Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0609
Level of Harm - Minimal harm
or potential for actual harm
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper
authorities.
Based on interview and record review the facility failed to ensure staff reported resident bruising for 1 of 6
residents (R1) reviewed for abuse in the sample of 6.
Residents Affected - Few
The findings include:
The facility's Resident Abuse Investigation Report Form for incident date 5/12/25 shows R1 found with large
bruise area to right arm, wrist, and hand. The investigation findings shows: Bruising was not present
throughout the overnight hours and was first noticed on the morning of 5/13/25 at approximately 8:30 AM.
Bruising was not reported at this time and was later reported at 4:10 PM to V7 Social Services Director.
Corrective Action taken: V6 Certified Nursing Assistant who identified bruise and failed to report was
re-educated on the importance of reporting skin abnormalities.
On 5/15/25 at 9:57 AM, V6 said she saw the bruising on the top of R1's fore arm in the morning around
8:30 AM when she was helping R1 get dressed. V6 said she did not tell anyone at that time, it was super
busy. V6 said later they called her and asked about when she saw it. V6 said she should have reported it
right away to the nurse.
On 5/15/25 at 11:49 AM, V7 said she is the abuse coordinator and abuse allegations or injuries of unknown
origin such as bruises are to be reported immediately.
The facility's Abuse, Neglect, and Exploitation Policy dated 2-1-25 shows The facility will implement policies
and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property,
and exploitation that achieves: Providing residents, representatives, and staff information on how and to
whom they may report concerns, incidents and grievances without the fear of retribution.
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:
145495
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
145495
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Medina Nursing Center
402 South Center Street
Durand, IL 61024
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
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
Based on observation, interview, and record review the facility failed to transfer a resident in a safe manner
for 1 of 6 residents (R1) reviewed for safety in the sample of 6.
Residents Affected - Few
The findings include:
On 5/15/25 at 10:15 AM, R1 was dressed at sitting up in her wheelchair. R1 had a large dark purple/red
bruise approximately 3 inches long by 1.5 inches wide on the top of her right forearm extending around the
outer side of the forearm to the underside of R1's forearm. The bruising almost formed a complete circle
around R1's forearm. R1 said the other night she had to go to the bathroom and the girl pulled her by her
arm to get her out of bed. R1 stated she doesn't have the strength to push herself up and the staff pulled
her arm to help get her up. R1 said the girl was in a hurry trying to get her up, but it wasn't intentional. R1
said she didn't remember her name, but it was nighttime and it was dark outside.
The facility's Resident Abuse Form dated 5-12-25 shows R1 stated overnight Certified Nursing Assistant
grabbed her arm to assist her from sitting to standing. R1 felt as thought this was rough but did not feel it
was abusive. R1 feels she was improperly transferred during cares.
On 5/15/25 at 9:25 AM, V2 Director of Nursing said she had assisted to investigate R1's bruise and
watched the cameras to determine the staff that had entered R1's room. V2 said V5 Registered Nurse and
V8 Certified Nursing Assistant (CNA)were the only staff that cared for R1 that evening. V2 said V5 went in
around 11:30 AM to pass medications and then did not go into the room until morning for AM medications.
V2 said V8 went into R1's multiple times that shift.
On 5/15/25 at 10:22 AM, V8 Agency CNA said during her shift on 5/12/25 to 5/13/25, R1 had to go to the
bathroom. V8 said it was her first time getting R1 out of the bed, R1 had never gotten out of bed before on
night shift. V8 said R1 told her she could stand up on her own with the walker so she assisted R1 to stand
and then held the gait belt on R1's waist. V8 said R1 was able to sit up by herself at the bedside. V8 said
after returning from the washroom, R1 slept the rest of the evening.
On 5/15/25 at 9:42 AM, V4 CNA said she works with R1 often and R1 can stand and pivot with a gait belt
for transfers. V4 said R1 does need some assist with bed mobility. V4 said she was told about R1's bruising
and when she saw it, from where the bruise is located, her first thought was who put their hand there? V4
said it looks like improper handling to her. V4 said R1 doesn't' flail her arms around so she wouldn't have
bumped it on anything. V4 said staff should use a gait belt and hold the gait belt to assist R1 out of bed to
stand.
On 5/15/25 at 9:57 AM, V6 CNA said she worked with R1 the morning shift on 5/13/25 when she noticed
the bruise on R1's forearm. V6 said R1 said staff pulled her around by her arm and that's how she got the
bruise. V6 said R1 is a one person assist with a gait belt and if R1 needs help to sit up in bed, you don't
grab her by the arms to pull her up to a sitting position.
On 5/15/25 at 11:49 AM, V7 Social Service Director said when she spoke to R1 about the bruise, R1 told
her the night staff had pulled her up by her arm to get her out of bed. V7 said R1 said she didn't feel like it
was abusive or intentional. V7 said their investigation concluded that it was an improper transfer and V8
was re-educated on transfers and an in-service was done.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145495
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
145495
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Medina Nursing Center
402 South Center Street
Durand, IL 61024
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
FORM CMS-2567 (02/99)
Previous Versions Obsolete
R1's Care Plan dated 3/20/25 shows R1 has diagnoses of weakness, muscle weakness, chronic fatigue,
primary generalized osteoarthritis,and chronic pain. This same Care Plan shows R1 transfers with one
assist and a gait belt and requires one person to reposition and turn in bed.
The facility's undated Gait Belt Policy shows It is the policy of this facility to instruct all staff in the proper
use of a gait belt and encourage the use of them with all non-mechanical transfers.
Event ID:
Facility ID:
145495
If continuation sheet
Page 3 of 3
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Back to topCitations
2 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.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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.
FAQ · About this visit
Common questions about this visit
What happened during the May 15, 2025 survey of MEDINA NURSING CENTER?
This was a inspection survey of MEDINA NURSING CENTER on May 15, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at MEDINA NURSING CENTER on May 15, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
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.