Inspection visit
Health inspection
4 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 4 deficiencies, 1 of them serious (actual harm or immediate jeopardy). The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility failed to provide treatment and services to prevent the development
and worsening of a residents pressure ulcer. These failures affect one (R1) of three residents reviewed for
pressure ulcers in the sample list of five. These failures resulted in R1's facility acquired pressure ulcer
worsening.
Residents Affected - Few
Findings include:
R1's undated Face Sheet document R1's diagnoses as Alzheimer's Disease, Fracture of unspecified part of
neck of unspecified femur, subsequent encounter for closed fracture with routine healing, methicillin
resistant staphylococcus aureus infection as the cause of disease classified elsewhere.
R1's March 2023 Weekly Wound Tracking documents on 3/9/23 R1's Stage Four pressure ulcer measured
0.5 cm by 0.2 cm by 0.1 cm. There are no documented measurements/assessments after 3/9/23 until
3/31/23 when R1's ulcer was larger and measured 2.5 cm by 2.5 cm by 0.8 cm.
R1's Treatment Administration Record (TAR) dated March 2023, documents no treatments being completed
on the following dates: 3/1/23 day and evening shifts, 3/3/23 day shift, 3/4/23 day shift, 3/5/23 evening shift,
3/9/23 evening shift, 3/10/23 day shift, 3/11/23 day shift, 3/12/23 day shift, 3/21/23 day shift, 3/25/23
evening shift, 3/27/23 evening shift, 3/29/23 day shift, and 3/30/23 day shift.
On 12/12/23 at 12:06 PM, V13 Licensed Practical Nurse (LPN) stated that V13 found R1 lying in urine and
feces all the time, R1's bed and R1 herself would be soaked. V13 stated R1 was only repositioned when the
nurses did it because the Certified Nursing Assistant's (CNA) never did it.
On 12/12/23 at 2:08 PM, V14 LPN stated V14 worked at the facility R1 was at before they both came to this
facility. V14 stated R1's wound got worse and worse at this facility. V14 stated R1 should have been
repositioned but don't think the CNA's did it at all or very often and she would frequently have to remind
them to do it. V14 stated she did find R1 lying in urine and feces.
On 12/12/23 at 2:37 PM, V21 Medical Doctor (MD) stated if treatments were not documented as being
completed and the (R1's) wounds were not treated then yes the wounds will get worse. V21 stated wound
assessments should be completed every time the dressing is changed with measurements and wound
descriptions.
On 12/13/23 at 1:43 PM V15 Corporate Nurse stated the nurses should follow the facility's policy when a
pressure ulcer is identified and wound assessments should include size, drainage, and depth. V15
confirmed wounds should be assessed upon identification, the stage of the ulcer should be
(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 5
Event ID:
146039
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
146039
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/14/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Eastview Healthcare & Senior Living
100 Eastview Place
Sullivan, IL 61951
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 0686
Level of Harm - Actual harm
Residents Affected - Few
included, and R1's initial wound assessment does not identify the stage. V15 stated barrier cream can be
applied by the CNA's and applications are not recorded. V15 stated daily skin checks are documented on
the Treatment Administration Record (TAR). V15 reviewed R1's July 2022 TAR and confirmed it does not
document daily skin checks were completed or barrier cream application. At 1:53 PM V15 provided R1's
July 2022 wound log and confirmed the log does not identify the stage of the wound prior to 7/28/22. V15
stated the nurses don't always have to stage the wound.
R1's medical record documents the following related to pressure ulcer history:
R1's Care Plan dated 7/13/22 documents R1 has incontinence and includes interventions for use of
incontinence briefs, change as needed, assess skin with each incontinence episode, and apply barrier
cream as needed. This Care Plan documents to provide scheduled toileting assistance upon rising,
before/after meals, and before bed. This Care Plan documents R1 is at high risk for developing pressure
ulcers due to thin skin, poor safety awareness, and Alzheimer's Disease. This care plan documents
interventions for daily skin checks, document any new skin conditions and to apply barrier cream to
perineal area with each incontinence episode and as needed, and assist R1 to turn and reposition per
schedule or at least every 2 hours.
R1's July 2022 Treatment Administration Record (TAR) does not document R1's care plan interventions for
daily skin checks and barrier cream application were implemented after admission on [DATE].
