Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to administer an ordered intravenous, IV,
antibiotic, timely transport, and contact prescribing Physician for 1(R2) of 3 residents in the sample of 23.
This failure resulted in R2's course of treatment being interrupted, R2 needing to have six additional days of
IV antibiotics, and the potential of septic infection. Findings include:R2's undated face sheet documents an
admission date of 11/28/2025 and a discharge date of 12/4/2025. Diagnosis include Fournier Gangrene,
Chronic Kidney Disease, Bacteriuria, Urinary Tract Infection, Acute Kidney Failure, Malignant Neoplasm of
Rectum, Colostomy Status.R2's Minimum Data Set, MDS dated R2's MDS dated [DATE] documents R2
has no cognitive deficits. R2 is dependent for rolling, sitting and transfers. R2's baseline care plan dated
12/4/2025 documents The resident has Catheter: Neurogenic Bladder. Interventions include Catheter Care,
Position catheter bag and tubing below the level of the bladder and away from entrance room door. R2's
order sheet dated 11/28/2025 Ceftazidime-Avibactam Intravenous Solution Reconstituted 2.5 (2-0.5) GM
(Ceftazidime-Avibactam Sodium) Use 0.94 gram intravenously two times a day for antibiotic until
12/08/2025 11:59PM.R2's November medication administration sheets, MARS, dated
11/1/2025-11/30/2025 documents Ceftazidime-Avibactam Intravenous Solution Reconstituted 2.5 (2-0.5)
GM (Ceftazidime-Avibactam Sodium)Use 0.94 gram intravenously two times a day for ABT until 12/08/2025
11:59PM. R2's 11/28/2025 PM, 11/29/2025 AM and PM dose, 11/30/2025 AM and PM doses all marked as
Hold.R2's December medication administration sheets, MARS, dated 12/1/2025-12/31/2025 documents
Ceftazidime-Avibactam Intravenous Solution Reconstituted 2.5 (2-0.5) GM (Ceftazidime-Avibactam
Sodium) Use 0.94 gram intravenously two times a day for ABT until 12/08/2025 11:59PM. R2's 12/1/2025
AM and PM doses and 12/1/2025 AM and PM doses marked as Hold. R2's progress notes dated
11/28/2025 at 7:00AM document The nurse reported that R2 was newly admitted to the facility with
intravenous, IV, antibiotics for Clostridioides difficile, C diff, and Extended Spectrum Beta-Lactamase,
ESBL, in the urine. The pharmacy informed that the ordered antibiotic is not available and cannot be
supported. The nurse was advised to contact the hospital or prescribing provider to request an alternative
medication. The patient remains stable per the nurse. Rounding provider to follow up. R2's progress notes
dated 11/28/2025 at 5:15PM documents Call received from pharmacist at to notify that he cannot supply IV
antibiotic until Monday 12/1/2025 due to having to order from a different pharmacy.R2's progress notes
dated 11/28/2025 at 5:32PM documents Received call from pharmacist. Pharmacist states that he is
unable to obtain IV antibiotic for supply, he is also unable to suggest appropriate interchange due to not
having culture and sensitivity for reference. V23, Facility Nurse Practitioner, NP, notified of above, with
suggestion to attempt to contact ordering hospitalist for new antibiotic. current order antibiotic to be placed
on hold pending new orderR2's progress notes dated 11/29/2025 at 11:32PM document Antibiotic/ESBL
urine/CDIFF (Vancomycin) IV antibiotic remains on Hold until Monday. No adverse side effects, ASE, noted
from medication, Afebrile. R2 voicing no
Residents Affected - Few
(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:
145454
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
145454
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Carlinville Rehab & Hcc
751 North Oak Street
Carlinville, IL 62626
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
Level of Harm - Actual harm
Residents Affected - Few
concerns/complaint/discomforts. Able to make needs and or wants known. IV site free of signs of infection
with dressing clean, dry, intact, CDI. R2's progress notes dated 12/1/2025 at 11:57AM document Health
Status Note Note Text: call placed to V20, Infectious Disease Physician, at this time to notify of unavailable
antibiotic order, message provided to nurse in with patient. awaiting response. R2's progress notes dated
12/3/2025 at 5:04PM documents Received call from nurse V20's office with orders to send R2 back to
hospital for continuing treatment of IV antibiotics if unable to obtain from any pharmacy for treatment
outside of hospital. Per V20 statement is he will not change the IV medication as it is the only medication
that can be used. R2's progress notes dated 12/3/2025 at 6:26PM documents Emergency Medical
Services, EMS, in facility, refusing to take resident to Emergency Department, ED.R2's progress notes
dated 12/3/2025 at 7:38PM out of town EMS refused at 6:23PM. Out of town EMS refused at 6:25PM. Out
of town EMS at 6:36PM refused. Out of town EMS at 7:01PM refused. Out of town EMS at 7:37PM refused.
