois Department of Public Health (IDPH).
On [DATE] at 10:11 AM, V1 (Administrator) stated, injuries of unknown origin could be bruises and if they
can't find a reason or a conclusion as to how the bruises happened then she would investigate the bruises
as an injury of unknown origin. V1 stated R1 had a bruise to her left thigh and a small mark to her right
thigh. On Thursday ([DATE]) morning the nurse documented that R1 had bruises to her thighs. V1 stated
they investigated the bruises and R1 would bump into things. V1 stated they thought that R1 would bump
into the foot board of her bed when she was trying to get snacks that were located on a credenza at the
end of her bed. V1 stated the bruises were to R1's inner thigh area on the left and a small one to inner thigh
on the right. On Friday ([DATE]) night R1 fell; she was on hospice. R1 didn't break her fall, was sent to the
hospital, and came back on Saturday ([DATE]) with a diagnosis of a urinary tract infection (UTI). V1 stated
that same day R1 complained of chest pain; she was restless and was acting out. Hospice was contacted
and they said to send her to the hospital. V1 stated she pulled up the pictures that the hospital had in R1's
chart of the bruises to her inner thigh and they did not look the same as what she saw when she observed
R1's bruises. They looked different from Thursday to Friday ([DATE]). When R1 went back to the hospital on
Saturday ([DATE]) they got her up to the commode, she stood up, collapsed, they put her in bed, and she
died. V1 stated she looked at the hospital records and the doctor documented that she possibly died from
an aortic dissection or aortic aneurysm, and this would explain the bruising. She also did have low vitamin
B level and bruised easily.
On [DATE] at 1:14 PM, V1 stated an injury of unknown origin is an injury that can't be explained as
(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 4
Event ID:
145151
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
145151
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allure of Mendota
1201 First Avenue
Mendota, IL 61342
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 0609
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
far as the cause or there are no witnesses to the injury. A bruise that shows up that can't be explained
would be investigated. V1 confirmed if a bruise were in an unusual place they would investigate it as injury
of unknown origin. V1 stated she should have reported to IDPH.
The Face Sheet dated [DATE] for R1 showed diagnoses including Alzheimer's disease, palliative care,
dementia with behavioral disturbance, type 2 diabetes mellitus, acute cystitis without hematuria, deficiency
of B vitamins, hypomagnesemia, unspecified behavioral syndromes, anxiety disorder, and essential
hypertension.
The facility's Unexplained Injuries policy ([DATE]) showed, all unexplained injuries, including bruises,
abrasions, and injuries of unknown source will be investigated. An injury should be classified as an injury of
unknown source when both of the following conditions are met: A, the source of the injury was not
observed by any person, or the source of the injury could not be explained by the resident; and b. The injury
is suspicious because of i. The extent of the injury or ii. The location of the injury (e.g., the injury is located
in an area not generally vulnerable to trauma) Reporting and investigation procedures shall be
implemented in accordance with the facility's abuse policies and procedures.
The facility's Abuse, Neglect, and Exploitation policy (2025) showed, possible indicators f abuse include,
but are not limited to: physical marks such as bruises or patterned appearances such as a handprint, belt or
ring mark on a resident's body. Physical injury of a resident, of unknown source. Reporting of all alleged
violations to the Administrator, state agency, adult protective services and other required agencies (e.g.,
law enforcement when applicable) within specified time frames: a. Immediately, but not later than 2 hours
after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily
injury, or b. Not later than 24 hours if the events that cause the allegation do not involve abuse and do not
result in serious bodily injury.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145151
If continuation sheet
Page 2 of 4
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
145151
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allure of Mendota
1201 First Avenue
Mendota, IL 61342
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 0610
Respond appropriately to all alleged violations.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to ensure a thorough investigation was done by interviewing
additional residents when a resident had an injury of unknown origin that consisted of bruising to her inner
thighs for 1 of 3 residents (R1) reviewed for injury of unknown origin in the sample of 6.
Residents Affected - Few
The findings include:
The Nurses Note dated [DATE] at 12:01 AM for R1 showed, the aides took the resident to the bathroom
and had noticed scattered bruising to her inner thighs (yellow, green, and purple bruises). The certified
nursing assistant (CNA) stated they were not sure how long they have been there due to resident being a
standby assist and taking herself to the bathroom. Resident also refuses cares at times. When I asked the
resident stated, it's from these and pointed to her depends. No pain or discomfort noted to the area of
bruising.
