Hawthorne Inn: Missing Medical Records Found - IL
The patient, identified as R1 in state inspection records, arrived at the facility on July 10 following coronary artery bypass surgery. Despite having fresh surgical wounds to the chest, left thigh, and right groin, plus bruising from surgical complications, admission records showed "no alterations" in the patient's skin.
Nursing notes from the day of admission contain no assessment of the patient's skin condition or existing injuries. The first mention of surgical incisions appeared three days later, on July 13, when a nurse noted the wounds were "closed." Even then, no documentation mentioned the patient's bruising.
The bruising stemmed from a serious surgical complication. Hospital records show R1 developed a "right femoral arterial sheath hematoma" during the June 5 bypass surgery — a dangerous bleeding condition that occurs when blood vessels don't seal properly after catheter insertion.
But nursing staff failed to document this critical information.
V10, the registered nurse assigned to R1's case, told state inspectors on August 13 that the patient had "bruising to her hip or rib area" upon admission. V10 claimed to have received verbal reports about the bruising from hospital staff during the transfer.
None of this appeared in R1's medical records.
The first written mention of bruising came six days after admission, buried in a July 16 skin assessment that noted "incisions & bruising" with "no new areas of concern." The assessment failed to specify where the bruising was located.
When pressed by inspectors, V10 defended the documentation gap. The nurse said the July 16 entry referred to the same bruising present at admission, claiming it wasn't considered "new" since hospital staff had mentioned it verbally.
V2, the facility's Director of Nursing, acknowledged the problem was more serious than missing paperwork. During the August 13 inspection, V2 confirmed that "admission assessments, skin assessments, and notes do not document R1 admitted with incisions or bruising."
The admission had happened more than a month earlier.
V2 scrambled to obtain documentation from V29, the nurse practitioner who had treated R1. Records show V2 was still "waiting on" the provider's notes and trying to "obtain documentation that R1 had hip bruising on admission" during the inspection itself.
The missing records finally arrived at 8:56 AM on August 13 — the same day state inspectors were questioning staff about the gaps. V29's progress note from July 11 detailed R1's surgical history, including the bypass surgery and arterial bleeding complication that caused the hip bruising.
This critical medical information had been available all along but never made it into the facility's records.
The documentation failures created a cascade of problems. Without proper records of R1's surgical incisions, nursing staff couldn't track healing progress or watch for signs of infection. The undocumented bruising meant no one was monitoring for potential internal bleeding or other complications from the arterial hematoma.
Federal regulations require nursing homes to maintain complete and accurate medical records that follow accepted professional standards. The facility's own job description for medical records staff, dating to May 2013, specifically requires "tracking and monitoring physician visits/notes" and "reporting discrepancies to the Director of Nursing."
None of this happened for R1.
The patient had undergone major heart surgery just five weeks before admission. Coronary artery bypass grafting involves harvesting blood vessels from other parts of the body — in R1's case, from the left thigh — to create new pathways around blocked coronary arteries. The procedure typically requires careful monitoring of multiple surgical sites.
R1's case illustrates how documentation failures can compromise patient safety even when the underlying care may be adequate. V10 told inspectors the surgical incisions were healing properly and required no active treatment. But without proper records, other staff members couldn't verify this assessment or continue appropriate monitoring.
The arterial hematoma that caused R1's bruising represents a particularly serious complication. These bleeding episodes can expand over time, potentially cutting off blood flow to surrounding tissues or indicating ongoing vascular problems that require immediate attention.
State inspectors found the documentation gaps affected one of four residents they reviewed for injury-related care. The violation received a "minimal harm" rating, suggesting inspectors believed the missing records didn't directly injure R1.
But the case raises questions about what other critical information might be missing from patient files at Hawthorne Inn, and whether documentation problems could mask more serious care deficiencies that inspectors haven't yet discovered.
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: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
HAWTHORNE INN OF DANVILLE in DANVILLE, IL was cited for violations during a health inspection on August 13, 2025.
The patient, identified as R1 in state inspection records, arrived at the facility on July 10 following coronary artery bypass surgery.
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.