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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to ensure call lights were answered timely for 3 of 3 (R14,
R27, and R66) residents reviewed for dignity in the sample of 31.
Findings Include:
1. R66's face sheet, print date 12/21/22, documents R66 was admitted to the facility on [DATE], with
diagnoses that include reduced mobility and osteoarthritis.
R66's MDS (Minimum Data Set), dated 12/09/22, documents a BIMS (Brief Interview for Mental Status)
score of 15, which indicates R66 is cognitively intact. This same MDS documents under Section G that R66
does not ambulate, requires assist of staff for dressing, showering, personal hygiene, and toileting.
On 12/18/22 at 12:19 PM, R66 stated it took staff over an hour to answer the call light this morning
(12/18/22) when he needed assistance going to the bathroom. When asked if he had reported it, R66
stated he had not, and asked this surveyor to see if V1 (Administrator) would come to his room.
The facility Grievance/Concern Form, dated 12/18/22, documents, (R66) spoke with administrator (V1) this
morning. (R66) stated he had his call light on. (V19, CNA/Certified Nursing Assistant) entered room and
asked what he needed. (R66) said he needed to use sit to stand to urinate. (V19) stated that she had to run
a bag of dirty linens to laundry. (V19) then turned off the call light and left. After approximately 10 minutes
(V19) did not return (R66) used his call light again. After 5-10 minutes call light was answered by (V19) and
(R66) stated that she immediately apologized because she forgot about him earlier. Under Resolution the
Grievance/Concern Form documents, Administrator (V1) spoke with (V19) and she was very apologetic.
(V19) realized she was wrong to turn off (R66's) call light before she was able to help him. (V19) received a
verbal counseling admin spoke to (R66) and he was pleased that we dealt with this so quickly.
On 12/21/22 at 10:56 AM, R66 stated V1(Administrator) had come and talked with him after this surveyor
spoke with R66, and the facility has resolved the issue and he hasn't had any more concerns with his call
light not being answered timely.
2. R27's face sheet, print date of 12/21/22, documents R27 was admitted to the facility on [DATE], with
diagnoses that include neuropathy and diabetes.
R27's MDS, dated [DATE], documents a BIMS score of 15, which indicates R27 is cognitively intact.
(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 5
Event ID:
145376
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
145376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/21/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Oakview Nursing & Rehab
1320 West 9th Street
Mount Carmel, IL 62863
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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
This same MDS documents under Section G that R27 requires assistance with locomotion, dressing, toilet
use, personal hygiene, and showers.
On 12/18/22 at 11:11 AM, R27 stated certain CNA's come to her room when she has a call light on and
turns it off. R27 stated the staff leave, and sometimes it takes them an hour to come back. R27 stated she
had complained about this at resident council.
On 12/21/22 at 2:20 PM, R27 stated last night (12/20/22), she was incontinent and needed to be changed,
and it took an hour and a half for them to answer the call light. When asked if she had reported this to
administration, R27 stated she had not, but she had told the nurse.
The facility Resident Council meeting minutes, dated 8/15/22, documents, .Still some concerns about call
lights not being answered timely. However wait time has been improving . There is no resolution attached to
this resident council meeting.
The facility Resident Council meeting minutes, dated 9/8/22, documents, .Seems that some staff take
longer to answer call lights than others . There is no resolution attached to this resident council meeting.
The facility Resident Council meeting minutes, dated 12/1/2022, documents .Nursing: Concerns about night
shift taking extended amount of time answering call lights . The undated facility December Resident Council
Resolution documents, Only concern was call lights not being answered timely on night shift. This will be
addressed by Administration. Administrator and DON (Director of Nursing) will alternate doing night shift
pop ins at least 3 times a week for 3 months to ensure this is improving.
3. R14's face sheet, print date 12/21/22, documents R14 was admitted to the facility on [DATE] with
diagnoses that include heart failure and lymphedema.
R14's MDS, dated [DATE], documents a BIMS score of 15, which indicates R14 is cognitively intact. This
same MDS documents under Section G that R14 requires assist with locomotion, dressing, toilet use,
personal hygiene, and showers.
On 12/18/22 at 12:48 PM, R14 stated it takes up to a couple of hours for facility staff to answer her call
light. When asked what happens when it takes them that long to answer it R14 stated, I poop and pee in the
bed.
On 12/21/22 at 2:50 PM, V1 (Administrator) and V2 (Director of Nursing) stated they would expect the
facility staff to answer call lights timely and to not turn them off until the resident need has been met
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145376
If continuation sheet
Page 2 of 5
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
145376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/21/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Oakview Nursing & Rehab
1320 West 9th Street
Mount Carmel, IL 62863
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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure interventions to prevent falls were
implemented for 1 of 7 (R19) residents reviewed for falls in the sample of 31.
Findings Include:
R19's facility face sheet, with a print date of 12/21/22, documents R19 was admitted to the facility on
[DATE], with diagnoses that include muscle weakness, heart disease, anemia, unsteadiness on feet, history
of falling, and reduced mobility.
R19's MDS (Minimum Data Set), dated 12/14/22, documents a BIMS (Brief Interview for Mental Status)
score of 08, which indicates R19 has a moderate cognitive impairment. This same MDS documents under
Section G that R19 requires assist with locomotion, dressing, and toilet use.
R19's Care Plan documents a Category of Falls, with a start date of 11/27/2020, documents interventions
that include, fall interventions: offer snacks, alarms, skid strips, dycem in chair, after meals take to room,
grab bars, gripper socks, safety mat on floor, low bed, with a start date of 11/4/22.
