Inspection visit
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 0600
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment,
and neglect by anybody.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to prevent physical abuse for 1 of 4 (R2) residents, reviewed
for abuse in a sample of 4.
Findings include:
R2's Minimum Data Set (MDS), dated [DATE] documented that R2's cognition was moderately impaired,
that she uses a wheelchair to be mobile and that she requires set up help on some Activities of Daily Living
(ADL's) and maximum assistance for mobility and dressing ADL's.
R2's Care Plan, dated 7/8/2024, documented, Physical Assault: (R2) was in an abusive relationship in the
past. She has dealt with this and declines services and intervention at this time.Resident will verbalize
understanding of available services if needed. Reevaluate as needed.
R2's Physicians order sheet, dated 10/2024, documented diagnoses of other postprocedural complications
and disorders of digestive system, peritoneal abscess, infection following a procedure, superficial incisional
surgical site, subsequent encounter, and urinary tract infection, site not specified.
On 10/28/2024 at 11:00 AM, R2 stated that V3, Certified Nurse Assistant, (CNA), was in and out of her
room, doing things for her, the evening before and that she was also on her cell phone talking to some girl
about being her girlfriend or something while in her room. R2 stated that she left her room and was out in
the hallway being loud on her phone. R2 continued to state that the next day, when (V5), Business Office
Manager, came down to see her, she let her know what was going on with V3 being on her phone instead
of assisting the residents. R2 continued to state that around 1:30 pm that day, (V3), CNA, came back into
her room took the bowl of soup and threw it at her. She continued to state that she was not hurt. R2
continued to state that she (V3) was yelling at her telling her that she wasn't getting fired and that they were
only moving her to a new hall and that she wasn't talking about a girlfriend. R2 stated that (V3), CNA, was
trying to intimidate her because she told on her about being on her phone. R2 was asked if she felt safe at
the facility and she stated that some people are very caring and some she is [NAME] of but she does not
feel threatened and she feels safe living at the facility. She also stated that she spoke with the police and
pressed charges against (V3), CNA. R2 stated that she does not fear (V3), CNA, coming back because it
was taken care of as it should have been.
On 10/28/2024 at 1:45 PM, V5, Business Office Manager (BOM), stated that she went in to see R2 when
she 1st got to work on 10/15/24. She stated that (R2) was her daughter's grandmother. She continued
(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:
146139
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
146139
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/29/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Regency Care
2120 West Washington
Springfield, IL 62702
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 - Minimal harm
or potential for actual harm
Residents Affected - Few
to state that (R2) told her that (V3) was on her phone being loud in her room and in the hallway, the day or
night before. V5 stated that once (R2) told her this she went to the (V2), Director of Nurses, immediately
with this information. She then stated that around 11:30 am she took (R2) some soup and then she went
and covered the front desk for another girl. V5 continued to state that at 1:39 pm she received a text
message from (R2) telling her to get down to her room and see what the CNA had done to her. She stated
that she immediately asked if she was hurt and if she was ok, V5 stated that was the soup that she brought
into her at 11:30 am so it wasn't hot any longer. V5 continued to state that she ran and got (V1),
Administrator and (V2), Director of Nurses to come and check out (R2). V5 also stated that around 1:00 pm,
they had the girl (V3), CNA in (V1's) office and the voices were getting really loud.
On 10/29/2024 at 10:00 AM, V2, Director of Nurses, stated that she was told by (V5), BOM, about (V3),
CNA being on the phone while taking care of residents and that she also had a complaint by another staff
member about her being on her phone and that she went and looked for her. V2 stated that she found her
in the sun room, talking on her phone. V2 stated that her and (V3) had a talk about not being on her phone
while taking care of residents and that she could use her phone on her break time and away from care
areas. V2 stated that (V3) apologized and went back to work. Later that morning, therapy staff came to her
and stated that a resident had complained that (V3) was on her phone while she was doing incontinent
care. V2 stated that she went down to that residents room to talk to him and (V3) walked by and saw her
sitting there talking to the resident and that was when she went to (V1's) office and was upset. V2 continued
to state that (V3) did raise her voice trying to talk over her but (V3) acted more upset and was defending
herself and did not seem to be agitated. V2 then stated that she did not see (V3) leave the facility, but was
told that soup was thrown on (R2) by (V3), so her, (V1), Administrator,(V5), BOM, and another nurse went
immediately to go check on (R2) and assess her. V2 stated that when (V3) left the building at 1:05 pm and
then returned around 1:39 pm to throw soup on (R2), no one would of even wondered why she was coming
possible through the employee entrance because she was working that day.
