Arcadia Care Bloomington
Inspection Findings
F-Tag F0584
F 0584
big box store.
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
08/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street Bloomington, IL 61701
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0921
F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
Based on observation, Interview, and record review the facility failed to maintain a safe, sanitary, comfortable environment by providing inadequate supplies of toilet paper for residents and failing to maintain communal shower floors in a safe sanitary manner. This failure has the potential to affect all 92 residents who reside in the facility.Findings Include:The facility's daily census dated 8/19/25 documents 92 residents reside at the facility.On 8/19/25 at 11:28AM, Resident R2 stated They have been out of toilet paper more than once. I keep some extra, so I have some. Resident R2 had two rolls of toilet paper in his drawer. On 8/19/25 at 11:15AM, Resident R1 stated for several days last week I had to have family members bring me some (toilet paper) or I would have been without toilet paper. On 8/19/25 at 11:35AM, Resident R3 stated we ran out of toilet paper last week. We had to use whatever we could like napkins and tissues. We went days like that. It just made me feel disrespected and ignored. On 8/20/25 at 12:30PM, V5 (CNA) Certified Nurse's Aide and V6 CNA verified there was a shortage of toilet paper a couple of days last week. The facility sent someone out and bought some. On 8/20/25 at 11:45 AM, V1 Administrator stated, I became aware we were out of toilet paper
on the floor last week and I went to (a local big box store) and purchased some toilet paper. The facility provided a receipt dated 8/8/25 from a local big box store to support the facility purchased a supply of toilet paper to rectify the shortage.On 8/19/25 at 11:40AM, The main shower room on 100 hall was observed to have several missing ceramic tiles in the shower. Several other tiles were cracked and loose creating an uneven, unstable surface where the shower chair is placed when giving a dependent resident a shower. On 8/19/25 at 2:58PM, V1 Administrator stated, I am aware of the broken tiles in the big shower, and I have a contractor coming to fix that.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
08/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arcadia Care Bloomington
1509 North Calhoun Street Bloomington, IL 61701
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0925
F 0925
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Level of Harm - Minimal harm or potential for actual harm
Based on observation, Interview, and record review the facility failed to provide adequate pest control when ants were observed for one (Resident R1) of three reviewed for pest control on the total sample of five. Findings include:The facility census report dated 8/19/25 documents 92 residents reside at the facility.Resident R1's current diagnosis list includes the following diagnoses: Chronic Neuropathy, Anxiety, and Major Depression.MDS (Minimum Data Set) dated 6/30/25 documents Resident R1 is cognitively intact.On 8/19/25 at 11:15 AM, Resident R1 was in her bed watching TV. The windowsill was covered in dust, dead spiders, and ants. Resident R1 stated there are ants
in here all the time they crawl on the walls and the window.Resident R2's current diagnosis list includes the following diagnosis: Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Diabetes, Anxiety, and Depression.Resident R2's MDS (Minimum Data Set) dated 7/19/25 documents Resident R2 is cognitively intact.On 8/19/25 at 11:28 AM, Resident R2 was sitting up in his room in a wheelchair. The windowsills in Resident R2's room were covered with dust and dead insects. Resident R2 stated there are ants in here all the time. They just crawl all over the wall by the window. I take my meals in here and I've had ants get in my food. On 8/20/25 at 11:30 AM, V6 and V5 Certified Nursing Assistants (CNAs) stated there are ants in the rooms and V5 stated I have even seen them on residents which is bad for residents who can't brush them off.On 8/20/25, V1 Administrator verified
she was aware there had been a problem with ants and she was planning to call the exterminator (the facility) has a contract with.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
ARCADIA CARE BLOOMINGTON in BLOOMINGTON, IL inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 BLOOMINGTON, 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 ARCADIA CARE BLOOMINGTON or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.