The Haven Of Arcola
THE HAVEN OF ARCOLA in ARCOLA, IL — inspection on August 10, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to ensure resident dignity for three of three residents (R4, R5, R6) reviewed for dignity in a sample list of seven residents.R4's Minimum Data Set (MDS) dated [DATE] documents R4 as cognitively intact.
This same MDS documents R4 requires supervision with eating, oral hygiene, toileting, bathing, dressing, personal hygiene and bed mobility. R4's Care plan documents medical diagnoses as Thoracic Scoliosis, Depression, Neuropathy, Thrombophlebitis of Lower Extremities, Unsteady on Feet, Muscle Wasting and Atrophy and Major Depressive disorder.
This same care plan initiated 11/8/24 does not document a focus area, goal nor interventions for R4's behaviors of consensual sexual behavior with male peers prior to 7/29/25.
This same care plan documents R4 requires a wheelchair for mobility. R5's Minimum Data Set (MDS) dated [DATE] documents R5 as cognitively intact. R6's Minimum Data Set (MDS) dated [DATE] documents R6 as cognitively intact. R4 and R5's shared Final Report to the State Agency dated 8/1/25 documents R4 stated R5 started rubbing her upper leg then moved up to touch her perineal area while she was sitting in the day room.
This same report documents R4 moved away from R5 and that R5 did not actually touch R4's perineal area. R4's written statement dated 7/29/25 documents (R4) was sitting next to the ping pong table. (R5) got up off the couch and came towards me. (R5) was standing and bent down and started rubbing my leg. (R5) started at the knee moving up towards my (points to vagina). I backed away from (R5) and went to my room. I don't know what (R5) was thinking. On 8/9/25 at 12:10 PM V7 Licensed Practical Nurse (LPN) stated R5 touched R4 inappropriately in the hall next to the dayroom on the South unit on 7/29/25. V7 LPN stated R5 walked up to R4 who requires a wheelchair and touched R4's upper thigh and then moved his hand farther towards R4's genital area then R4 wheeled herself back away from R5. V7 LPN stated R4 told V7 that ‘(R5) touched my leg and tried to reach my vagina. I didn't like that.' V7 LPN stated R5 was sent to the emergency room for evaluation due to his behaviors. On 8/9/25 at 2:55 PM R6 stated R4 was sitting in the resident lounge in her wheelchair when R5 got up off of the couch (in the same room) and walked over to R4. R6 stated R5 put his hand on the inside of R4's lower thigh/knee area and squeezed lightly and then left his hand there for a few minutes. R6 stated R5 then moved his hand ‘clear up there' (R6 motioned to his perineal area). R6 stated he couldn't believe what he was seeing. R6 stated he was in shock. R6 stated he saw R4 move her wheelchair back away from R5. R6 stated he did not think R5 made contact with R4's perineal area but that ‘it wasn't for lack of trying.' On 8/10/25 at 10:00 AM V1 Administrator stated R4 and R5 both reside on a locked psychiatric unit. V1 Administrator stated both R4 and R5 are cognitively intact yet unable to make decisions for themselves and require constant supervision. V1 Administrator stated she thinks this incident is more of a resident rights issue than abuse due to R5 did not make contact with R4's perineal area.
The facility policy titled Resident Rights Guideline revised October 2023 documents residents have the right to be treated with dignity and respect.
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
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
08/10/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
The Haven of Arcola
422 East Fourth Street Arcola, IL 61910
SUMMARY STATEMENT OF DEFICIENCIES
on 7/22/25 to identify opportunities for improvement/deficient practice. 2.
Immediate action consisted of: R1 and R2 were immediately separated. R1 was sent to the emergency room for evaluation and returned on continual monitoring (1:1) supervision.
This continual monitoring was in place until R1 could be seen by psychiatry at which time, R1 was placed on 15 minute visual checks which have remained in place. 3.
Actions completed and/or ongoing by 7/25/25: All staff were in serviced on behavioral intervention resources prior to the next shift; All behavioral care plans were reviewed to ensure interventions were in place; All Gradual Dose Reduction (GDR) requests and increases in behaviors within the last three months were reviewed; Behavioral Tracking and GDR audits were scheduled for three times the first week, twice the second week and then weekly for four weeks and were initiated and ongoing and; Resident care plans will be audited weekly for four weeks to ensure timely behavioral interventions are appropriate and effective with behavior tracking in place.
Staff in-service on ‘Different ways to deescalate behaviors and put interventions in place' was completed on 7/25/25.
Care plans and GDRs were reviewed by V1 Administrator, V2 DON and V16 Regional Clinical Nurse.
Behavioral care plans and GDR audits were initiated on 7/22/25 and completed on 7/25/25. 4. V1 Administrator will report the findings to the QAPI meeting quarterly. V1 Administrator stated the facility has not had the next QAPI meeting but thus far there have been no new substantiated instances of abuse since 7/18/25.
Facility ID: