Inspection visit
Health 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 0573
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Let each resident or the resident's legal representative access or purchase copies of all the resident's
records.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to provide a resident's medical records within two working
days upon request for two of three residents (R1, R7) reviewed for medical records request in the sample of
eight.
The findings include:
1. R1's Face Sheet dated February 20, 2025 shows she was admitted to the facility on [DATE] with
diagnoses including spinal stenosis, low back pain, history of falling, urinary retention, and lack of
coordination. R1 was discharged from the facility January 16, 2025.
On February 20, 2025 at 9:34 AM, V7 (R1's Spouse) said he has been waiting to receive R1's medical
records for over a month. V7 said they requested the records from V8 (Medical Records). V7 said that R1
just had another surgery on her back. V7 said R1 is entitled to those records. V7 said that he nor R1 has
heard anything back from the facility regarding their medical records request.
On February 20, 2025 at 11:18 AM, V8 (Medical Records) said if someone is requesting medical records,
then she has them fill out a form and she sends that form to her legal team. V8 said the legal team
processes the medical records request. V8 said she received a request from R1's medical records request
on January 25, 2025 and she sent that off to her legal department. V8 said she was always told that there
was 30 days to get the request fulfilled if they were not current residents in the facility and two days if they
were. V8 said she has not followed up with R1's request to see if she had received her medical records or
not. V8 said that R1 called the facility on February 20, 2025 and said she had not received her records yet
so V8 emailed her legal team to follow up.
R1's Authorization for Use and Disclosure of Protected Health Information request was signed by R1 on
January 24, 2025.
2. On February 20, 2025 at 11:42 AM, V6 (R7's Power of Attorney) said she requested R7's medical
records on January 27, 2025 and still had not received them as of February 20, 2025. V6 said she has
reached out to the facility one other time since the request and the facility said they would get R7's medical
records to V6.
R7's HIPPA Privacy Authorization for Disclosure of Protected Health Information Relevant to Litigation or
Pending Claims request was signed by V6 on January 17, 2025.
On February 20, 2025 at 11:18 AM, V8 (Medical Records) said R7's request was originally and
(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:
145980
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
145980
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pearl of St Charles, The
850 Dunham Rd
St Charles, IL 60174
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 0573
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
incorrectly made to a sister facility. But the current and correct facility received the request on January 27,
2025. V8 said she has not heard from R7's family if they have received the medical records has not followed
up to see if they have.
The facility's Medical Records Request policy dated February 27, 2023 shows, Residents are always
entitled to their medical records, but must follow the process for requesting them. Time to process a Record
Request: Residents that have been discharged from the facility-30 days.
The Illinois Long-Term Care Residents' Right booklet revised November 2018 shows, Your facility must
allow you to see your records within 24 hours of your request (excluding weekends and holidays). You may
purchase a copy of part or all of your records at a reasonable copy fee within two working days of your
request.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145980
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
145980
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Pearl of St Charles, The
850 Dunham Rd
St Charles, IL 60174
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 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to perform a fall assessment and monitor a resident after a fall
for one of three residents (R1) reviewed for quality of care in the sample of eight.
Residents Affected - Few
The findings include:
R1's Face Sheet dated February 20, 2025 shows she was admitted to the facility on [DATE] with diagnoses
including spinal stenosis, low back pain, history of falling, muscle wasting, urinary retention, abnormalities
of gait and mobility, and lack of coordination.
R1's Fall assessment dated [DATE] shows she is a high risk for falls.
R1's Progress Note dated January 13, 2025 shows, R1 was reported to be lowered on the floor in her
room. Per CNA (Certified Nursing Assistant) she was transferring R1 from her chair to her bed and R1's
legs gave out and R1 was lowered to the floor. R1 denied any pain or discomfort.
There was no fall report, fall assessment, or follow up assessment provided by the facility regarding R1's
fall.
On February 20, 2025 at 12:30 PM, V2 (Director of Nursing) said R1 was lowered to the floor. V2 said
technically that is still a fall. V2 said normally a fall assessment, pain assessment, and change in condition
forms would have been filled out. V2 said none of this was done after R1 was lowered to the floor. V2 said
the facility thought it was not a fall because R1 kind of fell into the CNA and then the CNA lowered R1 to
the floor.
The facility's Fall Prevention and Management policy revised April 8, 2024 shows, Fall risk screening will be
used after a fall. Procedure for Post-Fall Management: Perform assessment to the cause of the fall and
potential for injury, perform physical assessment, document the fall event in the electronic health record
under 'risk management'. Evaluate and monitor resident after the fall. Complete falls assessment and post
fall documentation.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145980
If continuation sheet
Page 3 of 3
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
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.
F573 - The resident has the right to access personal and medical records pertaining
Let each resident or the resident's legal representative access or purchase copies of all the resident's records.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
FAQ · About this visit
Common questions about this visit
What happened during the February 20, 2025 survey of PEARL OF ST CHARLES, THE?
This was a inspection survey of PEARL OF ST CHARLES, THE on February 20, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PEARL OF ST CHARLES, THE on February 20, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Let each resident or the resident's legal representative access or purchase copies of all the resident's records."
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.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.