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Inspection visit

Health inspection

La Bella of FreeburgCMS #1455154 citations on this visit
4 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 4 deficiencies, 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to protect the privacy and confidentiality of 4 of 6 residents (R5, R31, R70 and R82) in the sample of 42, by displaying identifying information that includes their names, date of birth s, room location, care needs and code status in plain view of the public hanging over the residents' beds. Residents Affected - Some Findings include: 1. R5's Face Sheet undated documents, R5's diagnosis as Severe Protein Malnutrition, Unspecified Dementia, Unspecified Severity without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance and Anxiety. R5's Minimum Data Set, (MDS), dated [DATE] documents, R5's Cognitive Skills for Daily Decision Making as severely impaired. R5 is Total Dependent for bed mobility, transfer, locomotion on and off unit, eating, personal hygiene and toilet use. Extensive Assistance is required for dressing. R5's Visual Bedside [NAME] Report, undated documents, R5's identifying information, (i.e., name. d.o.b. and room location) and admission date, allergies, bathing assistance requirements and toileting assistance needs. 2. R31's Face Sheet undated documents, R31 diagnosis as Acute kidney Failure, Unspecified, Delusional Disorder, Personal history of Covid-19, Dementia in other Disease classified elsewhere, Unspecified Severity, with other Behavioral Disturbance and Anxiety Disorder. R31's Minimum Data Set, (MDS), dated [DATE] documents, a BIMS of 1; Wandering behavior occurred daily, wandering significantly intrudes on the privacy or activities of others. R31 requires Limited Assistance in personal hygiene, toilet use, dressing, walk in corridor, walk in room, transfer, and bed mobility. Independent in locomotion on and off the unit and eating. Balance during transitions and walking- not steady, only able to stabilize with staff assistance, moving from seated to standing position, walking, turning around and facing the opposite direction while walking, moving on and off toilet and surface-to surface transfer. R31's Visual Bedside [NAME] Report undated documents, R31's identifying information (i.e., name. d.o.b. and room location) and admission date, allergies, bathing assistance requirements and toileting assistance needs. 3. R70's Face Sheet undated documents, R70's diagnosis as Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified, Nontoxic Single Thyroid Nodule, Chronic Fatigue, Unspecified, Frequency of (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 7 Event ID: 145515 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 0583 Micturition. Level of Harm - Minimal harm or potential for actual harm MDS dated [DATE] documents, a BIMS of 14; R70 is occasionally incontinent of urine and is always incontinent of bowel; R70 is not part of toileting program. R70 requires Extensive Assistance in personal hygiene, Limited Assistance in Toilet use, dressing and bed mobility, supervision in locomotion on and off unit, walk in corridor, walk in room and independent transfer and eating. Residents Affected - Some R70's Visual Bedside [NAME] Report undated documents R70's identifying information (i.e., name. d.o.b. and room location) and admission date, allergies, bathing assistance requirements and toileting assistance needs. 4. R82'sFace Sheet undated documents, diagnosis as Type 2 Diabetes Mellitus with Unspecified, Anxiety Disorder, Unspecified, Insomnia, and Muscle weakness. R82's Minimum Data Set, (MDS), dated [DATE] documents, R82 is cognitively severely impaired; requires Extensive Assistance in personal hygiene, toilet use and dressing. Limited Assistance in Walk in corridor, walk in room and transfer. Supervision in bed mobility and locomotion on unit; Independent in Locomotion off unit and eating. Balance during Transitions and walking- Not steady, only able to stabilize with staff assistance in moving from seated to standing position, walking, turning around and facing the opposite direction while walking, moving on and off toilet, surface to surface. R82's Visual Bedside [NAME] Report undated documents, R82's identifying information (i.e., name, d.o.b. and room location) and admission date, allergies, bathing assistance requirements and toileting assistance needs. On 9/21/23 at 3:45 PM V1 Administrator stated, the facility had a lot of agency staff, and we were trying to ensure that they were equipped to care for our residents in the manner we are accustomed. On 9/22/23 at 8:51 AM V13 LPN stated, the [NAME] is used to aid in resident care. If a staff person is rotated or assigned to this unit all the information, they need to adequately care for the resident is right in front of them. Each [NAME] is resident specific. Yes, anyone that enters the room can view the information. 9/22/23 at 10:41 AM V25 CNA, (agency), stated, the [NAME] helps in caring for the residents. The [NAME] includes care plan information, transfer information, toileting, bathing, feeding, and dressing assistance. Had not thought about how she could prevent visitors from viewing the resident's information. The State of Illinois Department on Aging Resident's Rights for People in Long-term Care Facilities undated documents, You have the right to .Privacy: Your medical and personal care are private. Your facility may not give information about you or your care to any unauthorized person(s) without your permission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 2 of 7 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement progressive fall interventions, in 1 (R87) of 9 residents in the sample of 42. This failure resulted in R87 falling and sustaining a femur fracture and head laceration and being sent out to local hospital. Findings include: R87's Face sheet documents, an admission date of 2/21/2023. Diagnosis include Dementia, Displaced Fracture of Lesser Trochanter of Left Femur, Subsequent Encounter For Closed Fracture With Routine Healing, Unsteadiness, Weakness. R87's Minimum Data Set, MDS, dated [DATE] documents, R87 is severely cognitively impaired. MDS dated [DATE] documents, R87 requires limited assist of 1 person for transfers and ambulation. R87's Care Plan dated 3/9/2023 documents, Physical mobility needs related to Right arm fracture and muscle weakness. Interventions include: Ambulation: R87 requires limited assistance by (1) staff to walk. Locomotion: R87 requires limited assistance by (1) staff for locomotion. The resident is weight-bearing, splint/sling to right upper extremity. R87's Fall assessment dated [DATE] documents, high risk for falls with a score of 90. Unsteady gait and history of falls. R87's fall investigation documents, on 6/6/2023 at 6:15 PM, R87 was in hallway near nurses' station in wheelchair. This nurse heard V16, Certified Nursing Assistant, CNA yell out hey what are you doing at that time this nurse heard a smack. This nurse got up from nurses' station and saw R87 laying on floor in hallway with head at employee breakroom door frame and legs extended outward towards hallway. R87 attempted to get up and was instructed to not move. Upon immediate assessment, this nurse had vitals obtained 132/82, 98.1, 20, 60, 98%, room air. R87 alert and oriented, noted profuse bleeding from crown of head, immediately applied pressure with cool cloths, noted decreased range of motion to left leg. R87 complained of pain to left hip. On palpation R87 unable to move leg at hip joint. R87 leg made comfortable to position. During time R87 states, What did I do wrong, what happened My sons are going to be so mad. R87 given care and continued to be made comfortable. Encouraging R87 to stay awake and keep eyes open. Noted Oxygen sats started to fall in low 90's, and R87 was placed on 2L Oxygen per NC, (nasal cannula), and Oxygen sats brought back up to 98%. R87 was able to follow questions, continued to answer her name and birth date, today's date, answered questions appropriately. Emergency Medical Services, (EMS), arrived and R87 was transferred from floor to stretcher via 2 EMS and this Nurse. Power of Attorney, (POA), Director of Nursing, (DON), made aware of fall. R87's History & Physical dated 6/6/2023 documents, Nursing Home resident. Fell out of wheelchair. Hit head on the back and developed a laceration. Brought to the Emergency Room. Work up for intracranial abnormality. Head laceration stapled. Acute comminuted moderately displaced left proximal femoral intertrochanteric fracture found. Ortho consulted. R87 complaining of leg pain. Otherwise, unable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 3 of 7 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 to provide history due to dementia. Level of Harm - Actual harm On 9/21/2023 at 3:00 PM, V1 stated, I know falls are a problem. For a while we had a lot of agency and agency staff don't know the residents as well. We are slowly reducing our number of agency and hiring our own staff again. Residents Affected - Few On 9/21/2023 at 1:10 PM, V13, LPN, stated, I was working the evening R87 fell. She was out of her wheelchair, and I heard the CNA, say (R87) what are you doing? Then I heard the worst sound I have ever heard in my life. She hit her head and it was bleeding profusely. We started treating her head wound and talking to her. She complained of pain in her left hip. She had seemed off that day and we found out later, she had a Urinary Tract Infection, (UTI). Unsure if R87 had a history of falls. On 9/21/2023 at 2:25 PM, V16, CNA, stated, I was in the hallway helping another resident and R87 was propelling in the hallway. I saw her get up and I said, What are you doing? and she fell and hit her head on the railing. Everyone ran to help her and get towels for the blood. R87 was one to get up on her own. On 9/22/2023 at 8:10 AM, V17, Nurse Practitioner, (NP), stated, she would've expected progressive fall interventions to be in place, regarding a resident with a history of falls. Fall policy undated states (Facility name), will make a good faith effort to fulfill regulatory and person-centered standards to reduce risk factors for falling. The process of reducing fall risks incudes the creation of an individualized care plan. For purpose of this policy and protocol, fall is defined as an unintentional change of plane from a higher to a lower position that is not the result of an external force. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 4 of 7 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and observation the facility failed to provide appropriate catheter care for one of four residents (R150) reviewed for catheter care in the sample of 42. Findings Include: R150's Care Plan dated 9/15/23 documents, resident (R150) has a urinary catheter. Interventions catheter care and treatment per current MD, (Medical Doctor), Observe/record/report to MD for signs and symptoms of UTI, (Urinary Tract Infection), which are pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temperature, urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, and change in eating patterns. R150's admission summary dated [DATE] documents, R150 was placed on contact isolation for MRSA, (Methicillin Resistant Staph Aureus), and penile drainage. R150's Genital culture dated 9/13/23 documents, MRSA, (Methicillin-resistant Staphylococcus aureus). R150's Physician Order Sheet, (POS), dated 9/19/23 documents, Linezolid 600mg, (milligrams), by mouth every 12 hours for MRSA in penis. R150's POS dated 9/21/23 documents, (indwelling Catheter), related to retention of urine unspecified. R150's POS for the month of September did not document catheter care. R150's Minimum Data Set, (MDS), dated [DATE] documents, R150 is moderately cognitively impaired. On 9/21/23 