R1's admission assessment dated [DATE], documents R1 admitted with redness to R1's sacrum. This
assessment does not document R1 had any open wounds upon admission.
R1's admission Minimum Data Set (MDS) dated [DATE] documents R1 has short/long term memory
impairment and R1 is dependent on two or more staff for assistance with bed mobility, transfers, and
toileting. This MDS documents R1 is at risk for developing pressure ulcers and did not have pressure ulcers
when R1 admitted to the facility. R1's Newly Acquired Skin Conditions form dated 7/26/22, documents R1
has a pressure area of the coccyx that measures 6 centimeters (cm) by 5 cm. R1's Nursing Note dated
7/26/22 documents R1 has an open area to R1's coccyx and a calcium alginate treatment was applied.
R1's July 2022 Weekly Wound Tracking report documents R1's ulcer began on 7/26/22 and the wound was
pink with minimal drainage and the wound was classified as a Stage Four on 8/19/22. There is no
documentation in R1's medical record of the stage of this pressure ulcer prior to 7/28/22. R1's Wound
Evaluation & Management Summary dated 7/28/22, recorded by V20 Wound Physician, documents R1 has
a full thickness pressure ulcer of the sacrum that was unstageable due to necrosis (dead tissue.) This
wound measured 5.5 cm by 4.5 cm by 0.1 cm deep and 20% of the wound was necrotic tissue which was
subsequently debrided.
The facility's Aseptic Wound and Skin Treatment Procedure dated Reviewed 1/18, documents the purpose
of this policy is to prevent contamination of a wound, to promote circulation and healing, prevent further
deterioration of skin tissue, prevent necrosis of deeper body structures, and promote resident comfort.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146039
If continuation sheet
Page 2 of 5
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
146039
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/14/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Eastview Healthcare & Senior Living
100 Eastview Place
Sullivan, IL 61951
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
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 properly transfer one resident (R1) of three residents
reviewed for falls on the sample list of five.
Finding include:
R1's undated Face Sheet document R1's diagnoses as Alzheimer's Disease, Fracture of unspecified part of
neck of unspecified femur, subsequent encounter for closed fracture with routine healing, methicillin
resistant staphylococcus aureus infection as the cause of disease classified elsewhere, Neuralgia and
Neuritis, Radiculopathy, R1's admission Minimum Data Set (MDS) dated [DATE], documents R1 has
short/long term memory impairment, and totally dependent with two or more staff for assistance with bed
mobility, transfers, and toileting.
R1's Computerized Tomography (CT) dated 7/5/23, results documents: comminuted (broken in at least two
places, a severe trauma due to serious trauma like falls from a high place, creates shatter-like breaks)
fracture of right femur involving portions of the neck, intertrochanteric region, and proximal shaft, variable
sized fracture fragments with variable displacement. R1's Discharge summary dated [DATE]-[DATE],
documents a hoyer lift is used at the nursing facility for transfers to a chair.
The facility's Final Incident Report dated 7/10/23, documents R1 had no falls or injury to right leg or hip, R1
unable to communicate how right leg/hip was injured, R1 is non-weight bearing and uses a mechanical lift
to be transferred.
On 12/12/23 at 12:06 PM, V13 Licensed Practical Nurse (LPN) stated R1 was found to have a fracture in
her femur when going to the Emergency Room. V13 stated when R1 was at the facility the Certified Nursing
Assistants (CNA) did not use a mechanical lift to transfer R1. V13 stated she saw the CNA's pick R1 up like
a baby and cradle R1, or two people would transfer without a mechanical lift, or put their arms under R1's
arms and pick R1 up from R1's chair and drop R1 in R1's bed. V13 stated R1 was contracted. V13 stated all
of the CNA's V13 worked with did not transfer R1 correctly and V13 told the staff numerous times to use a
mechanical lift with R1 but they would not.
On 12/12/23 at 2:08 PM, V14 LPN stated V14 worked at the facility R1 was at before they both came to this
facility. V14 stated R1 required a mechanical lift with two assist for transfers but would frequently see the
CNA's transfer R1 without the mechanical lift and would remind them to use the mechanical lift to transfer
R1.
The facility's Mechanical Lift Policy dated Revised 10/20/08, documents a mechanical lift may be used to lift
and move a resident with limited ability during a transfer while providing safety and security for the resident.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146039
If continuation sheet
Page 3 of 5
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
146039
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/14/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Eastview Healthcare & Senior Living
100 Eastview Place
Sullivan, IL 61951
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 0727
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on
a full time basis.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to employ a Registered Nurse to serve as full
time Director of Nurses. This failure has the potential to affect all 45 residents who reside in the facility.
