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Complaint Investigation

Arcadia Care Bloomington

Inspection Date: October 15, 2025
Total Violations 2
Facility ID 145371
Location BLOOMINGTON, IL
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Inspection Findings

F-Tag F0584

Resident Rights Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review the facility failed to ensure linens and windowsills were clean and free from cobwebs and dirt for one of four residents (Resident R5) reviewed for housekeeping on the sample list of six. Findings Include: Resident R5's Quarterly Minimum Data Set assessment dated [DATE REDACTED] documents Resident R5 was admitted to the facility on [DATE REDACTED] with diagnoses of Chronic Obstructive Pulmonary Disease with (Acute) Exacerbation and Essential (Primary) Hypertension. This assessment documents Resident R5 as cognitively intact.

On 10/14/25 at 10:30 AM, dusty hanging cobwebs holding insects were accumulated all along the windowsill next to Resident R5's bed. Resident R5 was lying in bed watching television. Particles of dirt were on the top of the linens on Resident R5's bed.

On 10/14/2025 at 1:54 PM, V11 Housekeeping Supervisor walked into Resident R5's room. V11confirmed the presence of the dusty hanging cobwebs holding insects that had accumulated all along the windowsill next to Resident R5's bed. V11 stated Resident R5's room needed to be cleaned better, and the staff needed to ensure all areas are cleaned.

On 10/15/25 at 1:30 PM, V1 Administrator stated that the housekeepers are to clean the residents' rooms daily. V1 stated the cleanliness of the facility has been an issue. V1 then provided a form titled, Environmental Cleaning Procedure and stated that the facility utilizes these guidelines in regard to cleaning procedures.

The facility's Undated Environmental Cleaning Procedures documents resident rooms will be visually inspected and cleaned daily ensuring resident linens and window areas are clean.

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:

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

10/15/2025

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)

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F-Tag F0689

Quality of Life and Care Deficiencies
Harm Level: Actual Harm

Federal health inspectors cited ARCADIA CARE BLOOMINGTON in BLOOMINGTON, IL for a deficiency under regulatory tag F-F0689 during a complaint investigation conducted on 2025-10-15.

Category: Quality of Life and Care Deficiencies

The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Scope/Severity Level G: isolated, actual harm that is not immediate jeopardy.

Actual harm to residents was documented as a result of this deficiency.

This was one of 2 deficiencies cited during this inspection of ARCADIA CARE BLOOMINGTON.

Correction Status: Deficient, Provider has plan of correction.

The facility reported correction as of 2025-11-14.

📋 Inspection Summary

ARCADIA CARE BLOOMINGTON in BLOOMINGTON, 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 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.
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