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Complaint Investigation

Tri-state Village Nrsg & Rhb

August 27, 2025 · Lansing, IL · 2500 East 175th Street
Citations 2
CMS Rating 2/5
Beds 84
Provider ID 145879
Healthcare Facility
Tri-state Village Nrsg & Rhb
Lansing, IL  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

TRI-STATE VILLAGE NRSG & RHB in LANSING, IL — inspection on August 27, 2025.

Found 2 citations. 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

FF0689
Quality of Life and Care Deficiencies

when needed.Observe for presence of pain/discomfort (such as verbalization, moaning, groaning,

secured prior to transfer.Provide appropriate foot wear prior to transferKeep call light in reach.Refer

assistance.Instruct in use of assistive device sit to stand lift as needed.Ensure proper transfer technique.Follow PT/OT recommendations r/t transfer type and weight bearing status.Refer to PT/ OT with any change in transfer status.

Care plan dated 8/30/2024 documents: R3 is at risk for falling R/T lower extremity weakness, numbness, and spasticity from multiple sclerosis.Goals: R3 will remain free from injury.Approach(es): Staff education for proper use of liftsOrient [NAME] when there has been new furniture placement or other changes in environment.Assure the floor is free of glare, liquids, foreign objects.Provide proper, well-maintained footwear.Leave night light on in room.Keep bed in lowest position with brakes locked.Keep personal items and frequently used items within reach.Keep call light in reach at all times.Provide R3 with an environment free of clutter.Obtain PT consult for strength training, toning, positioning, transfer training, mobility devices.Provide toileting assistance as needed.Give R3 verbal reminders not to transfer without assistance.

Using a Portable Lifting Machine Policy (Revised August 2008) documents:Purpose: The purpose of this procedure is to help lift residents using a manual lifting devicePreparation: 1.

Review the resident's care plan to assess for any special needs of the resident.General Guidelines: The portable lift should be used by two staff members.

Falls Clinical Protocol Policy undated documents:Assessment and Recognition: 2.

In addition, the nurse shall assess and document/report the following:a.

Vital signsb.

Recent injury, especially fracture or head injuryc.

Musculoskeletal function, observing for change in normal range of motion, weight bearing, etc.d.

Change in condition or level of consciousnesse.

Neurological statusf.

Paing.

Frequency and number of falls since last physician visith.

Precipitating factors, details on how fall occurredi.

All current medications, especially those associated with dizziness or lethargyj.

All active diagnoses5.

The staff will evaluate and document falls that occur while the individual is in the facilty; for example, when and where they happen, any observations of the events, etc.Cause Identification1.

For an individual who has fallen, staff will attempt to define possible causes within 24 hours of the fall.

145879 08/27/2025

Tri-State Village Nrsg & Rhb 2500 East 175th Street Lansing, IL 60438

oral/denture care, dressing, eating, support with needs related to hearing/vision/sensory impairment;

prevention/care; supporting resident independence in doing as much of these activities by

provid the level and types of support and care needed for your resident population.

Include staff certification requirements as applicable.

Potential data resources include hiring, education, training, competency instruction, and testing policies.

Aside from having licensure/certifications as required by law, the facliity has a comprehensive orientation program and annual in-service calendar. As needed, the facility continues to re-educate staff on specific areas of improvement.

Included: Orientation checklist, In-service Calendar, Nurse & CNA Competency.Physical environment and building/plant needs3.8 List physical resources for the following categories.

Review the resources in the example below and modify as needed. If applicable, describe your processes to ensure adequate supplies and to ensure equipment is maintained to protect and promote the health and safety of residents.

Physical equipment Bath benches, shower chairs, bathroom Maintenance Director to keep in safety bars, bathing tubs, sinks for good working conditions.

Residents and for staff, scales, bed scales Accurate Scale for all lifts and Ventilators, wheelchairs and associated scales.

Positioning devices, bariatric beds, Contracted companies for Bariatric wheelchairs, lifts, lift slings, bed all DME's (durable medical Frames, mattresses, room and common equipment that are needed.

Space furniture, exercise equipment, Therapy tables/equipment, walkers, Canes, nightlights, steam table, oxygen Tanks and tubing, dialysis chair and Station, ventilators

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 LANSING, 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 TRI-STATE VILLAGE NRSG & RHB or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.