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Complaint Investigation

Ignite Medical Mchenry

August 11, 2025 · Mchenry, IL · 550 Ridgeview Drive
Citations 1
CMS Rating 4/5
Beds 84
Provider ID 146195
Healthcare Facility
Ignite Medical Mchenry
Mchenry, IL  ·  View full profile →
Inspection Summary

IGNITE MEDICAL MCHENRY in MCHENRY, IL — inspection on August 11, 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.

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Inspection Findings

FF0677
Quality of Life and Care Deficiencies
Potential for More Than Minimal Harm

Based on observation, interview, and record review, the facility failed to ensure residents were changed in a timely manner for 1 of 5 residents (R5) reviewed for ADLs (activities of daily living) in the sample of 7.The findings include:On 8/11/25 at 10:22 AM, R5 was lying in bed in her room. A strong, foul odor was immediately noted upon entering R5's room. V6 and V7, Certified Nursing Assistants (CNAs) were in R5's room to change her. R5's brief, pad, and sheet were all saturated through to the mattress with dark, foul-smelling urine.On 8/11/25 at 10:39 AM, R5 said no one changed her earlier.On 8/11/25 at 1044 AM, V7 said she did not change or help change R5 earlier today and she doesn't know when R5 was last changed as V4 was R5's CNA.On 8/11/25 at 12:33 PM, V4 said R5 is her resident today and she and V6 changed R5 at about 7:30 AM today. V4 said residents should be changed every two hours.On 8/11/25 at 1:01 PM, V2, Director of Nursing/Chief Nursing Officer, said incontinent residents are supposed to be changed every two hours and as frequently as needed. V2 said staff are to prioritize the residents who cannot tell if they are wet or not, and they should be changed first. V2 said if a resident is changed and they are wet again in an hour, then they must change them again.R5's current care plan initiated on 10/18/21 shows R5 is incontinent of urine. R5's current care plan initiated on 12/28/23 shows R5 has an ADL (activities of daily living) self-care performance deficit. R5 is dependent on staff for toileting and toileting hygiene.The facility's Incontinence Care Policy (last reviewed 11/2024) shows incontinence care is provided to keep residents as dry, comfortable and odor free as possible.

Incontinent residents are changed every two hours and more frequently if needed.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

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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 MCHENRY, 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 IGNITE MEDICAL MCHENRY or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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