Inspection visit
Health 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 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to transfer a resident safely for 1 (R1) of 3 residents reviewed
for accidents in the sample of 6.
This past non-compliance occurred between 12/01/2024 to 12/13/2024.
The findings include:
R1's admission Record documents R1 was admitted to the facility on [DATE] and includes diagnoses of
cerebral aneurysm, non-ruptured, contracture of muscle, multiple sites, adult failure to thrive, altered mental
status, delusional disorder, generalized anxiety disorder, and Paroxysmal Atrial Fibrillation.
R1's Minimum Data Set (MDS) dated [DATE] documents a Brief Interview of Mental Status (BIMS) score of
01, indicating R1 has severe cognitive impairment. The same MDS documents that R1 has impairment on
both upper and lower extremities, is dependent for showers, bed to chair transfers, and getting in and out of
shower.
R1's Care Plan documents that R1 has an ADL (Activities of Daily Living) self-care performance deficit.
Documented interventions include that R1 requires extensive assist with bathing/dressing/hygiene and R1
requires two assist with full body mechanical lift for all transfers.
R1's [NAME] documents for Toilet Use: R1 requires two assist with full body mechanical lift for all transfers
and R1 requires two assist with full body lift for all transfers or two assists with transfers.
R1's Physician's Orders dated as of 11/1/2024 document an order for Eliquis tablet 2.5mg (milligrams) two
times a day for AFib (Atrial Fibrillation).
R1's Progress Note dated 12/2/24 at 12:51 PM by V12 (Licensed Practical Nurse) documents (R1) noted to
have a large bruise to right forearm. (R1) reported that staff transferred her to shower without using hoyer
(mechanical) lift yesterday afternoon. MD (physician) and POA (Power of Attorney) notified.
R1's Nurse's Progress Note dated 12/2/24 at 3:21pm by V1 documents I spoke with (R1) today regarding a
bruise that occurred the night before during a transfer prior to her shower. (R1) stated that the aides in no
way intentionally set out to harm her in any way. She thanked me for talking with her
(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:
146019
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
146019
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wabash Senior Living & Rehab
216 College Boulevard
Carmi, IL 62821
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
and had no other concerns at this time.
Level of Harm - Minimal harm
or potential for actual harm
On 12/10/24 at 2:00pm, V2 (Assistant Administrator) said there was an incident on 12/1/24 involving R1
that occurred on 12/1/24. V2 said that there were 2 Certified Nurse's Aides (CNA), that do not usually work
that hall, that gave R1 a shower. V2 said that instead of using the mechanical lift, they lifted R1 under her
arms. V2 said that both staff told her that R1 never screamed or yelled or even told them they needed to
use the lift. V2 said that the incident was brought to her attention on 12/2/24 (Monday) that R1 had a large
bruise on her right forearm from not being transferred with the mechanical lift. V2 said that V15 (Certified
Nurse's Aide/CNA) said that there were no issues with the mechanical lifts, they just didn't use it and lifted
her without it. V2 said that they should have used the mechanical lift, but didn't. V2 also said that R1 is on
Eliquis which is a blood thinner and does bruise easily.
Residents Affected - Few
On 12/10/24 at 11:30am, R1 was sitting in her recliner in her room. R1 said she did not want to talk about it
and she had told the story a million times and was not going to say it again. R1 would not let this surveyor
look at her arm. R1 was alert and answered questions appropriately at this time.
On 12/12/24 at 11:25 AM, R1 was asked about the incident on 12/1/24 and R1 said they didn't use the lift
and those girls were never going to shower her again. R1 said they are not allowed in her room again. R1
said she did not tell them to stop or to use the lift when they transferred her. R1 said that she is ok and that
that will not happen again. R1 said they made this big bruise on her arm. R1 was asked to see the bruise
and R1 would not let this surveyor look at the bruise. R1 was observed to have contractures in both hands
and unable to use them. The lower part of the bruising towards her wrist was visible and it was reddish pink
in color. R1 was alert and answered questions appropriately at this time.
On 12/12/24 at 3:15 PM, V15 (CNA) said she worked on 12/1/24 and said she was told that R1 needed a
shower and no one told her that she needed a mechanical lift. V15 said she was not aware of looking at the
[NAME] and has been employed at the facility for maybe 9-10 weeks. V15 said that they transferred R1
under her arms and held the seat of her pants. V15 said that facing R1 she put her arm under R1's arms in
the arm pit area and R1's arm pit area was in the bend of her arm. V15 said she also had ahold of the seat
of R1's pants. V15 said that R1 did not scream or yell and all that R1 said they were never giving her a
shower again. V15 said they used the shower in the 800 hall that was closed since the showers on the 500
hall were being used. V15 said that R1 never told them to stop and they should use the lift or they would
have used it. V15 said to her knowledge, the lifts were not broken. V15 said there was bruising on R1's right
arm before they showered her. V15 said after R1's shower, they lifted her back in bed. V15 said they did not
use the lift putting her in bed. V15 also said she did not use a gait belt.
On 12/10/24 at 3:24pm, V16 (CNA) said she was not aware that R1 required a mechanical lift for transfers.
V16 said she was being trained and had only worked a couple of days. V16 said that on 12/1/24 she
transferred R1 with V15. V16 said she was on the opposite side of V15 and placed her arm under R1's arm
with R1's weight resting in the bend of her arm and used her other hand to hold the seat of R1's pants. V16
also said she did not use a gait belt. V16 said R1 never told them they needed to use the lift. V16 said they
took R1 to the 800 hall to shower since the shower on the 500 hall was being used. V1 6 said that no one
could have heard R1 screaming and yelling since she did not yell or scream at all. V16 said that R1 kept
saying you will never give me a shower again and that was it. V16 said they showered her without any
issues and then put her back in bed again not using the lift.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146019
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
146019
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/13/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Wabash Senior Living & Rehab
216 College Boulevard
Carmi, IL 62821
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
Level of Harm - Minimal harm
or potential for actual harm
On 12/11/24 at 10:00am, V12 (Licensed Practical Nurse/LPN) said she came in on Monday (12/2/24) and
saw bruising on R1's right arm. V12 said that R1 told her that the CNA's couldn't get the lift to work and
lifted her under her arms and that is where the bruise came from yesterday (12/1/24) V12 said R1 also told
her that they were transferring her to a chair. V12 said she took a picture of the bruise and reported it to
administration on 12/2/24 and also called the physician and R1's POA (Power of Attorney).
Residents Affected - Few
On 12/11/24 at 10:50am, V14 (Registered Nurse/RN/Infection Preventionist/wound nurse) said that she is
aware of the incident. V14 said she was not aware of any bruising present on R1's right arm prior to the
incident on 12/1/24.
The facility policy titles Safe Lifting and Movement of Residents (revised July 2021) documents Mechanical
lifting devices shall be used for heavy lifting, including lifting and moving residents when necessary. A
resident that requires a mechanical lift may also be a two person assist with the use of proper equipment i.e
(in example) gait/transfer belts.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146019
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.
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 December 13, 2024 survey of WABASH SENIOR LIVING & REHAB?
This was a inspection survey of WABASH SENIOR LIVING & REHAB on December 13, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at WABASH SENIOR LIVING & REHAB on December 13, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
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.