Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
Based on observation, interview, and record review, the facility failed to maintain a sanitary, homelike, and
comfortable environment in, shower rooms, resident rooms, and a dining room. These failures affect
thirteen residents (R2, R8, R11, and R19 through R28) utilizing the shower room on the 100 Hall, nineteen
residents (R4, R6, R7, R10, R12, and R29 through R42) utilizing the shower room on the 300 Hall
Dementia Unit, seven residents (R3 and R13 through R18) who usually have meals in the small dining
room, one resident (R6) with a hole in the drywall and missing paint in her room, and one resident (R12)
with a padded floor mat adhered to the floor by food debris next to her bed. all from a total facility census of
83.
Findings include:
1. On 2/18/25 at 2:25 PM, R6's room had an outside corner adjacent to the bathroom door which was
missing paint in an area two inches wide by four feet high on both sides of the corner where there had
previously been a plastic corner protector, along with a patch of missing paint approximately one foot
vertical by seven inches horizontal, obviously torn away from the wall in the process of the corner protector
being removed from the wall. There was a one and one quarter inch diameter hole in the wall next to the
roommate's unoccupied bed. The roommate's bed was missing the mattress. There was an area on the wall
next to the roommate's bed approximately three feet by three feet which had deep scratches of missing
paint and exposed drywall which appeared to be caused by the bed being raised and lowered over time.
R6 stated she had spoken to a state guy last week (Ombudsman) who was trying to arrange for a different
facility to live in because of the multiple problems in her room.
On 2/19/25 at 2:45 PM, V16, Maintenance Director, stated he had accompanied a bank appraiser on a
comprehensive tour of the facility and had knowledge of many area of the facility that are missing paint and
had black wheelchair scuff marks on the walls and doors in the hallways and resident rooms. V16 further
stated he tried to keep up with the smaller maintenance items and does get some extra stuff done. V16
stated the facility was waiting to hear back from the bank and to get some corporate direction on fixing
more of the problems. V16 continued to say that the building is in mostly original construction and there was
a whole lot with this building that needs fixed.
2. On 2/18/25 at 2:50 PM, the common shower room on the 300 Hall was notably cold and had a
continuous stream of water emitting from the shower head. The floor to wall junction of the shower stall area
had a blackened substance along the junction and on the wall portions approximately eighteen inches up
from the floor in the corner and sloping downwards extending out to a point approximately seven feet from
the inner corner of the shower stall area into the shower room proper behind the tub
(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 7
Event ID:
145371
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
fixture. There was blackened substance and reddish pink gelatinous slimy substance along the plastic
shower chair legs and cross bars between the legs.
On 2/19/25 at 1:15 PM, R10 beckoned (surveyor) to come look at the 300 Hall shower room. R10 was
pointing to the blackened areas in the shower stall area and said, Look at all that black stuff on the walls, I
have asked them many times to get rid of that but it isn't gone, this is an atrocity, this is mildew, do you
know what that can do to people?
On 2/19/25 at 2:45 PM, V16 stated he was aware of the condition of the shower rooms in the facility. V16
stated he had one of the Housekeepers (V20) scrub the 300 Hall shower room wall in the shower stall area
and a lot of it had been cleaned just prior to this tour and interview. V16 stated what was left he would
probably have to go in and clean himself. V16 reached down to scrape at one of the remaining blackened
areas and stated he thought it was soap scum. V16 stated he was familiar with the pink slimy gelatinous
substance as he had previously encountered it in some plastic tubing from a drain.
The facility's Resident Roster dated 2/13/25 documents R4, R6, R7, R10, R12 and R29 through R42 reside
on the facility's 300 Hall and utilize the shower room on this hallway.
3. On 2/19/25 at 1:07 PM, the common shower room on the 100 Hall had a constant dripping of water from
the shower head. There was a crack in the tile grout approximately one-quarter inch wide in the corner of
the shower stall area from the floor upwards approximately four feet vertical, allowing water to penetrate
behind the wall.
On 2/19/25 at 2:45 PM, V16 stated the 100 Hall shower room could not be examined due to a resident
being in the shower at that time. V16 stated he had seen the very wide area of caulking in the corner of the
300 Hall shower room, in the exact position as the crack in the 100 Hall shower room, so he could picture
where the crack would be for the 100 Hall shower room.
The facility Resident Roster dated 2/13/25 documents R2, R8, R11 and R19 through R28 reside on the
facility's 100 Hall and utilize the shower room on this hallway.
4. On 2/18/25 at 10:25 AM, the small dining room directly across the hall from the central nursing station
was notably cold and there was food crumb debris on the tables and floor, as well as small areas of dried
food smears on the floor. There were three bath blankets folded and placed along the window sills.