R19's undated Physician Order List documents under Special Requirements an order, with a start date of
12/19/22 of Fall interventions: offer snacks frequently, alarm in place, skid strips, dycem to chair, grab bar,
gripper socks, mat on floor, low bed.
R19's Resident Incident Reports document the following: 12/17/22-R19 slid from her bed to her floor;
10/16/22- R19 was found sitting in the floor by bed after attempting to transfer self to bed; 9/2/22- R19 was
observed laying on floor in front of bed; and 9/3/22 R19 attempted to transfer self to bed and fell. All of
these Resident Incident Reports document R19 did not sustain significant injury when she fell, and
document interventions were implemented after each fall.
On 12/21/22 at 12:50 PM, R19 was assisted to stand up out of her wheelchair by V17 (Licensed Practical
Nurse) and V18 (Registered Nurse). V2 (Director of Nursing/DON) was also present in the room. There was
no dycem observed in R19's wheelchair during this observation. V2 placed a dycem in R19's wheelchair
before she sat back down.
On 12/21/22 at 2:26 PM, V2 (DON) and V1 (Administrator) both stated R19 should have had dycem in her
wheelchair seat during the observation on 12/21/22.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145376
If continuation sheet
Page 3 of 5
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
145376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/21/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Oakview Nursing & Rehab
1320 West 9th Street
Mount Carmel, IL 62863
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 0808
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or
licensed dietitian, to the extent allowed by State law.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview, observation, and record review, the facility failed to provide diet supplements as ordered by the
physician for 1 of 8 (R59) residents reviewed for nutrition in a sample of 31.
Findings Include:
R59's Current Face Sheet documents R59 is an [AGE] year old female, with an admission date of 01/20/22,
and a with a weight of 86 pounds. Diagnosis include: Dementia, Covid-19, Peptic ulcer, Hypothyroidism,
Hyperlipidemia, Insomnia, and Essential Hypertension.
R59's Current Physician Order Sheet (December 2022) documents: Health Shakes three times a day, 8:00
AM, 12:00 PM, and 5:00 PM, with an order start date of 09/07/22. Fortified Drinks at all Meals, with an
order start date of 09/07/22. Fortified Pudding at lunch, with an order start date of 03/22/22.
R59's Dietary Note by V18 (Registered Dietician/RD) documents on 11/26/2022 at 7:22 AM, RD Skin Note
Resident (R59) has stage 2 pressure ulcer to sacrum, improving, per wound report. Wt (weight) 86.7lb. BMI
(body mass index) 18.12, underweight. Resident (R59) had recent fall with no injuries, per nursing note. No
labs to review. Resident (R59) on regular diet with thin liquids, super cereal at breakfast, fortified pudding at
lunch, fortified drink at all meals. Intake ranges 50-75%, good. No diet changes recommended as intake is
good and wound is improving. RD to follow prn (pro re nata (as needed)).
On 12/20/22 at 11:40 AM, R59 received her lunch. There was no Health Shake, Fortified Drink or Fortified
Pudding with her lunch. R59's room was observed until 1:00 PM; there were no additional food or drinks
brought to R59.
On 12/20/22 at 1:10 PM, R59 was asked if she had pudding or a shake for lunch; she stated, no.
On 12/20/22 at 1:20 PM, V4 (Certified Nurse Aide) stated R59 did not receive supplements today. They
have been having problems with the kitchen staff sending the supplements over to the unit on the cart.
On 12/21/22 at 11:30 AM, R59's lunch was observed. There was no Health Shake, Fortified Drink or
Fortified Pudding with her lunch. R59's room was observed until 1:00 PM; there were no additional food or
drinks brought to R59.
On 12/21/22 at 2:30 PM, V1 (Administrator) stated they have had problems getting the supplements over to
the dementia unit; they will re-educate again.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145376
If continuation sheet
Page 4 of 5
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
145376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/21/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Oakview Nursing & Rehab
1320 West 9th Street
Mount Carmel, IL 62863
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 0851
Level of Harm - Potential for
minimal harm
Residents Affected - Many
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and
other verifiable and auditable data.
Based on interview and record review, the facility failed to electronically submit required PBJ (Payroll-Based
Journal) information within the mandatory time frames for the third quarter of 2022. This has the potential to
affect all 68 residents who reside at this facility.
Findings include:
On 12/18/2022 at 11:00 AM, V1 (Administrator) said the facility somehow did not electronically report it's
3rd quarter PBJ (Payroll-Based Journal) information to CMS (Centers for Medicare and Medicaid Services)
as mandated. V1 said the responsibility for reporting the PBJ information belongs to our Corporate office.
V1 said he does not understand what happened, but the facility and corporate is working on correcting the
problem.
A document titled PBJ Staffing Data Report CASPER (Certification and Survey Provider Enhanced Report)
1705D FY (Fiscal Year) Quarter 3 2022 (April 1 - June 30) documented the following: Facility Name: (Name
of Facility) Provider Number 145376, Facility ID (Identification) IL6003487 State: IL (Illinois) and This
Staffing Data Report identifies areas of concern that will be triggered: Failed to Submit Data for the Quarter
was triggered, One Star Staffing rating Triggered due to no data submitted for quarter.
A facility document titled Resident Census and Condition, dated 12/18/22, documented their were 68
residents living in the facility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145376
If continuation sheet
Page 5 of 5
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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.
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F808 - Therapeutic Diets
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
F851 - Mandatory submission of staffing information based on payroll data in a
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
FAQ · About this visit
Common questions about this visit
What happened during the December 21, 2022 survey of OAKVIEW NURSING & REHAB?
This was a inspection survey of OAKVIEW NURSING & REHAB on December 21, 2022. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at OAKVIEW NURSING & REHAB on December 21, 2022?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."
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.