F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on interview and record review the facility failed to respond to resident call lights in a timely manner
for nine of 11 Residents (R2, R3, R4, R5, R7, R8, R9, R10 and R11) reviewed for call light response in a
sample of 11.
Findings include:
Facility Call Light Guidance Policy, dated 7/1/23, documents: to provide guidance to all Facility staff on the
use, response and placement of call lights; Resident call lights shall be responded to within a reasonable
amount of time; it is the responsibility of all staff to respond to call lights; and if responding staff is unable to
meet the request/need of the Resident, staff shall leave the light on and elicit the assistance of appropriate
staff.
Facility Certified Nursing Assistant/CNA Job Description, undated, documents: the CNA provides each
assigned resident with routine daily nursing care and services in accordance with the Resident's
assessment and care plan; and will be accountable for carrying out the assigned duties and responsibilities
in accordance with current existing federal and state regulations and established company policies and
procedures; and follow assigned tasks in accordance with the facilities established policies and procedures
and as instructed by supervisors.
The Facility Grievance Log, dated 1/1/25 through 4/4/25, documents a complaint on 1/29/25 for R3's
concern for call bell response time.
Facility Resident Council Minutes, dated 1/2/25, document Resident nursing concerns about beds not being
made at all and about having to wait too long when they turn their call light on, which Resident's stated
happens mainly between 6:00 pm and 9:00 pm.
Facility Resident Council Minutes, dated 2/6/25, document Resident nursing concerns with water not being
refilled. Concerns about not being able to reach call lights.
On 4/2/25 at 12:57 pm, R3 stated, They easily most of the time take about an hour to answer my call light,
and sometimes it has been up to an hour and a half. They also are good about coming in and shutting off
the call light and saying that they will be back, and never come back.
On 4/2/25 at 12:59 pm, R5 stated, They do not mean to hurt me intentionally, but they take a really long
time to answer my call light and a lot of time they just come in, shut off my call light, and say they will be
back with help. They usually need two people because I use a (mechanical lift) to help me transfer, and it
always takes them forever to get two people, so I sit here for a long, long
(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 2
Event ID:
145820
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
145820
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
04/05/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Mount Sterling Health and Rehab Center
435 Camden Rd
Mount Sterling, IL 62353
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 0550
time waiting.
Level of Harm - Minimal harm
or potential for actual harm
On 4/3/25 at 2:30 pm, R2 stated, They could be better with answering call lights.
Residents Affected - Some
On 4/4/25 at 1:00 pm, R8 stated, I go to Resident Council meetings, and we always have complaints about
our call lights.
On 4/4/25 at 1:05 pm, R9 stated, We always have complaints about the call lights not getting answered.
Sometimes it takes a long time for them to get answered.
On 4/3/25 at 1:20 pm, R10 stated, We get complaints every month in Resident Council that the call light
response is an issue.
On 4/3/25 at 1:41 pm, R11 stated, We get complaints with call lights not getting answered almost every
month. They say they will look into it.
On 4/4/25 at 12:45 pm, R7 (Resident Council President) stated, We turn our problems with the call lights in
to them and tell us that they follow-up on it every month, but we continually have problems with the call
lights not getting answered.
On 4/5/25 at 12:46 pm, V1 (Administrator) stated, I know Resident Council does have complaints about the
call lights, I am going to try and figure out the best way to resolve these issues.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145820
If continuation sheet
Page 2 of 2