at 9:35 AM there is a sign on R150's door, for contact isolation and personal protective equipment outside the door. V20 and V21 CNAs donned gowns and gloves and entered the room. V20 and V21 CNAs told R150, they were going to do catheter care. V20 and V21 washed their hands, and donned gloves. V20 CNA wiped both sides of the peri area with a no rinse disposable incontinent pad. She with the same gloves with no hand sanitization. she cleansed the head of the penis. V20 grabbed more no rinse incontinent wipes and cleaned from the end of the penis down the tubing of the catheter, she then rolled him over, and grabbed more wipes and cleansed the rectum area. V20 did not change gloves or hand sanitize. On 9/22/23 at 10:45 AM, V7 CNA stated, I change gloves quite frequently. I hand sanitize every time I change gloves. On 9/22/23 at 10:47 AM, V23 CNA stated, every time, I touch something dirty. I hand sanitize, every time I take the gloves off. On 9/22/23 at 10:49 AM, V26 CNA stated, I change gloves every time I change an area. You should hand sanitize every time you take off your gloves. The facility's policy entitled Urinary Catheter, (Indwelling), Daily Care dated 6/24/09 documents, The purpose of daily catheter care is to assist in preventing infections and prevent bladder damage (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 5 of 7 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 0690 Level of Harm - Minimal harm or potential for actual harm due to improper care and handling. Routine catheter care is part of the resident's morning care, and as needed by the resident's specific needs. All residents who have an indwelling urinary catheter will receive catheter care every shift, and whenever necessary. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 6 of 7 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 145515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Freeburg Care Center 746 Urbanna Drive Freeburg, IL 62243 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the Facility failed to store, prepare, and serve food in a manner which prevents potential contamination. This has the potential to affect all 96 residents living in the Facility. Findings include: On 9/19/23 at 8:44 AM V10, dishwasher, was spraying dirty dishes in the third compartment of the three-compartment sink. The spray resulted in drops of water on the floor approximately three feet away and on the arm of the surveyor standing next to a shelf. The shelf held a container of clean eating utensils and two trays of mandarin oranges that were not covered, potentially allowing a point of entry for the rinse water. On 9/19/23 at 8:47 AM the beverage refrigerator, next to the steam table contained ten individual cups of chocolate pudding that were not covered, labeled, or dated. On 9/19/23 at 8:48 AM the first compartment of the three-compartment sink held a crate with nutritional supplements. There was a pair of dishwashing gloves draped across the faucet that were in contact with the crate. The second compartment of the sink held a crate with 2% milk. The third compartment was full of dirty dishes. On 9/19/23 at 8:55 AM the beverage refrigerator in the dry storage room had a 46-ounce container of grape juice that was opened and half empty but was not dated with opening date. On 9/19/23 at 9:53 AM V9, Dietary Manager, stated, she would expect staff to keep food away from dirty dishes and already told her staff to move the desserts away from the dirty dishes. On 9/21/23 at 3:10 PM, V1, Administrator, stated, she expects staff to follow their food service policies. The Facility's Food and Nutrition Policy updated 3/27/18 documents, (Facility) shall store, prepare, distribute and serve food under sanitary conditions and in a manner that protects it against contamination and spoilage in accordance with food service requirements of Chapter 3717-1 of the Administrative Code. The Facility's Food Storage (Dry, Refrigerated, and Frozen dated 2020 documents, Food shall be stored on shelves in a clean, dry area free from contaminants. Food shall be stored at appropriate temperatures and using appropriate methods to ensure the highest level of food safety. All items will be labeled. The label must include the name of the food and the date by which it should be sold, consumed, or discarded. Leftover contents of cans and prepared food will be stored in covered, labeled and dated containers in refrigerators and/or freezers. The Facility's Resident Census and Condition of Residents Form (CMS 672) dated 9/19/23 documents there are 96 residents living in the Facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145515 If continuation sheet Page 7 of 7

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Citations

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.

  • 0583GeneralS&S Epotential for harm

    F583 - Privacy and Confidentiality

    Keep residents' personal and medical records private and confidential.

  • 0690GeneralS&S Dpotential for harm

    F690 - Incontinence

    Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

  • 0812GeneralS&S Fpotential for harm

    F812 - Food safety requirements

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

  • 0689SeriousS&S Gactual harm

    F689 - Accidents

    Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

FAQ · About this visit

Common questions about this visit

What happened during the September 22, 2023 survey of La Bella of Freeburg?

This was a inspection survey of La Bella of Freeburg on September 22, 2023. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at La Bella of Freeburg on September 22, 2023?

Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Keep residents' personal and medical records private and confidential."

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

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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.