2:45 PM, V16 stated he was aware of the cold temperature in the small dining room. V16 extended a hand
to the lower portions of the window sill and stated there was a draft coming in along the sill. V16 explained
that someone in the past had placed a wide (approximately six inches wide) sticky tape to seal out the
draft, but over time the tape had lost stickiness and was no longer effective. V16 stated the staff had placed
the bath blankets along the sill in an attempt to block out some of the draft.
On 2/19/25 at 3:30 PM, using a Public Health automatic calibration digital thermometer, the small dining
room measured in the 55 to 56 degree Fahrenheit range along the window sill. Using the same
thermometer, the entrance doorway to this small dining room, approximately twelve feet away from the
window, measured in the 65 to 66 degree Fahrenheit range.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 2 of 7
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
On 2/20/25 at 11:30 AM, V3, Licensed Practical Nurse, identified the residents who usually eat in the small
dining room as R3, R13, R14, R15, R16, R17, and R18. V3 stated these residents did not want to continue
to eat in the small dining room because of the cold temperature and had been eating in their rooms. V3
stated each of these residents required verbal cues and supervision during meals. V3 stated there had
been some plastic placed over the window in the small dining room last year but had not been placed this
year.
On 2/20/25 at 12:50 PM, R11, speaking with V18, Social Services Director, stated he thought it was good
that there weren't any residents eating in the small dining room because it was very cold. V18 concurred
and said she could feel the cold just walking by the small dining room.
Throughout the course of the survey on 2/13/25, 2/18/25, 2/19/25, and 2/20/25 approximately half of the
direct care staff were wearing long sleeve jackets or coats, and two employees were wearing ear muffs and
making complaints about the cold temperature in the hallways. The conference room occupied by (survey
team) also measured in the 65 to 66 degree Fahrenheit range. V16 was observed at various locations in the
hallways and the conference room using an infrared thermometer to check temperatures at heating outlets
and making statements such as this one is just blowing cool return air.
On 2/20/25 at 1:15 PM, V16 stated he had found a large piece of material against the surface of the heating
unit on the roof which supplies heat to the conference room. The measured temperature did not change in
the conference room.
5. On 2/18/25 at 2:40 PM, there was a padded floor mat next to the bed of R12. This floor mat was adhered
to the floor and took a considerable amount of effort to lift a corner of the mat. There was dried food debris
and smears under the mat.
On 2/18/25 at 2:45 PM, V20, Housekeeper, stated she had not noticed the floor mat was stuck in place and
had not been trained to clean underneath mats.
On 2/19/25 at 2:45 PM, V16 stated he had just become aware of the mat in R12's room being stuck on the
floor.
On 2/20/25 at 2:08 PM, V16 was in process of replacing twelve vinyl one foot square tiles on the floor next
to R12's bed. V16 stated that pulling up the floor mat had damaged the tiles so that they needed to be
replaced.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 3 of 7
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to protect the residents right to be free from mental and
emotional abuse. This failure affects one (R1) resident out of three residents reviewed for abuse in the
sample of 43.
Findings include:
The facilities Abuse Prevention and Reporting policy effective 9/2024 documents mental abuse is the use of
verbal or nonverbal conduct which causes, or has the potential to cause, the resident to experience
humiliation, intimidation, fear, shame, agitation, or degradation. When an allegation of abuse, exploitation,
neglect, or mistreatment has occurred the Department of Public Health shall be informed by telephone or
fax.
R1's Minimum Data Set (MDS) dated [DATE] documents R1 is cognitively impaired. R1 was unable to
complete a brief interview for mental status and required a staff assessment indicating R1 experiences
inattention and disorganized thinking, long term and short term memory problems, unable to recall staff
faces, location of R1's room and the seasons.
R1's Comprehensive Incident Fall assessment dated [DATE] at 10:30 PM documents R1 sustained a
witnessed fall coming out of the shower room into the hallway.
On 2/13/25 at 1:40 PM, V8 Licensed Practical Nurse, stated (on 1/28/25) she saw R1 stumbling backwards
out of the shower room door into the hallway attempting to reach the grab bar on the hallway wall and fell
on the floor. V8 stated V12, Certified Nursing Assistant, was standing in hallway watching R1 and was
laughing hysterically. V8 further stated V12 did not attempt to stop R1 from falling or help R1 after he fell.
