Centralia Manor
Inspection Findings
F-Tag F0550
F 0550 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
for other resident in the same room such as Resident R1 for Resident R4. V8 said that Resident R4 did have a horn, but she was trying to use it the wrong way and kept trying to honk the horn, but it wasn't' making any noise so she ended up with bells. V8 said it is harder to hear some of the resident who are on the end of the halls. On 09/23/25 at 10:05AM, V4 (Licensed Practical Nurse/LPN) stated that the facility call light system on 300, 400, and 500 hallways went out around the end of August. V4 stated they gave the resident whistles, bells, and horns to be able to ring and notify staff that they need them. V4 said she thinks that staff can hear the whistles, bells, and horns but it is challenging trying to figure out where the sound is coming from. V4 said she does think it takes the staff long to be able to answer when the resident is ringing, whistling, or honking because they must figure out who it is. V4 stated that she does know there have been a couple of residents that complained that they had an incontinent episode, but she didn't know if it was because of the bells, whistles, or horns and staff not being able to find out who it was or if it is because they have a lot of resident to care for. V7 said that she thinks a lot of the residents wait till the last minute and then try to get staff to help them and staff might be in another room taking care of another residents. On 09/23/25 at 11:40AM, V1 (Administrator) stated that the call light system on 300, 400, and 500 hallways went out on 08/29/25. V1 stated she called someone right away to see what was wrong with the call light system on those halls, but the soonest someone could come look at it was on 09/03/25. V1 said they did come in and look at the call light system and they told her that the system has just out lived its life and that they need to replace the system on those halls. V1 said that when the system went down on 08/29/25 that they did get
an alternative call system of whistles, horns, and bells for the residents, so they had a way to communicate when they need help from staff. V1 said that they did try different things with the residents to make sure that
they could use the device they gave each resident. V1 said she is not aware of any resident that can't use
the device they have been given. V1 said staff has told her that they do have a hard time hearing the devices if the resident has their doors closed or if the resident is at the end of the hall. V1 said she did have
a resident complain to her since the call light system was down it was taking a long time for staff to respond to her device. V1 said that on 09/05/25 they gave them an estimate on the new call light system for 300, 400, and 500 hallways. V1 said on 09/08/25 they ordered the new system and then on 09/16/25 they sent in payment for the new call light system. V1 said the company who is installing the new call light system said it could take 2-3 weeks before they could install the new call light system. On 09/23/25 at 12:33PM, V2 (Director of Nursing/DON) stated that they did have a problem with the call light system on 300, 400, and 500 halls it went out around the end of August. V2 said they gave the residents an alternative method to be able to call for help like whistles, horns, and bells. V2 said the shift coordinators also said something about doing 15-minute checks on those residents as well. V2 stated that she didn't know how they were tracking it
the 15-minute checks. V2 stated that they don't have any documentation stating that the 15-minute checks were done on those residents. V2 said she has heard resident complain that staff has been in places where
it was hard for them to hear the whistle, bells, and horns and that they tell the residents to keep whistling, honking, or jingling the bells until they figure out who it was the was making the sound with their device. On 09/24/25 at 11:00AM, V1 stated that the facility does not have a policy on dignity. The facility policy titled Call Light with a revised date of 01/04 documents under objective: To respond to resident's request and needs. Equipment documents: Functioning call light.
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
09/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Centralia Manor
1910 East McCord Rte 161 East Centralia, IL 62801
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 F0919
F 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
from staff. V1 said that they did try different things with the residents to make sure that they could use the device they gave each resident. V1 said she is not aware of any resident that can't use the device they have been given. V1 said staff has told her that they do have a hard time hearing the devices if the resident has their doors closed or if the resident is at the end of the hall. V1 said she did have a resident complain to her since the call light system was down it was taking a long time for staff to respond to her device. V1 said that
on 09/05/25 they gave them an estimate on the new call light system for 300, 400, and 500 hallways. V1 said on 09/08/25 they ordered the new system and then on 09/16/25 they sent in payment for the new call light system. V1 said the company who is installing the new call light system said it could take 2-3 weeks
before they could install the new call light system. On 09/23/25 at 12:33PM, V2 (Director of Nursing/DON) stated that they did have a problem with the call light system on 300, 400, and 500 halls it went out around
the end of August. V2 said they gave the residents an alternative method to be able to call for help like whistles, horns, and bells. V2 said the shift coordinators also said something about doing 15-minute checks
on those residents as well. V2 stated that she didn't know how they were tracking it the 15-minute checks.
V2 stated that they don't have any documentation stating that the 15-minute checks were done on those residents. V2 said she has heard resident complain that staff has been in places where it was hard for them to hear the whistle, bells, and horns and that they tell the residents to keep whistling, honking, or jingling
the bells until they figure out who it was the was making the sound with their device.The facility resident bed list report dated 09/22/25 documents 13 residents reside on 300 hall, 16 residents reside on 400 hall, and 3 residents reside on 500 hall. The facility policy titled Call Light with a revised date of 01/04 documents under objective: To respond to resident's request and needs. Equipment documents: Functioning call light.
Event ID:
Facility ID:
If continuation sheet
CENTRALIA MANOR in CENTRALIA, 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 CENTRALIA, 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 CENTRALIA MANOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.