F 0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
Level of Harm - Actual harm
Residents Affected - Few
Note: The nursing home is
disputing this citation.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review the facility failed to provide adequate supervision to prevent
verbal and physical resident-to-resident abuse for two of four residents (R1 and R2) reviewed for abuse in
the sample of seven. These findings resulted in R1 physically assaulting R2 causing R2 pain, a laceration to
the left cheek, and two large hematomas to the bilateral shins which required emergency room
services.Findings include:The facility's Abuse Prohibition Policy, dated 1/29/2026, documents Abuse and
Neglect Prohibited: 1. All residents have the right to be free from verbal, sexual, physical, mental abuse,
corporal punishment, involuntary seclusion, neglect, misappropriation of property, and exploitation. Abuse is
the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting in
physical harm, pain, or mental anguish. Abuse includes deprivation by an individual, including a caretaker,
of goods or services that are necessary to attain or maintain physical, mental, or psychosocial well-being.
Physical Abuse means the infliction of injury on a resident that occurs other than by accidental means and
that requires medical attention. Physical abuse may include, but it is not limited to such acts as hitting,
slapping, kicking, hair pulling, and pinching. Verbal Abuse means the use of oral, written, or gestured
language that includes disparaging and derogatory terms to a resident or within his or her hearing or
seeing distance, regardless of the resident's age, ability to comprehend, or disability. R1's admission
Record documents R1 is an [AGE] year-old admitted to the facility on [DATE] with diagnoses of Alzheimer's
Disease, Dementia with Agitation, Major Depressive Disorder, and Anxiety Disorder.R1's MDS (Minimum
Data Set) Assessment documents R1 is moderately cognitively impaired and has behaviors every one to
three days.R1's current Care Plan documents R1 has behaviors of yelling out, being demanding, making
inappropriate sexual comments, touching on staff, and most recently (2/13/26) having physical behavioral
symptoms.R2's admission Record documents R2 is an [AGE] year-old that was admitted to the facility on
[DATE] with diagnoses of Osteoarthritis, Cardiomyopathy, Aortic Aneurysm, Hypertensive Heart Disease
with Heart Failures, and Idiopathic Peripheral Autonomic Neuropathy.R2's MDS assessment dated [DATE]
documents R2 is cognitively intact and self-propels in a wheelchair.R1 and R2's Final Abuse Report dated
2/12/26 and signed by V1 (Administrator-In-Training) documents that on 2/7/26 at 8:45 PM R1 and R2 had
a verbal altercation while in the bathroom that turned into a physical altercation when R1 hit R2 in the face
and R1's walker hit R2's leg. This same Abuse Report documents R2 was sent to the hospital for treatment
of left cheek abrasion and lower leg bruising.R1's Progress Notes dated 2/7/26 at 10:22 PM document R1
had a physical altercation with another resident (R2).R2's Emergency Department Notes dated 2/7/25 at
8:30 PM document, Chief Complaint: (R2) arrives via EMS (Emergency Medical Services) from (the facility)
for assault by another resident (R1). (R2) arrives with abrasion to left side of face and bilateral hematomas
to shins from being hit with (R1's) walker multiple times. (R2) punched in head then struck by walker in
shins. Left temporal pain 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 2
Event ID:
146068
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
146068
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/28/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sunny Acres Nursing Home
19130 Sunny Acres Road
Petersburg, IL 62675
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 0600
Level of Harm - Actual harm
Residents Affected - Few
Note: The nursing home is
disputing this citation.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Tramadol 50 mg (milligrams) administered for pain.R1 and R2's Police Report dated 2/7/26 and signed by
V4 (Police Officer) documents, Offense: Battery. Offender: (R1). On 2/7/26 (V4) was dispatched to (the
facility) for a battery report. The incident took place at (the facility). I spoke to (V7/RN/Registered Nurse).
(V7) explained that (R2) and (R1) had gotten into a verbal and physical altercation inside the common
bathroom (R2) and (R1) shared. (V7) said both (R2) and (R1) are separated now. (V7) stated that (R2)
needed to go to the hospital to get his injuries checked after I was done speaking with (R2). (V7) briefly
explained the situation to me, stating that both (R1) and (R2) were arguing and (R1) struck (R2) in the face
with (R1's) fists and struck (R2) in the face several times, and hit (R2) with (R1's) walker. (R2) was unable
to provide a written statement and wanted to go to the hospital to be checked out. I requested dispatch to
send EMS to my location for transport to (ED/Emergency Department). I took photographs of the injuries
too (R2). I then went to speak to (R1) inside (R1's) room. I asked (R1) what happened tonight. (R1) stated
that he beat (R2) up because (R2) had called (R1) a Son of a bi**h. (R1) stated that he hit (R2) several
times and may have hit (R2) with the walker. I photographed (R1's) hands and (R1's) right hand did appear
to possibly have some bruising and (R1) stated it hurt. I asked (V7) if any staff witnessed the incident. (V7)
stated (Certified Nursing Assistant/CNA/V3) did. (V3's) statement is attached to the report.The Police
Report Photos printed 2/9/26 were observed. In the photos R2 had a laceration to the left upper cheek and
a softball sized, dark purple hematoma to the right lower leg, and R1 had reddish discoloration to the top of
his right hand and end of his right fingers.On 2/27/26 at 9:30 AM R2 was sitting in his room in a wheelchair.
R2 had a 2-inch by 2-inch dressing with brownish drainage covering an open area to the top of the left shin.
R2 had a baseball sized dark red hematoma to the right shin. R2 stated, Several weeks ago I had a friend
visiting me and (R1) was in the bathroom singing a song repeatedly, It's bare a** time. What (R1) was
singing was embarrassing and (R1) does it just to aggravate me. I went into the bathroom and told (R1),
Shut the h**l up you son of a bi**h! (R1) took his walker and slammed it into my legs over and over and
when I grabbed ahold of the walker to get (R1) to stop, (R1) started to punch me in the face. Both of my
shins are really swollen and sore and my cheek got busted open. It hurt really badly, and I asked to go to
the hospital to make sure my cheek wasn't broken. I definitely felt abused and should not have to deal with
(R1). My shins are still swollen and are painful every day.On 2/27/26 at 2:12 PM V3 (CNA) stated, On
2/7/26 around 8:30 at night I heard someone yelling help. I went into (R2's) room and (R2) was in the
doorway of the bathroom and (R1) was in the bathroom. I saw (R1) punching (R2) in the chin with closed
fists. I yelled at (R1) to stop, and (R1) had ahold of (R2's) wheelchair. I removed (R1's) hands from (R2's)
wheelchair and separated (R1) and (R2). (R2) had a bloody mouth and a soft-ball sized bruise to the right
shin. (R2's) left cheek was busted open. (R2) told me that (R1) was singing its bare a** time, so (R2) yelled
at (R1) and called (R1) a son of a bi**h. (R2) stated (R1) hit him multiple times in the face and hitting (R2) in
the shins with (R1's) walker. (R2) was hurting and wanted to go to the hospital.
Event ID:
Facility ID:
146068
If continuation sheet
Page 2 of 2