On 2/18/25 at 10:30 AM, V2, Director of Nursing, stated that on 1/29/25 V2 came to work and witness
statements from R1's fall on 1/28/25 were on her desk. V2 stated she read the statements from V12 and
V13, Certified Nursing Assistants and felt like this incident needed to be investigated. V2 stated V1,
Administrator, was able to pull up camera footage from the camera in hallway facing the shower room. V2
stated she observed V12 and V13 open the shower room door and go inside. V12 came out of the shower
room door and stood in the hallway looking into the shower room laughing. V2 further stated V12 then
continued laughing very hard and moved out of the way of the shower room door. V2 stated she then
observed R1 quickly stumbling out of the shower room and grabbed the side rail on the wall on other side of
hallway and then fell on floor. V2 stated V12 continued laughing and didn't attempt to stop R1 from falling or
help R1 after he fell. V2 stated we did an inappropriate fall investigation, and determined V12 and V13
would not return to work for inappropriate care of residents and not reporting a fall. V2 further stated
laughing at a resident for falling is abuse and I don't tolerate it.
On 2/18/25 1:13 PM, V9, Registered Nurse/ Minimum Data Set Nurse, stated she watched the video of R1
falling with V2 and V1 at the facility. V9 stated she could only see R1 coming out of shower room. V9 stated
because of the angle of the camera V9 was unable to see inside the door of the shower room. V9 stated
she observed R1 stumble fast out of the shower room and V12 moved to the side and was laughing. V9
stated V12 did not try to stop the fall or help R1 after he fell.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 4 of 7
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 0600
On 2/18/25 at 12:00 PM, V5, Family Member, stated prior to R1's cognitive decline if R1 had fallen and
someone laughed, R1 would have been hurt and humiliated.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 5 of 7
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 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 allegations of mental abuse for one (R1) of three
residents reviewed for abuse out of a sample list of 43.
Findings include:
The facilities Abuse Prevention and Reporting policy effective 9/2024 documents mental abuse is the use of
verbal or nonverbal conduct which causes, or has the potential to cause, the resident to experience
humiliation, intimidation, fear, shame, agitation, or degradation. When an allegation of abuse, exploitation,
neglect, or mistreatment has occurred the Department of Public Health shall be informed by telephone or
fax.
R1's Comprehensive Incident Fall assessment dated [DATE] at 10:30 PM, documents R1 sustained a
witnessed fall coming out of the shower room into the hallway. The Assessment further documents R1 was
walking out of the shower room and R1 attempted to grab V13 Certified Nursing Assistant by the neck, V13
blocked R1's hand then R1 tried to grab V13's arm, V13 pulled her arm back and R1 then stumbled into the
hallway trying to reach the grab bar in hallway and fell.
On 2/18/25 at 10:30 AM, V2 Director of Nursing stated that on 1/29/25, V2 came to work and the witness
statements from the fall on 1/28/25 were on her desk. V2 stated after reviewing the statements she felt the
incident needed further investigation and went to V1 Administrator immediately to report concerns.
On 2/13/25 at 12:25 PM, V1 Administrator stated there was an abuse allegation that a staff member
hit/pushed R1 on 1/28/25 resulting in a fall. V1 stated she investigated the allegation and there was no
evidence anything happened, so it wasn't reported.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 6 of 7
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
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 staff failed to wait for a licensed nurse assessment before standing
a resident up after a witnessed fall. This failure affects one resident (R1) out of three reviewed for abuse
allegations on the sample of 43.
Residents Affected - Few
Findings include:
The Facility's Fall Prevention Program policy revised 5/2022 documents a Fall Assessment will be
completed after any fall.
R1's Comprehensive Incident Fall assessment dated [DATE] at 10:30 PM documents R1 sustained a
witnessed fall coming out of shower room into the hallway.
On 2/13/25 at 1:40 PM, V8 Licensed Practical Nurse stated she walked onto the unit as R1 was falling onto
the hallway floor. V8 stated that she told V12 and V13 Certified Nursing Assistants that she would be back
to assess R1 and to stay with him until she was finished providing care for another resident. V8 stated when
she came out into the hallway R1 was no longer laying on the floor and V13 told her that they put R1 to bed
and he was fine. V8 further stated when she went into R1's room to assess him R1 was complaining of pain
and wouldn't move.
On 2/18/25 at 11:22 AM, V12 Certified Nursing Assistant stated she didn't want to get R1 up from the floor
because R1 was complaining of pain after he fell, stating his back was hurting. V12 further stated the V13
Certified Nursing Assistant and another resident tried to stand R1 up and R1 was complaining of pain. V12
stated she got a wheelchair and sat R1 in it and V13 took R1 to his room.
On 2/18/25 at 10:30 AM, V2 Director of Nursing stated we did an inappropriate fall investigation, and V12
and V13 should have not got R1 up off the floor without nurse, R1 could have been hurt worse.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145371
If continuation sheet
Page 7 of 7
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Back to topCitations
4 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.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
FAQ · About this visit
Common questions about this visit
What happened during the February 24, 2025 survey of ARCADIA CARE BLOOMINGTON?
This was a inspection survey of ARCADIA CARE BLOOMINGTON on February 24, 2025. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ARCADIA CARE BLOOMINGTON on February 24, 2025?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
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.