Evercare Of Calhoun
Evercare of Calhoun in HARDIN, IL — inspection on October 16, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
was the one working with (R2) the night she fell. (V3) left (R2) on the toilet and (R2) got up on her own and fell with no one around her. On 10/15/25 at 4:00 PM, V3, CNA, stated It all began when (R2) requested to use the restroom, and her roommate was already in their restroom, so I took her across the hall to use a different one. I assisted (R2) to the toilet and then heard an alarm going off in another room so I asked (R2) if she could use the call light when she is finished, and she said yes. I even asked R2 again, what do you do when you are done and she said she would use the call light, so I felt like she understood so I left her to check on the other alarm.
After I checked one alarm, I heard another one going off, so I checked on that one too.
Both of those residents were fine, so I stopped to talk to the nurse about those residents when we heard (R2) fall on the floor.
When we got there, (R2) was on the floor by the toilet, and it looked like she was trying to walk towards the restroom door and collapsed to the floor.
When asked what R2's transfer status was, V3 stated I believe she was a one-person assist with a gait belt. I was never told not to leave her alone until after the fall, now everyone is telling me that she should never be left alone. I was never taught in school when or when not to leave someone by themselves and that I didn't know (R2) well enough to know.
On 10/15/25 at 11:48 AM, V5, CNA, stated I worked all the time with (R2) and she was a feisty one, especially when trying to redirect her to call for help. I would always stay with (R2) while in the restroom and she would even get mad at me for staying with her. (R2) always had an alarm on either in her bed or wheelchair.On 10/15/25 at 3:20 PM, V6, CNA, stated (R2) is typically an assist of one with a gait belt.
Sometimes she would walk with staff using a gait belt, and sometimes she would complain of her legs hurting and refuse to walk and would have to use her wheelchair.
Staff should never leave her on the toilet or anywhere else by herself because she would get up on her own.
She always had an alarm on her wheelchair and on the bed and would typically hang out by the nurse's desk talking to everyone. On 10/15/25 at 3:25 PM, V7, RN, stated (R2) was always very quick and the minute you turned your back on her, she was up.
You always had to keep your eye on her and know where she is and what she is doing.On 10/15/25 at 3:45 PM, V2, DON, stated I would expect the staff to follow resident fall precautions and interventions to keep them safe. I would expect the staff to monitor any resident who is a High Fall Risk and stay with them while using the restroom to prevent them from getting up on their own and falling.On 10/15/25 at 3:47 PM, V1, Administrator, stated I would expect all staff to keep residents safe at all times and to monitor those residents who are a high fall risk.On 10/16/25 at 9:46 AM, V1 stated That is the only policy we have for fall precautions or Resident safety.The Facility's Interdisciplinary Fall Reduction / Injury Prevention Protocol, dated 1/2025, documents in part Intent: An interdisciplinary approach at reducing falls, preventing injury and increasing safety awareness ultimately resulting in improved quality of care for our residents.
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