Findings Include:
On 12/6/2023 at 12:50 PM, V1 Administrator confirmed the facility does not currently employ a Registered
Nurse to serve as full time Director of Nurses.
Upon survey entrance and throughout the survey (12/6/23- 12/14/23) there was no Director of Nurses
present and/or employed by the facility.
The facility's Facility assessment dated [DATE], documents a full time Director of Nurses is required in order
to meet the resident's needs and provide support and care for the facility's resident population.
The facility's Room Roster/Census given on 12/6/2023 documents 45 residents currently reside in the
facility.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146039
If continuation sheet
Page 4 of 5
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
146039
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
12/14/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Eastview Healthcare & Senior Living
100 Eastview Place
Sullivan, IL 61951
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
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review, the facility failed to implement infection control during
incontinent care. The facility also failed to properly clean a wound for one resident (R2), of three residents
reviewed for infection control in the sample list of five.
Residents Affected - Few
Findings include:
R2's undated Face Sheet documents R2's diagnoses as: Urinary Tract Infection, Diabetes Mellitus Type II,
Peripheral Arterial Disease.
R2's Wound Evaluation and Management Summary dated 11/2/23, documents a diabetic wound of the
right, first toe full thickness and a diabetic wound of the right distal, plantar. lateral foot.
R1's Physician Order Sheet (POS) dated 12/2023, documents treatments as: right lateral foot, apply foam
and tape to area three times a week; and right first toe, apply two by two gauze soaked with Betadine
(Antiseptic) solution, then cut an abdominal (dressing) pad to size and gauze wrap twice a day.
On 12/6/23 at 1:15 PM, V2 Licensed Practical Nurse (LPN) performed a treatment to R2's right foot and
toe. At this same time, V2 stated R2 had foot drop and R2's toe was rubbing against the bed so we added
cushions to it. During the treatment, V2 removed R2's dirty dressing, changed gloves and washed hands,
put on clean gloves, put wound cleanser on a 2 x 2 gauze pad and proceeded to clean R2's right lateral
foot and R2's right tip of big toe using the same side of the 2 x 2 gauze pad without changing the sides of
the gauze pad or getting a clean gauze pad.
The facility Aseptic Wound and Skin Treatment Procedure Policy dated Reviewed 1/18, documents clean
the wound as ordered, clean from center outward, never going back over area which has been cleaned.
On 12/7/23 at 3:14 PM, V10 Certified Nursing Assistant (CNA) and V12 CNA were in R2's room and took
off R2's pant stating they were going to do perineal care for R2. During the procedure, V10 removed R2's
dirty depends and used wet cloths to clean R2's bottom. After cleaning the dirty area (contaminated with
feces), V10 did not change V10's glove or wash V10's hands and continued to use the same dirty gloves to
use clean cloths to wipe R2's bottom, the same dirty gloves to dry off R2, the same dirty gloves to put a
depends on R2. After this procedure, V10 removed the soiled gloves and then washed V10's hands. When
V10 was asked about the procedure, V10 stated V10 knew what she did was wrong but continued anyway.
On 12/13/23 at 2:10 PM, V15 Corporate Nurse stated the nurse (V2) should have changed sides of the
gauze pad when cleaning R2's wound or got a clean gauze pad. V15 stated while doing
incontinent/perineal care, CNA (V10) should have changed her gloves when going from dirty to clean.
The facility's Hand Hygiene Policy dated Updated 8/14/23, documents to wash hands before and after
direct resident care and when moving from contaminated body site to clean body site during resident care.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146039
If continuation sheet
Page 5 of 5
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Back to topCitations
4 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.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
F727 - Except when waived under paragraph (f) or (g) of this section, the
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
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 December 14, 2023 survey of EASTVIEW HEALTHCARE & SENIOR LIVING?
This was a inspection survey of EASTVIEW HEALTHCARE & SENIOR LIVING on December 14, 2023. The surveyor cited 4 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at EASTVIEW HEALTHCARE & SENIOR LIVING on December 14, 2023?
Yes, 4 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide appropriate pressure ulcer care and prevent new ulcers from developing."
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.