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 0880
Provide and implement an infection prevention and control program.
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 follow the recommended guidelines to properly
treat and disinfect a resident room with suspected bed bugs to prevent the spread of bed bugs for 2 of 3
residents (R1, R2) reviewed for infection control in the sample of 3.
Residents Affected - Few
The findings include:
On 6/27/25 at 9:33 AM, R2 was in him room, sitting in his wheelchair. R2 said the staff reported bed bugs
were found in this room on 6/23/25. R2 said they bagged his clothing this time on 6/24/25 (Tuesday) and he
moved to another room and came back to his room on 6/26/25.
On 6/27/25 at 9:47 AM, R1 was in his wheelchair out of his room on the computer in the lounge area. R1's
hair was past his shoulder, long, scraggly, greasy and matted in the back. R1 had a long facial beard
approximately 3 inches past his chin. R1 said on 6/23/25, the staff found a bed bug on his blanket near his
leg. R1 said he stayed in his room until 6/26/25, when his room was sprayed by a pest exterminator. R1
said when they were treating his room, he was placed in the dining room for several hours. R1 said when
he came out of his room on 6/26/25, he did not receive a shower. R1 said about a month ago, they found a
bed bug, they took his clothes but left his roommate (R2's) clothes in his closet, this time they bagged both
of their clothing.
On 6/27/25 at 9:55 AM, R1's top dresser drawer had multiple items including, shirt, multiple pairs of socks,
slipper socks, gauze wraps, knee brace, and toiletry items. A pair of shoes were in his armoire and wash
bin of personal items located on top of the armoire. There were no items bagged in his room. R2 had
personal items stored in drawer and wash bin of personal items on the top of his armoire.
On 6/27/25 at 9:57 AM, V4 (Licensed Practical Nurse-LPN) said last month R1's room was being treated for
bed bugs. At that time R1 and R2 could not leave the room, until they treated the room and went back to
the same room after 3-4 hours. They did not remove all the clothing or items in the drawers at that time. We
questioned if the proper treatment was done, but we were told the pest exterminator decides the type of
treatment. It was frustrating clearly it was not done properly because another live bed bug was found on
6/23/25. On 6/23/25, staff reported they saw a bed bug on him. We were told the pest exterminator was
supposed to come that day to treat the room, but they did not come until 6/26/25. R1 was isolated to his
room, and they moved R2 to a different room. On 6/26/25, R1 was out in the common area while his room
was being treated. He was supposed to get a shower before leaving his room but that did not happen.
On 6/27/25 at 10:06 AM, V5 (Certified Nursing Assistant-CNA) said on 6/23/25, the staff found a bed
(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:
145801
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
145801
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/27/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pleasant View Luther Home
505 College Avenue
Ottawa, IL 61350
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 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
bug on R1. R1's roommate (R2) refused to go back into that room, and we moved him to different room. R1
was placed on isolation. On 6/24/25, R2 was in the same clothes as the day before and she gave R2 a
shower. R1's shower day is on Wednesdays, she worked on Monday, Tuesday and Friday this week. By
looks of R1 he did not receive a shower this week. I'm not sure what they did to solve the problem with the
bed bugs. She was told R1 should have received a shower before leaving him room. This is horrible for the
residents and staff.
On 6/27/25 at 1:09 PM, V6 (CNA) said she was R1's CNA on 6/25/25 and 6/26/25. She did not know R1's
room had bed bugs; staff did not report anything to her. R1 told me the staff found a bed bug on his blanket
on Monday 6/23/25. On 6/26/25, his room was sprayed, and she placed R1 in the dining room. She did not
shower him before he left the room. No one educated us on what to do if bed bugs are found. V6 said R1's
brother passed away and the family brought his clothing to him and his brother's home had bed bugs, she
thinks that's where the bed bug came from.
On 6/27/25 at 10:41 AM, V7 (Pest Exterminator) said if bed bugs are found all clothing should be bagged,
removed, and laundered. All drawers should be emptied, and he recommends a decontamination room
where the resident can go while the room is being treated. The day of treatment the resident should be
cleaned before leaving the room.
On 6/27/25 at 9:24 AM, V3 (Building Service Director) said about a month ago, R1's room was treated for
bed bugs. On 6/23/25, another bed bug was found on R1. R1's room was treated yesterday, and we bagged
and removed all of R1 and R2's clothing. V3 said they only bagged clothing and not personal items. V3 said
he handles the environmental treatment of bed bugs and V2 (Director of Nursing) handles the clinical side
of treatment. V3 said he did not keep a record of timing in May 2025 when bed bugs were found in R1's
room.
On 6/27/25 at 11:15 AM, V2 (DON) said if bed bugs are found residents should be isolated until the room is
treated by the exterminator. Clothing should be bagged, removed, and washed. I don't understand why the
resident should be showered before leaving their room. V2 said clothing may be potentially infected with
bed bugs and that makes perfect sense. At 1:45 PM, V2 confirmed education was provided to staff on how
to handle bed bugs, she was not familiar on the guidelines for treatment of bed bugs. V2 confirmed there
was no documentation in R1 and R2's medical records regarding the treatment of bed bugs.
R1's electronic health records for May to June 2025 does not show documentation of bed bugs found and
the treatment provided.
The facility provided a timeline on 6/27/25, it shows on 6/23/25, a bed bug was reported in room [ROOM
NUMBER] and clothing items removed (there is no mention of bagging personal items) and 6/26/27 the
room was treated.
The facility's Treatment for Bed Bugs undated Policy states, Bed bugs can travel in clothing, bags, and can
hide in small places, including under carpeting in drawers, light switches, electronic plugs, picture frames,
padding, cervices, and screw holds in furniture, mattresses .cell phones, laptops, books. Bed bugs can live
for over 1 year without feeding, so they can survive even if a room or apartment is not occupied .Suspected
Steps to be taken if bed bugs are suspected or seen: contract with a professional pest control company that
will treat the problem with an integrated pest management approach .all actions should be performed in the
room to prevent the spread of bed bugs to other rooms. Assist the resident to showered, dress in clothing
from the outside the room, including shoes,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145801
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
145801
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/27/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pleasant View Luther Home
505 College Avenue
Ottawa, IL 61350
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 0880
Level of Harm - Minimal harm
or potential for actual harm
socks and transfer to another room. Personal belongings, equipment and furnishings including beds should
not leave the room until they have been thoroughly inspected and determined to be bed bug free .bag
clothing in room in plastic bags, tie bag tightly. Wear PPE (personal protective equipment) including gown,
and gloves. Bag everything in the closet, under the bed, in dresser drawers .Shoes and non-washable items
should be bagged and left in the room for the professional pest control management.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145801
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.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the June 27, 2025 survey of PLEASANT VIEW LUTHER HOME?
This was a inspection survey of PLEASANT VIEW LUTHER HOME on June 27, 2025. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PLEASANT VIEW LUTHER HOME on June 27, 2025?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
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.