Skip to main content

Clark-Lindsey Village: Abuse and Neglect Violations - IL

Healthcare Facility
Clark-lindsey Village
Urbana, IL  ·  2/5 stars

The aide's own account, recorded by inspectors, was direct about the reason. She didn't want feces on her shoe.

The resident, identified in the report as R7, was left in her room after the incident. A second aide, identified as V11, was also present. Both left together. A third staff member, identified as V16 and described as R7's power of attorney, was also in the room and kept yelling at the two aides. The aides said they were done with V16. One of them said that V16 could finish getting R7 cleaned up.

Advertisement
Advertisement

CMS rated the violation at the level of actual harm, affecting a few residents. The citation was filed under F0600, the federal tag covering abuse, neglect, and exploitation.

What the camera showed was worse than the account alone.

R7's power of attorney had installed a camera in the room. On October 14, 2025, at 4:00 PM, V16 turned over the footage to inspectors. The recording showed that at 6:01 AM, an unidentified nursing aide had provided perineal care for R7. At 8:00 AM, a speech therapist came in and conducted a therapy session while R7 lay in her bed. After that, nothing. No staff entered R7's room from 8:00 AM until 3:10 PM, when a CNA identified as V9 finally answered R7's call light.

Inspectors conducting direct observations confirmed what the camera showed. From 10:30 AM to 3:10 PM, no staff entered R7's room.

That is more than four and a half hours.

The inspection report does not describe R7's diagnosis, mobility level, or what she needed during those hours. It does not say whether she had eaten, whether she needed medication, or whether she called out during that time. What it records is that she had been crying and screaming when the aides left, and that no one came back for the better part of a working day.

The account from the aides themselves, as recorded by inspectors, describes the sequence with a kind of flat matter-of-factness that makes it harder to read, not easier. R7 was having a bowel movement. One of the aides, V10, let her finish into the trash can so it wouldn't get on her shoe. When R7 was done, V10 and V11 transferred her back to her bed and left the room. R7 kept crying and screaming. V16 kept yelling at them. The aides said they had had enough of it, and they left.

The report does not describe what R7 said, or whether she could speak clearly, or what she understood about what was happening to her. It records that she was crying and screaming when the aides walked out.

Clark-Lindsey Village is located at 101 West Windsor Road in Urbana. The inspection was a complaint investigation, meaning someone had contacted regulators before inspectors arrived. The report does not identify who filed the complaint, though the timeline suggests V16, who was present during the incident and turned over camera footage the same day inspectors were on site, had been in contact with the facility or regulators.

The facility's own abuse prevention policy, dated February 20, 2025, states that all residents have the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, neglect, misappropriation of resident property, and exploitation. The policy defines neglect as the failure to provide goods and services necessary to avoid physical harm, mental anguish, mental illness, or deterioration of a resident's physical or mental condition. It states that mental abuse includes humiliation and harassment.

The policy was eight months old when the incident occurred.

The inspection report does not describe any immediate investigation by facility management after the incident, any disciplinary action taken against V10 or V11, or any response to R7 during the hours her room went unvisited. It does not say whether anyone checked on her between 8:00 AM and 3:10 PM by any means other than physically entering the room. It does not say what condition she was in when V9 finally answered her call light at 3:10 PM.

What it says is that a woman was left crying and screaming in her bed, that the staff members responsible said they were done, and that for the next several hours, the camera recorded an empty doorway.

The report covers a single deficiency tag, F0600, at the actual harm level. It does not describe additional violations, additional residents, or a pattern of prior citations from this inspection. The statement of deficiencies runs to twelve pages total; this article is drawn from the narrative portion made available.

For information on the facility's plan to correct the deficiency, CMS directs readers to contact Clark-Lindsey Village or the Illinois state survey agency directly.

R7 was still in that room when inspectors arrived. The report does not say what she told them, or whether she was able to.

Full Inspection Report

The details above represent a summary of key findings. View the complete inspection report for Clark-lindsey Village from 2025-10-15 including all violations, facility responses, and corrective action plans.

Additional Resources


Editorial Standards

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 25, 2026  ·  Our methodology

Quick Answer

CLARK-LINDSEY VILLAGE in URBANA, IL was cited for abuse-related violations during a health inspection on October 15, 2025.

The aide's own account, recorded by inspectors, was direct about the reason.

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.

Frequently Asked Questions

What happened at CLARK-LINDSEY VILLAGE?
The aide's own account, recorded by inspectors, was direct about the reason.
How serious are these violations?
These are very serious violations that may indicate significant patient safety concerns. Federal regulations require nursing homes to maintain the highest standards of care. Families should review the full inspection report and consider whether this facility meets their safety expectations.
What should families do?
Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in URBANA, IL, (5) Report any new concerns directly to state authorities.
Where can I see the full inspection report?
The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from CLARK-LINDSEY VILLAGE or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 145381.
Has this facility had violations before?
To check CLARK-LINDSEY VILLAGE's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.


Advertisement