Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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 ensure residents were free from abuse for 1 of 3 (R1)
residents reviewed for abuse in the sample of 18.This past non-compliance occurred between [DATE] and
[DATE]. Findings Include:R1's undated Resident Face Sheet documents R1 was admitted to the facility on
[DATE] with diagnoses that include dementia with mood disturbances, heart failure, anxiety disorder,
Parkinsonism, and localized edema. R1's Minimum Data Set (MDS) dated [DATE] documents a BIMS (Brief
Interview for Mental Status score of 07, indicating a moderate cognitive deficit. R1's Care Plan documents a
Problem area with a start date of [DATE] of, Category: Behavioral Symptoms, Resident is alert and able to
let his needs be known most of the time. He has dx (diagnoses) of depression and anxiety. He has made
inappropriate comments to the young staff members, false accusations against staff.likes to get some of the
residents stirred up.he will make a fist and threaten them.he also likes to call female resident his girlfriend.
12/3 altercation with another resident. The interventions documented for this Problem area include,
Approach start date: [DATE] try to keep this resident away from other resident. R5's undated Resident Face
Sheet documents R5 was admitted to the facility on [DATE] with diagnoses that include neuroleptic induced
parkinsonism, bipolar disorder, and schizophrenia. R5's MDS dated [DATE] documents a BIMS score of 13,
indicating R5 is cognitively intact. R5's Care Plan documents a Problem with a start date of [DATE] of,
Category: Behavioral Symptoms, she is alert and able to let her needs known.she has the dx of anxiety,
depression.schizophrenia, bipolar, and insomnia.12/3 manic and hit another resident Klonopin started 12/4
delusions and hallucinations. Labs ordered. This Problem area includes interventions of, Approach Start
Date: [DATE] see MAR (Medication Administration Record) for Klonopin assess for effectiveness. A facility
Long-Term Care Facility and IID (Individuals with Intellectual Disability)-Serious Injury Incident Report
dated [DATE] documents, (R5) (perpetrator) female who is [AGE] years old was in her wheelchair going
down the hall when (R1) (victim) 81 was walking back to her (sic) room. (R5) reach out with fist making
contact with (R1) side and arm. (R1) then took his fist at (R5) making contact with her arm. Both patients
were separated by staff and assessed for any injuries. Skin assessment was performed with no signs of
bursing (sic) or red marks. Patient had no other interaction with one another. POA (Power of Attorney), MD
(Medical Doctor), and police notified. Care plans updated. No further altercations have occurred with either
patient. R1's Progress Notes document on [DATE] at 9:28 AM, CNA (Certified Nursing Assistant) reported
to this nurse that resident was hit with a closed fist 4 times by another resident in the torso and arm. CNA
stated that resident then grabbed the other resident's arm. Residents assessed for injury and separated.
Administrator notified of situation. Called and notified (name of physician). Attempted to notify resident's
wife (V4) of situation, no answer, voicemail left to call back. R5's Progress Notes document on [DATE] at
9:13 AM, This nurse was notified by CNA that resident closed fist hit another resident 4 times in the torso
and arm. CNA
(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:
145388
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
145388
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Helia Healthcare of Olney
410 East Mack
Olney, IL 62450
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
stated that the other resident grabbed her left arm. Both residents were immediately assessed and
separated. Administrator notified. Resident is also having hallucinations and made the statement, I wish I
could die. Devil come and get me. Called and notified (name of physician). Attempted to notified (sic)
POA/daughter (name of POA), no answer. Left voicemail to call back. [DATE] 4:30 PM, (name of physician)
office called back with N.O. (new order) Klonopin 0.5 mg (milligrams) BID (twice daily). Called
POA/daughter (name of POA) and received verbal consent for medications. [DATE] 12:43 PM, Resident
very calm and relaxed today. No behaviors or hallucinations. 15 minute checks continue. R1 is deceased so
this surveyor was unable to obtain an interview. This surveyor attempted to interview R5 on [DATE] at 1:25
PM, R5 was unable to recall details of the incident. On [DATE] at 1:56 PM, V4 (Family Member) stated R1
was involved in an altercation with another resident and was hit in the stomach 2-3 times.On [DATE] at 1:39
PM, V3 (Licensed Practical Nurse/LPN) stated the altercation between R1 and R5 was reported to her by
V7 (CNA). V3 stated she reported it to V1 (Administrator) and documented it in the residents' medical
records. On [DATE] at 2:08 PM, V7 (CNA) stated she reported an altercation she witnessed between R1
and R5 to V3 (LPN). V7 stated after she reported it, she resumed providing care to other residents. On
[DATE] at 1:34 PM, V2 (Director of Nurses) stated V7 (CNA) reported an altercation between R1 and R5 to
her. V2 stated V7 told her V1 (Administrator) was with the residents. V2 stated she confirmed V1 was with
the residents and did not have any direct knowledge of the events after that. On [DATE] at 1:58 PM, V1
(Administrator) stated she didn't witness the altercation between R1 and R5, but it was reported to her. V1
stated V7 (CNA) told her R5 said something to R1 and made a punching/tapping motion to R1's arm and
R1 did it back to R5. V1 stated R5 was very upset and agreed to a psychiatric evaluation so they contacted
R5's psychiatrist. V1 stated both residents were assessed with no injury and their care plans were reviewed
and updated. V1 stated she reported the incident to the physician, local police and state survey agency. The
facility Abuse Prevention Program dated [DATE] documents, Abuse: Abuse is the willful infliction of injury,
unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental
anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services
that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse
of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental
anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse
facilitated or enabled through the use of technology Willful, as used in this definition of abuse, means the
individual must have acted deliberately, not that the individual must have intended to inflict injury or harm
Prior to the survey date, the facility took the following actions to correct the deficient practice according to
the QAPI (Quality Assurance Performance Improvement) Ad Hoc Form with meeting date of [DATE]:1.
Immediate Corrective Action for those affected by the deficient practice:Both residents were immediately
separated upon discovery of the incident.(R5) was assessed by nursing staff following the incident. No
marks, bruising or redness noted. Resident remains stable.(R1) was assessed by nursing staff following the
incident. No marks, bruising, or redness notes. Resident remains stable.Comprehensive skin check
performed on both residents [DATE].Increased supervision implemented pending investigation.Staff
interviews initiated on [DATE] Resident interviews initiated on [DATE].Police, POA, MD notified [DATE].2.
Process/Steps to identify others having the potential to be impacted by the same deficient practice:All other
residents could be affected by the deficient practice.3. Measures put into place/systematic changes to
ensure the deficient practice does not recur.Behavioral care plans for involved and at-risk residents were
reviewed and updated to Include triggers, redirection techniques, and supervision interventions. Initiated
staff educated
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145388
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
145388
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Helia Healthcare of Olney
410 East Mack
Olney, IL 62450
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
FORM CMS-2567 (02/99)
Previous Versions Obsolete
abuse policy on [DATE]. Initiated staff educated on resident rights on [DATE]. Customer service training/in
service scheduled [DATE]. Resident Council meeting held to review resident rights and abuse prevention.4.
Plan to monitor performance to ensure solutions are sustained.DON (Director of Nurses)/designee will
audit 1 resident 3x (times) a wk. (week) for 2 weeks, and monthly for 2 months to ensure no concerns with
resident's right/abuse. Any non-compliance will be addressed immediately.Administrator to review audits to
ensure compliance.Trends will be reported to the QA (Quality Assurance) Committee for review with any
identified deficiencies to have further corrective action implemented as needed.
Event ID:
Facility ID:
145388
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.
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.
FAQ · About this visit
Common questions about this visit
What happened during the December 17, 2025 survey of HELIA HEALTHCARE OF OLNEY?
This was a inspection survey of HELIA HEALTHCARE OF OLNEY on December 17, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at HELIA HEALTHCARE OF OLNEY on December 17, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
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.