The Haven On The River
Inspection Findings
F-Tag F0755
F 0755 Level of Harm - Minimal harm or potential for actual harm
Medications will be administered safely to residents within the facility by licensed nurses at the specified time/timeframe.The facility's Daily Census sheet, dated 8/13/25, documents there are 49 residents residing
in the facility.
Residents Affected - Many
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
08/19/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
The Haven on the River
320 South 2nd Street Grayville, IL 62844
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 F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Based on interview and record review, the facility failed to provide medical records requested to aide in the survey process for 2 of 2 residents (Resident R3 and Resident R4) reviewed for medication administration in a sample of 19.Findings includeOn 8/14/25, this surveyor reviewed the July 2025 Medication Administration Records (MAR's) for Resident R3 and Resident R4 in their Electronic Health Records. The MAR's for Resident R3 and Resident R4 did not document the actual time the medication was administered.On 8/14/25 at 3:30 PM, this surveyor requested Resident R3 and Resident R4's July 2025 MAR's with documented and timestamped medication administration times from V2, Director of Nurses (DON).On 8/18/25 at 8:00 AM, V2, DON, stated he had been instructed by V24, Chief Operating Officer, not to provide the copies of Resident R3 and Resident R4's MAR's with documentation of the times the medications were administered or allow this surveyor to visualize them in the Electronic Health Record.On 8/18/25 at 3:20 PM, V2, DON, he stated he was instructed by V24 not to turn the time stamped MAR's Resident R3 and Resident R4 over to this surveyor because the facility had started an internal Quality Assurance investigation, and those documents were now considered confidential. V2 stated the internal investigation was started approximately 2-3 weeks ago. V2 stated the internal investigation was started when Resident R3 and Resident R4 had brought
it to administration's attention that medications were being administered past the ordered time ranges.
Event ID:
Facility ID:
If continuation sheet
The Haven on the River in GRAYVILLE, 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 GRAYVILLE, 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 The Haven on the River or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.