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Complaint Investigation

Helia Southbelt Healthcare

Inspection Date: September 12, 2025
Total Violations 1
Facility ID 145241
Location BELLEVILLE, IL
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Inspection Findings

F-Tag F0600

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

interview and record review, the facility failed to prevent resident to resident abuse in 1 of 3 residents (Resident R9) reviewed for abuse in a sample of 3.Findings Include:Resident R9's Face Sheet, undated, documents Resident R9 was admitted to the facility on [DATE REDACTED] and has a medical diagnosis of Psychoactive Substance Abuse, Blindness Right Eye Category 3, Blindness Left Eye Category 3, and Hallucinations.Resident R9's Minimum Data Set (MDS) dated [DATE REDACTED] documents Resident R9 is moderately cognitively impaired and has displayed verbal behaviors directed towards others. Resident R9's Care Plan Resident R9's Care Plan Last Reviewed/ Revised 8/18/2025 documents resident is considered at risk for abuse/neglect. Resident R9's Progress Note dated 9/8/2025 at 6:05 PM documents This resident had an altercation with another resident related to resident hitting him in the groin.

Then resident started slapping other resident in the face. No injury noted Admin and Director of Nursing (DON) made aware and police was call. Stated to keep everyone separated.The Facility's Initial Serious Injury Incident and Communicable Disease Report dated 9/8/2025 documents the following: Resident to Resident Immediately separated. Administrator notified. Final to follow.On 9/11/2025 at 1:50 PM V1, Administrator, stated he got a call Monday 9/8/2025 evening that there was an incident with Resident R9 and Resident R10. V1 stated Resident R9 was outside of the facility with another resident when an argument occurred and Resident R9 made contact with Resident R10. V1 stated nursing staff separated the residents and both were assessed. On 9/11/2025 at 1:55 PM V7, Licensed Practical Nurse (LPN) stated V22, Certified Nursing Assistant (CNA) came to her and stated that she saw Resident R9 hit Resident R10 and herself and V22 went outside of the facility to separate the residents and assess each resident. On 9/11/2025 at 2:05 PM V25, LPN, stated she was informed by nursing staff that Resident R9 had hit Resident R10. V25 stated she went outside of the facility with V7 to access Resident R9 and Resident R10.On 9/11/2025 at 2:24 PM Resident R9 stated he was outside with Resident R8 when Resident R10 started arguing with them. Resident R9 stated Resident R10 hit him in his private area and Resident R9 smacked Resident R10 back.On 9/11/2025 at 3:16 PM V22, CNA, stated she was in a resident room passing a food tray when she saw Resident R9 smack Resident R10 through the room window. V22 stated she told V7 what she has seen, and they went outside along with V25 to separate the residents. The Facility's Abuse Prevention Policy, Revision Date 9/29/2022, documents This facility desires to prevent abuse, neglect, or misappropriation of property by establishing a resident sensitive and resident secure environment.

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

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

HELIA SOUTHBELT HEALTHCARE in BELLEVILLE, IL inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in BELLEVILLE, IL, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from HELIA SOUTHBELT HEALTHCARE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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