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 provide timely laundry services to
maintain residents personal clothing in a clean useable condition for six of eighteen residents (R10, R12,
R13, R14, R16 and R17) reviewed for Homelike environment.Findings include:On 12/3/25 at 9:50 AM,
three clean linen carts observed in laundry room, filled with residents clean laundered clothing awaiting
delivery. On 12/4/25 at 9:45 AM, the same three clean linen carts observed in laundry room still awaiting to
be delivered. On 12/4/25 at 9:31 AM, R12 stated that it takes a while to get you clothes back, and R12
sometimes goes to laundry and asks to get some clothes. On 12/4/25 at 9:45 AM, V5 Laundry Aide stated
there is an issue with missing and late laundry, as you can see both washers and dryers are going, and we
have three 55-gallon garbage container, and two laundry carts filled of dirty clothes. V5 stated there is also
two carts of clean clothes that have been here since yesterday and need to be delivered to the residents.
On 12/4/25 at 9:50 AM, V15 Laundry Aide stated that there is a lot of clothes that need to be cleaned, there
are three 55-gallon garbage containers and two laundry carts full of dirty clothes and linens. V15 stated that
if it's only V15 working it's hard to wash, dry and fold the clothes and get them back to the residents. V15
stated that it takes several days to get the residents clothes, wash, dry, fold, hang them up and get them
back to the residents. V15 stated that lots of residents come to the laundry door and knock and ask for their
clothes. On 12/4/25 at 10:16 AM, R13 stated that a couple of weeks ago R13 filled out a complaint form for
a missing hoodie that was brought to laundry to be cleaned. R13 stated three days later the hoodie was
located in laundry and given back to R13. R13 stated that it always takes two-three days to get your clothes
washed and returned by laundry. R13 stated that that is too long, R13 is always looking for R13's clothes
and they are in laundry. On 12/4/25 at 10:50 AM, V6 Certified Nursing Assistant stated that there is an
issue with residents getting their clean clothes back from laundry, it's been taking two-three days or more
for them to get their clothes back.On 12/4/25 at 11:20 AM, V16 Certified Nursing Assistant stated that there
has been an ongoing issue with residents not getting their clean clothes back for several days. V16 stated
that laundry is backed up and it takes several days to clean and return clothes. On 12/4/25 at 11:45 AM, V2
Director of Nursing stated that the facility has been getting Concern/Complaint Forms regarding missing
clothing. V2 stated that the residents' clothes have been found in laundry. V2 stated that laundry is not
returning residents clean laundry in a timely manner and the resident believes that their clothes are
missing. V2 confirmed there are three linen carts of clean laundry in the laundry room that needs to be
delivered to the residents. On 12/4/25 at 1:19 PM, V1 Administrator confirmed there is an issue with the
timing of returning residents clothes. V1 stated we are making plans to address this issue and get the
residents clothes back to them in a timely manner. V1 stated that the facility has gotten several Concern
forms regarding missing clothing that were later found in laundry due to not being returned to them in a
timely manner.On 12/4/25
(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:
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
12/05/2025
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
FORM CMS-2567 (02/99)
Previous Versions Obsolete
at 1:30 PM, R10 stated that R10 is always missing clothing. R10 stated that R10 has filed
Concern/Complaint Forms and staff have found R10's missing items in laundry. R10 stated that it takes
laundry two-three days to clean R10's clothes and get them back to R10, which is way too long. R10 stated
they don't have enough staff to clean the clothes and bring them back to the residents. On 12/4/25 at 2:20
PM, R14 stated that R14 has had clothes missing, that show up days later from laundry. R14 stated that it
always takes several days from the time R14's clothes go to laundry till they come back. R14 stated that
R14 has gone to laundry to ask for clothes that R14 needed. R17's Concern/Complaint Form dated 10/9/25
documents R17 missing blue blanket. Summary of findings dated 10/10/25 documents: Found in laundry.
R16's Concern/Complaint Form dated 11/1/25 documents R16's Power of Attorney stated POA had to buy
more sweatpants for R16 since they keep going missing. Summary of findings dated 11/3/25 documents:
Two pair found. R10's Concern/Complaint Form dated 11/4/25 documents R10 says R10 is missing
leggings, size XL they look like jeans. Summary of findings dated 11/5/25 documents: Leggings found in
laundry. Corrective action taken: Laundry team educated on promptness of cleaning and returning
items.R13's Concern/Complaint Form dated 11/14/25 documents R13 says R13 is missing a hoodie, size
large. Summary of findings dated 11/17/25 documents: Hoodie found in laundry. Corrective action taken:
Laundry team educated on promptness of cleaning and returning items.R10's Concern/Complaint Form
dated 11/25/25 documents R10 says a shirt is missing, size 2x purple. Summary of findings dated 11/26/25
documents: Shirt found in laundry. Corrective action taken: Laundry team educated promptness of cleaning
and returning items.Resident Council Meeting Minutes dated 9/9/25 documents: Laundry/Housekeeping:
missing clothes. Resident Council Meeting Minutes dated 10/14/25 documents: Laundry/Housekeeping:
clothes are going missing for residents.Resident Council Meeting Minutes dated 11/11/25 documents:
Laundry/Housekeeping: missing laundry still, taking weeks to return.
Event ID:
Facility ID:
145371
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
145371
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/05/2025
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 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
Based on observation, interview, and record review, the facility failed to maintain the shower rooms in a
safe and functional condition. This failure has the potential to affect all 94 residents residing in the
facility.Findings include:On 12/3/25 at 1:49pm, the facility's shower room on the 100 hall was in a state of
disarray. There were loose pieces of tile, a crack in the shower board, floor tile grout dirty with black
substance, an orange substance (appears to be rust) along baseboard edges, peeling caulk, and a
gray/black fuzzy substance appearing on the caulking on lower shower head wall. These blackened areas
were in spotted arrangement with radiating strands and resembled mold. There was a bathtub in this room
with hair, boxes of gloves, and a gait belt inside of it.On 12/3/25 at 2:45pm, the facility's shower room on the
400 hall was in a state of disarray. There was approximately two feet of baseboard detached from wall,
black substance on caulk, an orange substance (appears to be rust) on the shower board, overall dirty
appearing tiles, black substance on areas of floor near the shower walls. These blackened areas were in
spotted arrangement with radiating strands and resembled mold. The toilet was full to the rim with what
appeared to be feces.On 12/4/25 at 10:10am, the facility's shower room on the 300 hall was in a state of
disarray. The toilet bowl water was black, an orange substance (appears to be rust) and a black substance
(appearing to be mold and/or mildew) on baseboards/baseboard caulking and a black substance on floor
tiles near the shower walls. These blackened areas were in spotted arrangement with radiating strands and
resembled mold.On 12/4/25 at 1:03pm, V4 Maintenance Director accompanied this surveyor to all three
shower rooms. V4 confirmed all three shower rooms were in disrepair. V4 confirmed the following
observations: 400 hall shower room-base board pulled off approximately two feet on shower head wall from
corner to mid-point of shower wall. Toilet dirty with unknown substance. Unidentifiable black substance on
floor and around shower walls and on caulking. Approximately six inches of black fuzzy substance along
baseboard. 100 hall shower room-numerous broken floor tiles around shower drain, shower chair seat has
what appears to be feces on the top of the seat, black substance along shower base boards, and peeling
caulk. 300 hall shower room-toilet needs cleaned, garbage noted on floor (plastic wrappings/tissues), black
substance on floors along baseboards. Tiles missing from wall. V4 stated all three of these shower rooms
need deep cleaned and completely remodeled.On 12/3/25 at 10:09am, R1 stated both showers are gross
and who knows what is on the floors.On 12/3/25 at 1:45pm, R8 stated R8 has used both the 100 and 400
hall showers. R8 stated the shower rooms are dirty and need remodeled. R8 stated the wall is pulling off at
the bottom in the 400-hall shower and there is mold on the walls and floors.On 12/4/25 at 9:19am, R10
stated R10 uses both the 100 and 400 hall showers. R10 stated the shower rooms are disgusting and the
facility keeps putting a Band-Aid on the issues instead of fixing the shower rooms.On 12/5/25 at 9:40am,
R12 stated R12 uses the 400-hall shower, and the baseboard has been coming off for a while now. R12
stated, it's not very clean in there.Resident Council Meeting Minutes dated 9/9/25 documents the following:
Maintenance: So much maintenance needs to be done. Concerned that it is too much for one to handle.
Maybe additional help.The facility Resident Listing Report dated 12/3/25 documents 94 residents reside in
the facility.
Event ID:
Facility ID:
145371
If continuation sheet
Page 3 of 3