Hawthorne Inn of Danville: Wound Care Failures - IL
The complaint inspection, completed August 13, 2025, focused on wound care being provided to a resident identified in the report as R4. The bordered foam dressings on R4's heels were protective, ordered to guard against breakdown of vulnerable skin. The treatment protocol called for hand hygiene and a glove change after each step, including after cleaning the wound. Inspectors found that was not happening.
The harm level was recorded as minimal, with potential for actual harm. Few residents were affected.
What the inspection also revealed, almost in passing, was the way treatment orders were making it into the medical record in the first place. A nurse identified as V8 told inspectors that orders and notes from the treating provider, identified as V30, were handed off to V8 or to the Director of Nursing, identified as V2, who then entered them into the resident's electronic medical record. V30 was not entering the orders directly.
That is a separate problem from the gloves and the handwashing, but it sits in the same inspection for a reason. When the chain of communication between a treating provider and a resident's medical record runs through two intermediaries before anything is documented, the margin for error widens. A wound treatment order that is transcribed rather than entered by the person who wrote it is an order that depends on accurate relay at every step.
R4's heels needed protection. The dressing change schedule, every five days, was the active order. The purpose, according to V8, was protection. What inspectors found was that the nurses responsible for executing that order were moving through the wound care steps without the infection controls the protocol required.
Hand hygiene and glove changes between steps of wound treatment are not procedural formality. When a nurse cleans a wound and then continues handling dressing materials without changing gloves, anything picked up during the cleaning moves forward into the next step. For a resident whose heels are already compromised enough to require bordered foam dressings, that is not a theoretical risk.
The inspection report does not describe how long this had been occurring, how many dressing changes were performed without proper technique, or whether R4 showed any signs of wound complications. What it documents is that when inspectors looked, the nurses were not following the protocol, and the nurse who explained the treatment to inspectors confirmed the steps that should have been taken.
Hawthorne Inn of Danville is located at 3222 Independence Drive. The inspection was a complaint survey, meaning someone reported a concern before inspectors arrived.
The report is three pages. The narrative is brief. What it contains is a resident with injured heels, a wound care order designed to protect them, and staff who were not completing that care the way it was written.
For R4, the dressings were still being changed. The order was being followed in that basic sense. But the hygiene controls around each change, the part designed to keep the wound from getting worse during the very treatment meant to help it, were not.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Hawthorne Inn of Danville from 2025-08-13 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Last verified: October 25, 2026 · Our methodology
HAWTHORNE INN OF DANVILLE in DANVILLE, IL was cited for violations during a health inspection on August 13, 2025.
The complaint inspection, completed August 13, 2025, focused on wound care being provided to a resident identified in the report as R4.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.