Inspection visit
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 0602
Protect each resident from the wrongful use of the resident's belongings or money.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview and record review, the facility failed to prevent misappropriation of controlled substance
medications for five of six residents (R1, R2, R3, R4, and R5) reviewed for misappropriation of resident
medications in a sample of six. Findings include:The facility's Abuse Prevention Policy, undated, documents
This facility affirms the right of our residents to be free from abuse, neglect, exploitation, misappropriation of
property, deprivation of goods and services by staff or mistreatment. This facility therefore prohibits abuse,
neglect, exploitation, misappropriation of property, and sensitive and resident secure environment. The
purpose of this policy is to assure that the facility is doing all that is within its control to prevent occurrences
of abuse, neglect, exploitation, misappropriation of property, deprivation of goods and services by staff and
mistreatment of residents. This facility is committed to protecting our residents from abuse, neglect,
exploitation, misappropriation of property and mistreatment by anyone including, but not limited to, facility
staff, other residents, consultants, volunteers, staff from other agencies providing services to the individual,
family members or legal guardians, friends, or any other individuals. Definitions: The following definitions
are based on federal and state laws, regulations, and interpretive guidelines. Misappropriation of Resident
Property means the deliberate misplacement, exploitation, or wrongful temporary, or permanent use of a
resident's belongings or money without the resident's consent. Misappropriation of a resident's property
means the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's
belongings or money without the resident's consent.On 7/17/25 at 8:45 AM, V1 (Administrator) stated on
6/16/25, R1 requested a pain pill, but no Norco was available. V9 (Registered Nurse) contacted the
pharmacy to request a refill. The pharmacy informed her that a card of 30 Norco 5-325 mg tablets had been
delivered on 6/13/25. V2 (Director of Nursing) confirmed the presence of the packing slip in the narcotic
binder but found no medication card or narcotic count sheet. R1's missing Norco prompted an internal
review and launched a broader investigation into potential misappropriation. V1 stated on review of facility
video footage V4 (Registered Nurse) was observed taking the medication cart down the hallway and
positioning her body to obscure the camera's view of the narcotic box. V4 stood on the side of the cart,
leaned over, and appeared to write in the narcotic count book. V4 consistently zipped up her lab coat
immediately afterward and positioned her body in a way that made it unclear if she was popping pills from
blister cards or placing entire cards into her clothing. V1 noted the behavior and body positioning were
unnatural for standard medication administration practices and inconsistent with legitimate narcotic
handling procedures. V1 stated V4 is known to be right-handed but was seen moving cards awkwardly with
her left hand, further raising concern. V1 further stated after receiving past narcotic slips, the facility
identified altered scripts that had been wrote to dispense 60 pills changed to 160 pills, the Drug
Enforcement Administration (DEA) number wrote on the scripts appeared to be written in V4's handwriting.
V1 stated after comparing schedules to the dates on the scripts, V4 was working on the days that the
scripts were
Residents Affected - Some
(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:
145793
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
145793
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Renaissance Care Center
1675 East Ash Street
Canton, IL 61520
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 0602
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
altered. On 7/17/25 at 9:30 AM, V2 (Director of Nursing) stated on 6/16/25, around 10:00 AM, V2 was
informed by V9 (Registered Nurse) that R1 was out of Norco and V9 had contacted the pharmacy. The
pharmacy confirmed a card of 30 Norco tablets was delivered on 6/13/25. V2 confirmed the packing slip for
the 6/13 delivery was present but the medication card could not be located. R1's Norco was not found in
medication carts on 100 or 200 halls. V2 stated she conducted interviews with staff who had worked on and
after the delivery date. V11 (3rd shift Registered Nurse) on 6/13 stated V11 placed the Norco in the narcotic
box, signed the narcotic sheet, and filed the packing slip. V4 (Day shift Registered Nurse) on 6/14 and V5
(Assistant Director of Nursing), working 6/14-6/15 both reported R1 did not have Norco available during
their shifts. V2 stated on review of security footage, the facility found no evidence the Norco was placed in
the cart or signed into the narcotic count sheet, despite packing slips and delivery records confirming
receipt. V2 further stated V4 was on vacation from 6/16-6/24. V2 stated V4 was suspended pending
investigation and when asked to return on 6/23/25 for an interview, V4 responded that she wouldn't pass a
drug test and V4 later resigned via text message and denied taking narcotics. 1.) R1's medical chart
includes a prescription dated 3/27/25 for Hydrocodone 5-325 milligrams, one tablet by mouth every six
hours as needed for pain, with instructions to dispense 160 tablets and six refills, not to exceed four tablets
per day. The facility's final investigation report, documents R1 had an active order for Norco 5/325
milligrams and received the following quantities monthly, as documented on the Pharmacy Delivery List
Report compared to what was administered per the electronic Medication Administration Record (MAR):
For the month of March 2025, 119 Norco pills were delivered to the facility from the pharmacy, 68 Norco
pills were administered to R1, and 51 Norco pills were unaccounted for. April 2025, 90 Norco pills were
delivered to the facility from the pharmacy, 55 Norco pills were administered to R1, and 35 Norco pills were
unaccounted for. May 2025, 120 Norco pills were delivered to the facility from the pharmacy, 55 Norco pills
were administered to R1, and 65 Norco pills were unaccounted for. June 2025, 60 Norco pills were
delivered to the facility from the pharmacy, 24 Norco pills were administered to R1, and 36 Norco pills were
unaccounted for. These discrepancies total 187 Norco tablets unaccounted for over a four-month period.On
7/17/25 at 10:00 AM, R1 stated There were times I didn't get my pain pills because the staff said they were
waiting for delivery. They gave me Tylenol instead.2.) R2's Physician Orders document R2 had an active
physician order for Norco 7.5/325 milligrams, one tablet every four hours as needed for pain.The facility's
final investigation report document R2 had an active order for Norco 7.5/325 milligrams and received the
following quantities monthly, as documented on the Pharmacy Delivery List Report compared to what was
administered per the electronic Medication Administration Record (MAR): For the month of March 2025,
210 Norco pills were delivered to the facility from the pharmacy, 13 Norco pills were administered to R2,
and 197 Norco pills were unaccounted for. April 2025, 160 Norco pills were delivered to the facility from the
pharmacy, 22 Norco pills were administered to R2, and 138 Norco pills were unaccounted for. May 2025,
200 Norco pills were delivered to the facility from the pharmacy, 20 Norco pills were administered to R2,
and 180 Norco pills were unaccounted for. June 2025, 70 Norco pills were delivered to the facility from the
pharmacy, 11 Norco pills were administered to R2, and 59 Norco pills were unaccounted for. These
discrepancies total 574 Norco tablets unaccounted for over a four-month period. On 6/20/25, an additional
30 Norco 5-325 mg were delivered, but never documented or located.On 7/17/25 at 10:40 AM, V2 (Director
of Nursing) stated V4 was taking the delivery slips and the narcotic sheet with the medications and that's
why nobody noticed. V4 denied all knowledge during her interview.3.) R3's Physician Orders documents an
order for Norco 5-325 milligrams, one tablet every four hours as needed for pain.Pharmacy delivery logs
and MAR
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145793
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
145793
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/18/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Renaissance Care Center
1675 East Ash Street
Canton, IL 61520
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 0602
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
review from March 1 to June 30, 2025, revealed: For the month of March 2025, 150 Norco pills were
delivered to the facility from the pharmacy, 0 Norco pills were administered to R3, and 150 Norco pills were
unaccounted for. April 2025, 90 Norco pills were delivered to the facility from the pharmacy, 0 Norco pills
were administered to R3, and 90 Norco pills were unaccounted for. May 2025, 130 Norco pills were
delivered to the facility from the pharmacy, 0 Norco pills were administered to R3, and 130 Norco pills were
unaccounted for. June 2025, 90 Norco pills were delivered to the facility from the pharmacy, 0 Norco pills
were administered to R3, and 90 Norco pills were unaccounted for. These discrepancies total 460 Norco
tablets unaccounted for over a four-month period.On 7/17/25 at 10:50 AM, R3 stated R3 does not have
pain that requires taking her Norco.4.) R4's Physician orders document an order for Norco 5-325
milligrams, one tablet every six hours as needed for pain.Pharmacy delivery logs and MAR review from
March 1 to June 30, 2025, revealed: For the month of March 2025, 90 Norco pills were delivered to the
facility from the pharmacy, 10 Norco pills were administered to R4, and 80 Norco pills were unaccounted
for. April 2025, 150 Norco pills were delivered to the facility from the pharmacy, 11 Norco pills were
administered to R4, and 139 Norco pills were unaccounted for. May 2025, 120 Norco pills were delivered to
the facility from the pharmacy, 4 Norco pills were administered to R4, and 116 Norco pills were
unaccounted for. June 2025, 90 Norco pills were delivered to the facility from the pharmacy, 2 Norco pills
were administered to R4, and 88 Norco pills were unaccounted for. These discrepancies total 423 Norco
tablets unaccounted for over a four-month period.Pharmacy delivery logs and Facility Incident report
document a delivery of Norco for R4 on 6/15/25 is missing. Records confirm V4 worked during this delivery.
On 7/17/25 at 9:45 AM, R4 stated there have been times Norco wasn't available because pharmacy had
not delivered it to the facility. 5.) R5's Physician Orders documents an order for Acetaminophen-Codeine
(Tylenol #3) 300-30 milligrams, one tablet by mouth every six hours as needed for severe pain.Pharmacy
delivery logs and MAR review from March 1 to June 30, 2025, revealed: For the month of March 2025, 30
Tylenol #3 pills were delivered to the facility from the pharmacy, three Tylenol #3 pills were administered to
R5, and 27 Tylenol #3 pills were unaccounted for. April 2025, 0 Tylenol #3 pills were delivered to the facility
from the pharmacy, three Tylenol #3 pills were administered to R5, and 0 Tylenol #3 pills were unaccounted
for. May 2025, 60 Tylenol #3 pills were delivered to the facility from the pharmacy, five Tylenol #3 pills were
administered to R5, and 55 Tylenol #3 pills were unaccounted for. June 2025, 60 Tylenol #3 pills were
delivered to the facility from the pharmacy, two Tylenol #3 pills were administered to R5, and 58 Tylenol #3
pills were unaccounted for. These discrepancies total 127 Tylenol #3 pills unaccounted for over a
four-month period.On 7/17/25 at 9:30 AM, V2 stated a delivery of Tylenol #3 on 6/15/25 for R5 is missing
entirely. V4 was the only nurse on duty at the time.
Event ID:
Facility ID:
145793
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.
F602 - The resident has the right to be free from abuse, neglect, misappropriation of re
Protect each resident from the wrongful use of the resident's belongings or money.
FAQ · About this visit
Common questions about this visit
What happened during the July 18, 2025 survey of RENAISSANCE CARE CENTER?
This was a inspection survey of RENAISSANCE CARE CENTER on July 18, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at RENAISSANCE CARE CENTER on July 18, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from the wrongful use of the resident's belongings or money."
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
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.