Integrity Hc Of Carbondale

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

V6 stated he plans to have the plumbing company look at it when they come to address the plumbing issues in the kitchen. On 9/25/25 at 12:09 PM, V20 (CNA) stated when she started working at this facility, which was in the beginning of August of 2025, Resident R40 already had a bedside commode in her room. V20 stated Resident R40 would get confused because she couldn't use the bathroom in her room and would urinate in

the floor. V20 stated Resident R40 urinated in the corner of her room one time and Resident R40 used her wig to mop it up.

V20 stated Resident R40's bathroom was locked due to not functioning properly from the time she started working at

this facility until Resident R40 was moved to a different room. V20 stated since Resident R40 was moved to a different room with a working bathroom she uses the bathroom in her room without any issues and has not urinated or defecated in the floor. On 9/25/25 at 12:13 PM, V26 (CNA) stated Resident R40 was admitted to the room with the nonfunctioning toilet when she first came to the facility. V26 stated Resident R40 had a bedside commode in her room because the bathroom in her room was not functioning properly, and the door was padlocked so Resident R40 could not get into it. V26 said Resident R40's room was connected to the room next door via a shared bathroom. V26 stated the bathroom door on Resident R40's side was locked so she could not enter it from there, but it was not locked on the adjoining side so it could be entered from that room. V26 stated at one point, Resident R40 got confused trying to find a bathroom so she went to the room next to hers that shared the adjoining bathroom, went into the bathroom and defecated and urinated onto a plastic cover that was covering the toilet due to it not being operational. V26 stated Resident R40 also defecated in her closet at one point. V26 stated since Resident R40 has been moved to the North Hall with a properly functioning bathroom, Resident R40 is using her bathroom properly and has not urinated or defecated on the floor or in a closet. Resident R40's Progress Note dated 8/12/25 at 7:42 PM documented under Required Daily Note: Resident (Resident R40) compliant with meds today. Up ambulating and redirected back to her w/c (wheelchair). Memory deficit keeps her from complying at time.

Incontinent of stool and deficated [sic] in her closet this afternoon. Area cleaned. Appetite remains poor and fluid intake is encouraged. POC (Plan of Care) continues. Resident R40's Progress Note dated 8/31/25 at 6:15 PM documented under Required Daily Note: Resident up ambulating independently and redirected numerous times to her w/c . Vision is poor and is unable to determine distance and objects until they are up close.

Appetite is good today. Fluids encouraged. Assisted to the bathroom as she gets lost finding it and unable to see where she is going. No s/sx (signs or symptoms) of pain or discomfort. She has been continent of B&B (Bowel and Bladder) today. No signs of distress noted. Assisted with all adls (activities of daily living).

POC (Plan of Care) continues. Resident R40's Progress Note dated 9/12/25 at 12:55 PM documented under Required Daily Note: Resident is alert and confused. Redirected multiple times today from other residents rooms. Noted resident pilfering through others belongings. Redirected back to her room for snacks. Was incontinent of urine x 1 on the floor. Poor eyesight and needs assist with toileting as she does not always see the toilet. No signs of pain. BG (Blood Glucose) readings wnl (within normal limits). Staff continues to redirect as needed. Staff assist with all adls (activities of daily living). POC (Plan of Care) continues. On 9/22/25 at 10:00 AM, V1 (Former Administrator) stated she wasn't aware of Resident R40 urinating in the floor and not being able to find the bathroom in the hallway. V1 stated Resident R40 should have probably been moved to a room with a properly functioning bathroom. V1 stated there were other open rooms that had a properly functioning toilet that she could have been moved to.

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

10/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Carbondale

120 North Tower Road Carbondale, IL 62901

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 0627 Level of Harm - Actual harm Residents Affected - Some

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

get a 30-day notice or anything in writing. Resident R25 stated they packed my bags and away we went. Resident R25 said

they told her it was because the building needed work, but no one told her it was an emergency. Resident R25 said

she doesn't remember having any kind of meeting for discharge planning. 8. Resident R24's admission Record documented admission to the facility on 2/23/22 and included diagnoses of generalized anxiety disorder and unspecified intellectual disabilities. This admission Record also lists V30 (Family Member) as Resident R24's guardian/responsible party. Resident R24's MDS dated [DATE REDACTED] documented a BIMS score of 2, indicating severe cognitive impairment. Resident R24's Care Plan includes a Focus area of Resident R24 doesn't have plans for discharge and will reside at the facility for long term care, with an intervention documenting as necessary, meet with the resident/representative on a regular basis to discuss discharge plans. Provide the resident with an opportunity to express any thoughts or feelings. Address concerns as they arise. This focus area and intervention were initiated on 3/18/25 with no updates or revisions to indicate the interdisciplinary team did any planning for transfer or discharge to another facility. Another Focus area initiated on 3/9/22 documents Resident R24 has impaired cognitive function and impaired thought processes r/t (related to) dx (diagnosis) MR (mental retardation) with interventions of discuss concerns about confusion, disease process, NH placement with the resident/family/caregivers, Resident R24 needs assistance with all decision making, and keep his routine consistent to try and provide consistent caregivers as much as possible in order to decrease confusion. Resident R24's Progress Notes include an entry on Sunday 9/14/25 at 9:00AM authored by V31 (MDS/Care Plan Coordinator) documenting spoke with POA (V30) and discussed the need to move residents to another facility temporarily in order to complete the needed extensive sewer repairs within the facility. Choices of available facilities

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

10/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Carbondale

120 North Tower Road Carbondale, IL 62901

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 0628 Level of Harm - Minimal harm or potential for actual harm

can't remember the exact day, but thinks V1 told staff that the residents needed to transfer out of the facility due to repairs during a morning meeting maybe a few days to a week before she started making calls to families. V3 said that making the calls was more of the last thing they did before transferring residents out.

Residents Affected - Some

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

10/09/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Carbondale

120 North Tower Road Carbondale, IL 62901

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 0689 Level of Harm - Actual harm Residents Affected - Few

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

measures will be put into place or what systemic changes will you make to ensure that the deficient practice does not recur: Facility nurse immediately educated staff on duty to ensure fall interventions are in place for Resident R42, including fall mats and bed in lowest position. Facility immediately conducted a fall investigation with risk management and Resident R42's care plan was updated. Inservice documentation noted staff education was completed on 9/1/25. 4. How will you monitor the corrective actions to ensure the deficient practice will not recur i.e., what quality assurance program will be put into place: Administrator, Director of Nursing, and or designees will do random observations of fall interventions in place a minimum of 5 times per week for 4 weeks. Results of the observations will be discussed in the Quarterly Quality Assurance meeting times 2 with educational needs discussed as needed by the Facility Administrator/Director of Nursing or designee.

Event ID:

Facility ID:

If continuation sheet