Out of town EMS at 7:42PM refused. Out of town EMS at 7:45PM refused. Out of town EMS at 8:08PM
refused. Out of town EMS at 8:18PM refused. On 12/9/2025 at 12:46PM V4, Minimum Data Set, MDS
Coordinator, stated R2 was discharged on an IV that is usually only given in hospitals. We got a hold of the
Infectious Disease Doctor, IDD, and the IDD wanted R2 to go back to the hospital for the IV med to be
given there. Then we had an issue with getting him back to the hospital. We could not get an ambulance to
come get him. He was almost 500# and was too big for us to take him in our van. We have our own
transportation but R2 was too wide to fit. On 12/11/2025 at 11;30AM V4 stated I did not realize the order to
hold the IV antibiotic did not come from V20. The order came from V23. On 12/9/2025 at 12:49PM V2,
Director of Nursing, DON, stated R2 came to the facility on [DATE]. The pharmacy could not get the IV
antibiotic until 12/1/2025. He was still on his oral antibiotics. We called and got a hold of V20 he said to hold
the IV antibiotic until 12/1/2025. The pharmacy then said they could not get the IV antibiotic at all. We tried
several times to get a hold of V20. V20's office finally called on 12/3/2025 and said R2 could only get that IV
antibiotic in the hospital. I was here until 10:00PM on 12/3/2025 trying to get different ambulance
companies to agree to transport R2. We called bariatric companies and could not get anyone to come.
Finally, a company agreed to come get him on the morning of 12/4/2025. On 12/11/2025 at 11;30AM V2
stated I was under the impression the order to hold the antibiotic was from V20. The order came from
V23.On 12/11/2025 at 12:45PM V3, Assistant Director of Nursing, ADON, stated R2 got here on
11/28/2025. Pharmacy called and said they could not get the IV antibiotic that was ordered. We tried to call
V20, and they were unavailable, and it was the weekend. We called V23 that is over us and V23 is who
gave us the order to Hold the IV antibiotic until Monday 12/1/2025 when we could get in touch with V20. On
12/11/2025 at 2:00PM V20 stated The facility should not have accepted (R2). By the facility accepting (R2)
and then not being able to provide prescribed antibiotic caused an interruption in treatment. This was a
near miss for (R2) and it is unacceptable. There was a miscommunication between the hospital and the
facility. The antibiotic prescribed is very expensive and no facility can afford it. (R2) was readmitted with an
abscess of the pelvis and needed another 6 days of antibiotic therapy due to the interruption of therapy.
(R2) needed assessment and to resume antibiotic therapy. Our office was not notified that (R2) was not
getting the antibiotic until 12/2/2025. On 12/12/2025 at 11:00AM V20, ID, stated When I say (R2) was a
near miss I mean (R2) had the potential for septic infection and recurrence of infection. (R2) was readmitted
with an abscess of the pelvis and needed another 6 days of antibiotic therapy due to the interruption of
therapy. On 12/12/2025 at 11:15AM V22, Pharmacist, stated I dealt with this situation involving (R2). The
reason the antibiotic was unavailable was due to the logistics of the antibiotic. It was unavailable from our
primary and secondary supplies. The
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145454
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
145454
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Carlinville Rehab & Hcc
751 North Oak Street
Carlinville, IL 62626
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
Level of Harm - Actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
reason is the dose of the drug. It is a mandatory compound drug. It is a very new drug. It is very unstable. It
is for immediate use only. There is no extended stability. The drug is so new and so unstable it would have
to be sent out every 12 hours. (R2) should've never left the hospital. Had we been contacted prior to (R2)
being discharged I would've been able to tell them that this antibiotic was unavailable. We don't typically get
advanced notice. We don't typically get forms prior to admission. On 12/16/2025 at 11:15AM V1,
Administrator, and V5, Social Services Director, SSD, stated All our referrals go through our corporate
office. A clinical liaison through our corporate office is who does the screening and they let us know who
and when they will be coming. We may get 2-day notice or we may get 1 hour. V5, SSD, stated I give V2,
DON, the packet when I get it for her to look at the orders. On 12/16/2025 at 12:35PM V2, DON, stated On
11/26/2025 in the afternoon was my first day as DON. On 11/26/2025 I received the discharge packet for
(R2). In the packet were his preliminary orders. I am not sure if those orders were sent to pharmacy or not.
Then the next day was Thanksgiving. The orders could've gone to Pharmacy on 11/28/2025. Facility
Medication Administration policy dated 11/2025 states Medications shall be administered according to
established schedules. Administration times can be changed to meet each facility's unique resident
population and to maintain compliance with state and federal laws. A physician's order for specific times
supersedes any routine schedule. Residents may request alternate medication schedules. Such times must
be documented on the resident's medication administration record and care plan.
Event ID:
Facility ID:
145454
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.
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 December 18, 2025 survey of CARLINVILLE REHAB & HCC?
This was a inspection survey of CARLINVILLE REHAB & HCC on December 18, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at CARLINVILLE REHAB & HCC on December 18, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate treatment and care according to orders, resident’s preferences and goals."
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.