The facility did not report the bruises to R1's inner thighs to Illinois Department of Public Health (IDPH).
On [DATE] at 10:11 AM, V1 (Administrator) stated, injuries of unknown origin could be bruises and if they
can't find a reason or a conclusion as to how the bruises happened then she would investigate the bruises
as an injury of unknown origin. V1 stated R1 had a bruise to her left thigh and a small mark to her right
thigh. On Thursday ([DATE]) morning the nurse documented that R1 had bruises to her thighs. V1 stated
they investigated the bruises and R1 would bump into things. V1 stated they thought that R1 would bump
into the foot board of her bed when she was trying to get snacks that were located on a credenza at the
end of her bed. V1 stated the bruises were to R1's inner thigh area on the left and a small one to inner thigh
on the right. On Friday ([DATE]) night R1 fell; she was on hospice. R1 didn't break her fall, was sent to the
hospital, and came back on Saturday ([DATE]) with a diagnosis of a urinary tract infection (UTI). V1 stated
that same day R1 complained of chest pain; she was restless and was acting out. Hospice was contacted
and they said to send her to the hospital. V1 stated she pulled up the pictures that the hospital had in R1's
chart of the bruises to her inner thigh and they did not look the same as what she saw when she observed
R1's bruises. They looked different from Thursday to Friday ([DATE]). When R1 went back to the hospital on
Saturday ([DATE]) they got her up to the commode, she stood up, collapsed, they put her in bed, and she
died. V1 stated she looked at the hospital records and the doctor documented that she possibly died from
an aortic dissection or aortic aneurysm, and this would explain the bruising. She also did have low vitamin
B level and bruised easily.
On [DATE] at 1:14 PM, V1 stated an injury of unknown origin is an injury that can't be explained as far as
the cause or there are no witnesses to the injury. A bruise that shows up that can't be explained would be
investigated. V1 confirmed if a bruise were in an unusual place they would investigate it as injury of
unknown origin. V1 stated residents were not interviewed as part of their investigation and should have
been. V1 stated they only interviewed staff.
The Face Sheet dated [DATE] for R1 showed diagnoses including Alzheimer's disease, palliative care,
dementia with behavioral disturbance, type 2 diabetes mellitus, acute cystitis without hematuria, deficiency
of B vitamins, hypomagnesemia, unspecified behavioral syndromes, anxiety disorder, and essential
hypertension.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145151
If continuation sheet
Page 3 of 4
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
145151
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Allure of Mendota
1201 First Avenue
Mendota, IL 61342
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 0610
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
The facility's Unexplained Injuries policy ([DATE]) showed, all unexplained injuries, including bruises,
abrasions, and injuries of unknown source will be investigated. An injury should be classified as an injury of
unknown source when both of the following conditions are met: A, the source of the injury was not
observed by any person, or the source of the injury could not be explained by the resident; and b. The injury
is suspicious because of i. The extent of the injury or ii. The location of the injury (e.g., the injury is located
in an area not generally vulnerable to trauma) Reporting and investigation procedures shall be
implemented in accordance with the facility's abuse policies and procedures.
The facility's Abuse, Neglect, and Exploitation policy (2025) showed, possible indicators f abuse include,
but are not limited to: physical marks such as bruises or patterned appearances such as a handprint, belt or
ring mark on a resident's body. Physical injury of a resident, of unknown source. Investigation of alleged
abuse, neglect, and exploitation - an immediate investigation is warranted when suspicion of abuse, neglect
or exploitation, or reports of abuse, neglect or exploitation occur. Identifying and interviewing all involved
persons, including the alleged victim, alleged perpetrator, witnesses, and others who may have knowledge
of the allegations.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145151
If continuation sheet
Page 4 of 4
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
2 citations 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.
F609 - The facility must develop and implement written policies and procedures that:
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
F610 - In response to allegations of abuse, neglect, exploitation, or mistreatment, the
Respond appropriately to all alleged violations.
FAQ · About this visit
Common questions about this visit
What happened during the May 7, 2025 survey of ALLURE OF MENDOTA?
This was a inspection survey of ALLURE OF MENDOTA on May 7, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ALLURE OF MENDOTA on May 7, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities."
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
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.