On 10/29/2024 at 8:45 AM, V1, Administrator, stated when asked about when (V3), CNA, was pulled into
the office and spoken with about her being on her phone how was her demeanor. V1 stated that they didn't
pull (V3) into her office, and that she came in there upset and not agitated as she could tell, stating that she
could not lose her job because she was homeless and that she was on her phone because someone was
calling her about a place to live. V1 continued to state that she was concerned that this person needed
assistance because she was homeless. V1 continued to state that (V3) left the building at or around 1:05
pm, but then at 1:15pm or so, (V5), BOM, got a text message from (R2) to come down to her room
immediately to see what (V3) had done to her. V1 continued to state that no one saw (V3) come back into
the building through the front door and that every door code was the same so she may have come in
through the employee entrance. V1 continued to state that she had maintenance change all the door codes
the same day.
On 10/17/2024, an Interview was done by V1, Administrator. V7, CNA was interviewed regarding the event
that took place on 10/15/2024. It documented, Tuesday October 15, 2024. Delivered lunch tray to (R2). Did
anything occur when you delivered her lunch tray (V7, CNA): The girl that had that group was standing in
the room. I assumed she was doing something with (R2). Did you hear or see anything occur when you
delivered the tray? (V7, CNA)- No. Did you speak to the CNA that was in the room? (V7) when she came
out of the room, yeah. What was said during that conversation? (V7) She was asking me who she needed
to talk to because she was fed up with having that group. I told her go talk to (Staffing). What time was that?
(V7) Around lunch time maybe 12:30. Did you see this aid after that? (V7) No. Do you know the aides
name? (V7, CNA) I believe it was ( V3, CNA). It
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146139
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
146139
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/29/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Regency Care
2120 West Washington
Springfield, IL 62702
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 - Minimal harm
or potential for actual harm
Residents Affected - Few
continued to document, Did you see or hear that CNA, (V3) speak inappropriately to any resident while you
were working? (V7, CNA) No. Did you see (V3) enter (R2's) room around 1:30 PM? (V7) No. Did you see
(V3) throw soup at (R2), (V7)- No. It continues, Did (V3,CNA) have any interaction with you around 1:30
PM? (V7) No.
Report to State Agency, dated 10/18/2024, documented, (R2) reported to the Business Office Manager
(V5) that an Agency CNA, (V3) entered her room at approximately 1:35 pm and stated I didn't say I had
some girlfriend. They are not going to fire me; they are going to just move me. (R2) then stated, That girl
with the pink bonnet picked up my bowl of soup and threw it at me and said that's what you get. (R2) had
soup on her gown, her bed, the wall and the soup bowl was upside down on the right side of (R2's) bed.
Head to toe assessment completed, no injuries. (R2) state, The soup was not hot. It continues, (V3, CNA)
left the facility prior to her scheduled shift ending after being upset about being told she was not to be on
her phone by the DON (V2). (V1) Administrator attempted to call (V3, CNA) per phone number on file
(XXX-XXX-XXXX), a female aswered and said, wrong number. It continues, (V3) was immediately put on
the do not return list with (Staffing Agency), (V6, Staffing Agency Supervisor) was notified via phone that
(V3, CNA) is to not return to our facility or facility property related to occurrence and provided allegation
information.
The facility's policy, Resident care policy and procedure regarding abuse and neglect, involuntary
seclusion, exploitation, Misappropriation of Resident Property, Injuries of Unknown Origin, and social
Media, dated 03/15/2018, documented, 1. All residents have the right to be free from verbal, sexual,
physical, mental abuse, corporal punishment, involuntary seclusion, neglect, misappropriation of property,
exploitation
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
146139
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.
F600 - Freedom from Abuse, Neglect, and Exploitation
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
FAQ · About this visit
Common questions about this visit
What happened during the October 29, 2024 survey of REGENCY CARE?
This was a inspection survey of REGENCY CARE on October 29, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at REGENCY CARE on October 29, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect b..."
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.