Integrity Hc Of Marion

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

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

other times.On 8/6/25 at 10:53 AM, V24 (CNA) stated when the call system was down the residents would ring the bells. V24 stated they would take the bells with them when they went to the bathroom. V24 stated

they made sure the residents had their bell with them most of the time. V24 stated Resident R1 required supervision with transfers because she was unsteady at times.On 7/31/25 at 4:20 PM, V1 (Administrator) stated the call system had been down and they gave all of the residents a bell to use. V1 stated the residents should take

the bells with them when they go to the bathroom. When asked how they ensured residents took their bells with them, V1 stated, They have to take them with them.

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

08/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Marion

1301 East Deyoung Marion, IL 62959

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 0697 Level of Harm - Actual harm Residents Affected - Few

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

wasn't sent to the pharmacy until 7/31/25 at 9:30 AM, and then it went into a prior authorization bin, and that may have delayed it. V5 stated he wasn't sure how long it sat in the bin. V5 stated having the pharmacy call him for emergency medication is the safest way to get them. V5 stated he got messages on 7/30/25 at 4:40 PM that she admitted and needed scripts for the pain medication and on 7/31/25 at 8:57 AM he received a message Resident R3 was in severe pain. V5 stated then they called him sometime that afternoon.The facility Pain Management Policy, dated 2022, documents, Purpose: To facilitate resident independence, promote resident comfort and preserve resident dignity. The purpose of this policy is to accomplish that mission through an effective pain management program, providing our residents the means to receive necessary comfort, exercise greater independence, and enhance dignity and life involvement. General Guidelines: The facility will achieve these goals through: Promptly and accurately assessing and managing pain to the greatest extent possible. Pain will be assessed and managed in a timely fashion, especially if it is of recent onset. Communication with the physician will ensure an appropriate individualized pain management plan.

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

08/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Marion

1301 East Deyoung Marion, IL 62959

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

resident didn't have the medications they needed, V1 stated they would get the order from the attending physician and/or medical director, contact the pharmacy, and it would be delivered. When asked if they had done that with Resident R3's medications, V1 stated they had contacted the physician the morning of 7/31/25. When asked what the next step would be to ensure Resident R3's pain was treated, V1 stated she guessed they would send Resident R3 to the emergency room. V1 stated they did offer Resident R3 Tylenol for the pain, and she refused it.On 8/5/25 at 2:37 PM, V5 (Physician) stated he got a text late afternoon on 7/30/25 related to Resident R3 not having pain medication. V5 stated the actual prescription wasn't sent to the pharmacy until 7/31/25 at 9:30 AM, and then it went into a prior authorization bin, and that may have delayed it. V5 stated he wasn't sure how long it sat in the bin. V5 stated having the pharmacy call him for emergency medication is the safest way to get them. V5 stated he got messages on 7/30/25 at 4:40 PM that she admitted and needed scripts for the pain medication and on 7/31/25 at 8:57 AM he received a message Resident R3 was in severe pain. V5 stated then

they called him sometime that afternoon. This surveyor reviewed the list of medications Resident R3 did not receive as ordered on 7/30/25 at 8:00 PM, V5 stated it was never good to not administer medications but there would not be serious consequences related to not getting the medications as ordered one time. The facility Out of Stock Medication, dated December 2018, documents, (Name of Pharmacy) will maintain an inventory of medications available to meet resident needs In the event the facility orders a medication that

the pharmacy does not currently stock .3. The facility should call the patient's physician and let him/her know that the ordered medication is not available. The physician can then decide whether to hold the medication until it is available or change the medication to one that is readily available in emergency dispensing kit. The original medication that was ordered will be sent as soon as it becomes available.

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

08/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Marion

1301 East Deyoung Marion, IL 62959

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 0807 Level of Harm - Minimal harm or potential for actual harm

residents didn't have water because the hall monitors passed it, and they were normally good about doing it first thing in the morning. V4 stated she then checks the water around noon to make sure they don't need more.On 8/6/25 at 1:11 PM, V2 (Director of Nurses) stated staff should be passing ice water at the beginning of each shift, with meals, and as needed.The facility was unable to provide this surveyor with a policy regarding ensuring residents have water available in their rooms.

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

08/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Integrity Hc of Marion

1301 East Deyoung Marion, IL 62959

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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

residents complain related to the call system being down. V4 stated she was the staff who assisted Resident R1

during this surveyors observation. V4 stated she had never had to assist Resident R1 with putting her legs in the bed until that day then stated she had assisted Resident R1 with it maybe three other times.On 8/6/25 at 10:37 AM, V23 (CNA) stated V1 (Administrator) got bells when they didn't have a working call system. V23 stated she didn't think the residents were using them the way they use the call system. V23 stated she wasn't sure why they didn't.On 8/6/25 at 10:53 AM, V24 (CNA) stated when the call system was down, the residents would ring

the bells. V24 stated they would take the bells with them when they went to the bathroom. V24 stated they made sure the residents had their bell with them most of the time. V24 stated Resident R1 required supervision with transfers because she was unsteady at times.On 8/6/25 at 1:11 PM, V2 (Director of Nurses) stated they intermittently have issues with staff not answering call lights timely and when they do they educate staff on

the importance of answering call lights timely.On 7/31/25 at 4:20 PM, V1 (Administrator) stated the call system had been down and they got one quote, but they have to get one more quote before they can start

the repairs. V1 stated they gave everyone a bell to ring if they needed assistance. V1 stated the system went out Saturday (7/26/25); it was repaired for a short time and then went back out again. When asked if

the bathroom call systems were also down, V1 stated they were. When asked how the residents would get assistance in the bathroom if needed, V1 stated they have to take their bells with them. When asked how

they ensured residents took their bells with them to the bathroom, V1 stated, They have to take them with them.The facility did not have a policy related to the call system.

Event ID:

Facility ID:

If continuation sheet