Sharon Health Care Elms: Infection Control Failure - IL
The resident, identified in inspection records as R66, had been placed on Enhanced Barrier Precautions since August. Those precautions require staff to gown and glove before providing care, a step a licensed practical nurse did follow during a visit on September 17. What the facility failed to do was something more fundamental: order the correct level of isolation after a lab result came back positive for VRE, vancomycin-resistant enterococcus, a bacteria that does not respond to one of the most powerful antibiotics in medicine.
The culture that confirmed VRE was dated September 7. The Director of Nursing reviewed it with inspectors on September 17, ten days later.
VRE spreads through direct contact. It can colonize surfaces and skin for extended periods. In a long-term care setting, where residents share staff, shared equipment, and sometimes shared spaces, the gap between a positive result and a documented isolation order is not a paperwork problem. It is the interval during which infection control depends entirely on whether every person entering that room happens to know what the chart has not been updated to say.
The Director of Nursing, identified as V2, told inspectors on the afternoon of September 17 that she had gone ahead and placed R66 on contact isolation. Her explanation: "I went ahead and placed R66 on contact isolation even though it is only two more days."
Two more days until what, the inspection report does not say. What it does say is that the following morning, when inspectors returned and asked V2 whether a physician's order for contact isolation existed in the electronic health record, she confirmed there was not one.
That confirmation came on September 18 at 9:15 in the morning.
V2 had told inspectors the previous afternoon that a physician's order is placed in the electronic health record whenever a resident is moved to contact isolation. She said that herself. Then she confirmed, less than twenty-four hours later, that no such order existed for R66.
The licensed practical nurse who cared for R66 on September 17 had followed the Enhanced Barrier Precautions that were documented, gowning up partway through the visit after first performing hand hygiene and flushing the feeding tube with gloves on. Enhanced Barrier Precautions and contact isolation are not the same thing. Contact isolation is the higher standard triggered by a confirmed communicable pathogen like VRE. It requires a physician's order, a documented care plan, and specific protocols that go beyond what Enhanced Barrier Precautions alone require.
R66's diagnoses, multiple sclerosis, gastrostomy, heart failure, and endocarditis, describe a resident with significant medical complexity. A gastrostomy means a feeding tube directly into the stomach, a route that bypasses the body's normal defenses and creates a potential pathway for infection. Endocarditis is an infection of the heart's inner lining, a condition that requires careful infection management on its own. This is not a resident for whom a missing isolation order was a minor administrative gap.
Inspectors cited the deficiency under F0880, the federal tag covering infection prevention and control. The level of harm was assessed as minimal harm or potential for actual harm, and the finding affected a few residents.
The facility's plan of correction was not included in the inspection report provided.
Sharon Health Care Elms sits on North Rochelle Lane in Peoria. The inspection was completed November 18, 2025, following a complaint.
R66 had a positive VRE culture for at least ten days before inspectors arrived. The Director of Nursing knew about it. She said she had acted on it. The physician's order that her own account required was not there.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Sharon Health Care Elms from 2025-11-18 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.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 30, 2026 · Our methodology
SHARON HEALTH CARE ELMS in PEORIA, IL was cited for violations during a health inspection on November 18, 2025.
The resident, identified in inspection records as R66, had been placed on Enhanced Barrier Precautions since August.
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.